Cultural Formulation Interview Overview

Cultural Formulation Interview (CFI) and Supplementary Modules

Overview of CFI

  • The American Psychiatric Association (APA) offers the Cultural Formulation Interview (CFI) and its supplementary modules for research and clinical evaluation.

    • The CFI serves as a potential tool for enhanced clinical understanding and decision-making.

    • It is emphasized that the CFI should not be used as the sole basis for clinical diagnosis.

  • Additional information can be located in the DSM-5, specifically in Section III of the chapter titled "Cultural Formulation."

  • Clinicians and researchers are encouraged to contribute feedback regarding the CFI via the APA feedback form at http://www.dsm5.org/Pages/Feedback-Form.aspx.

Reproduction Rights

  • Rights granted: The material may be reproduced without permission by researchers and clinicians for patient use.

  • Rights holder: American Psychiatric Association.

  • For uses beyond those specified, contact the APA at http://www.appi.org/CustomerService/Pages/Permissions.aspx.

CFI Structure

  • CFI consists of multiple modules intended to delve into the individual's cultural context and experiences.

  • The guide includes italicized instructions directed to the interviewer.

Objectives of the Interview

  • To clarify key aspects of the presenting problem from the individual's perspective as well as from their social network (family, friends, etc.).

    • Major aspects include the meaning of the problem, sources of potential help, and expectations for services.

Interview Introduction

  • The opening statement directed at the individual:

    • "I would like to understand the problems that bring you here so that I can help you more effectively. I want to know about your experience and ideas. I will ask some questions about what is going on and how you are dealing with it. Please remember there are no right or wrong answers."

Cultural Definition of the Problem

  • Explanatory Model, Level of Functioning: Focus on the individual's personal understanding of their problem.

  • Key Questions:

    1. "What brings you here today?"

    • If the individual provides limited information or focuses solely on symptoms or a medical diagnosis, the interviewer should ask:

      • "People often understand their problems in their own way, which may be similar to or different from how doctors describe the problem. How would you describe your problem?"

    1. "How would you describe your problem to your family or friends?"

    • Focus on what aspects are most significant to the individual.

    1. "What troubles you most about your problem?"

Cultural Perceptions of Cause, Context, and Support

  • Causes (Explanatory Model, Social Network, Older Adults): Understanding the individual's meaning of their condition is critical for clinical care.

    • Key Questions:

    1. "Why do you think this is happening to you? What do you think are the causes of your [PROBLEM]?"

    • Individuals may cite various causes based on different facets of the problem.

    • Additional probing may include asking about various explanations for their problem, encompassing:

      • Life experiences

      • Relationships

      • Physical illness

      • Spiritual reasons

    1. "What do others in your family, friends, or community think is causing your [PROBLEM]?"

Stressors and Supports

  • Knowing Context: Investigate the individual's life context regarding resources, social support, and resilience.

  • Key Questions:

    1. "Are there any kinds of support that make your [PROBLEM] better?"

    2. "Are there any kinds of stresses that make your [PROBLEM] worse?"

Role of Cultural Identity

  • Cultural Identity, Psychosocial Stressors: Identifying how cultural aspects impact the individual's problem.

  • Key Questions:

    1. "What are the most important aspects of your background or identity?"

    2. "Are there any aspects of your background or identity that make a difference to your [PROBLEM]?"

    3. "Are there any aspects of your background or identity that are causing other concerns?"

Cultural Factors Affecting Self-Coping and Help Seeking

  • Self-Coping: Identify strategies the individual employs.

  • Key Questions:

    1. "What have you done on your own to cope with your [PROBLEM]?"

Past Help Seeking

  • Understanding Sources of Help: Explore various assistance avenues that the individual sought in the past.

  • Key Questions:

    1. "In the past, what kinds of treatment, advice, or healing have you sought for your [PROBLEM]?"

    2. "Has anything prevented you from getting the help you need?"

    • Potential barriers might include:

      • Financial issues

      • Time commitments

      • Stigma

      • Language barriers

      • Lack of culturally competent services

Cultural Factors Affecting Current Help Seeking Preferences

  • Clarification of Needs: Identify specific current needs and expectations.

  • Key Questions:

    1. "What kinds of help do you think would be most useful to you at this time for your [PROBLEM]?"

    2. "Are there other kinds of help that your family or friends suggested?"

Clinician-Patient Relationship

  • Addressing Concerns: Discuss potential issues that may affect communication and care.

  • Key Question:

    1. "Have you been concerned about this, and is there anything we can do to provide the care you need?"

  • This aspect acknowledges potential misunderstandings due to cultural differences, thereby promoting better mutual understanding between clinicians and patients.