Cultural Formulation Interview
PART ONE: CULTURAL FORMULATION INTERVIEW
CULTURAL FORMULATION INTERVIEW (CFI): ELIZABETH
Supplementary modules used to expand each CFI subtopic are noted in parentheses.
| GUIDE TO INTERVIEWER | INSTRUCTIONS TO THE INTERVIEWER ARE ITALICIZED |
| The following questions aim to clarify key aspects of the presenting clinical problem from the point of view of the individual and other members of the individual’s social network (i.e., family, friends, or others involved in current problem). This includes the problem’s meaning, potential sources of help, and expectations for services. | INTRODUCTION FOR 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 rights or wrong answers. |
CULTURAL DEFINITION OF THE PROBLEM
(Explanatory Model, Level of Functioning)
| Elicit the individual’s view of core problems and key concerns.
Focus on the individual’s own way of understanding the problem. Use the term, expression, or brief description elicited in question 1 to identify the problem in subsequent questions (e.g., “your conflict with your son”). Ask how individual frames the problem for members of the social network. Focus on the aspects of the problem that matter most to the individual.
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1. What brings you here today?
I am here because of my family. Of late, I quarrel with my husband Bob almost every day about my son’s (Frank) behavior. There’s marital tension in my family. I am unable to relax when arguing with Bob. I would want to know what we can do to enable Frank control his behavior as I only see this as the way to solve our marital tension. 2. Sometimes people have different ways of describing their problem to their family, friends, or others in their community. How would you describe your problem to them? When amused, I am unable to relax when expressing my concerns to Bob and Frank. I normally become “too high-strung” and not controllable even in the sight of children. My anger is enough to describe my frustration. 3. What troubles you most about your problem? What troubles me most about my problem is Bob’s way of defending Frank’s unusual behavior. Also, Elizabeth is troubled by Bob’s amusement by her anecdotes and the way he accuses her of ‘overreacting’ while Frank is a boy and ‘Boys will be boys’ statement. |
CULTURAL PERCEPTIONS OF CAUSE, CONTEXT, AND SUPPORT
CAUSES
(Explanatory Model, Social Network, Older Adults)
| This question indicates the meaning of the condition for the individual, which may be relevant for clinical care. Note that individuals may identify multiple causes, depending on the facet of the problem they are considering.
Focus on the views of members of the individual’s social network. These may be diverse and vary from the individual’s. |
4. Why do you think this is happening to you? What do you think are the causes of your [PROBLEM]?
Well, Frank has always been an active son; this is why I believe his behavior is getting worse. Before I resigned, I was a family law attorney and this gives me good experience about childhood. I’m fully convinced that Frank might have ADHD, and when Bob keeps ignoring this I find myself unable to relax and overreacting. I feel like Bob isn’t taking Frank’s mental health with the seriousness it deserves. 5. What do others in your family, your friends, or others in your community think is causing your [PROBLEM]? Well, my husband Bob thinks that I do not understand what boys behave in their childhood. Maybe, this is the reason he is amused by the accusations and anecdotes I have against Frank’s recent change in behavior both at home and in the school. |
STRESSORS AND SUPPORTS
(Social Network, Caregivers, Psychosocial Stressors, Religion and Spirituality, Immigrants and Refugees, Cultural Identity, Older Adults, Coping and Help Seeking)
| Elicit information on the individual’s life context, focusing on resources, social supports, and resilience. May also probe other supports (e.g., from co-workers, from participation in religion or spirituality).
Focus on stressful aspects of the individual’s environment. Can also probe, e.g., relationship problems, difficulties at work or school, or discrimination |
6. Are there any kinds of support that make your [PROBLEM] better, such as support from family, friends, or others?
NO. This is the main reason why I am here seeking for counseling help. I believe that counselor help is the only way to improve our marriage and restore family peace dramatically. 7. Are there any kinds of stresses that make your [PROBLEM] worse, such as difficulties with money, or family problems? Of course YES. I have marriage problems with Bob my husband. The major problem is Bob’s inability to support me in disciplining Frank, and this is overly stressing and depressing to me. I also have job problem; since I resigned as a Family law attorney, I have not worked again as my children are still young. |
ROLE OF CULTURAL IDENTITY
(Cultural Identity, Psychosocial Stressors, Religion and Spirituality, Immigrants and Refugees, Older Adults, Children and Adolescents)
| Ask the individual to reflect on the most salient elements of his or her cultural identity. Use this information to tailor questions 9–10 as needed.
Elicit aspects of identity that make the problem better or worse. Probe as needed (e.g., clinical worsening as a result of discrimination due to migration status, race/ethnicity, or sexual orientation). Probe as needed (e.g., migration-related problems; conflict across generations or due to gender roles). |
8. For you, what are the most important aspects of your background or identity?
9. Are there any aspects of your background or identity that make a difference to your [PROBLEM]? 10. Are there any aspects of your background or identity that are causing other concerns or difficulties for you? |
CULTURAL FACTORS AFFECTING SELF-COPING AND PAST HELP SEEKING
SELF-COPING
(Coping and Help Seeking, Religion and Spirituality, Older Adults, Caregivers, Psychosocial Stressors)
| Clarify self-coping for the problem. | 11. Sometimes people have various ways of dealing with problems like [PROBLEM]. What have you done on your own to cope with your [PROBLEM]? |
PAST HELP SEEKING
(Coping and Help Seeking, Religion and Spirituality, Older Adults, Caregivers, Psychosocial Stressors, Immigrants and Refugees, Social Network, Clinician-Patient Relationship)
| Elicit various sources of help (e.g., medical care, mental health treatment, support groups, work-based counseling, folk healing, religious or spiritual counseling, and other forms of traditional or alternative healing).
Probe as needed (e.g., “What other sources of help have you used?”). Clarify the individual’s experience and regard for previous help |
12. Often, people look for help from many different sources, including different kinds of doctors, helpers, or healers. In the past, what kinds of treatment, help, advice, or healing have you sought for your [PROBLEM]?
Although I have marital tension, inability to relax, and inability to cope with child unusual behavior, I have never sought help from another source before. This is my first case of seeking for counselor help for I fear for our marriage and extreme ADHD for my son. |
BARRIERS
(Coping and Help Seeking, Religion and Spirituality, Older Adults, Psychosocial Stressors, Immigrants and Refugees, Social Network, Clinician-Patient Relationship)
| Clarify the role of social barriers to help seeking, access to care, and problems engaging in previous treatment.
Probe details as needed (e.g., “What got in the way?” |
13. Has anything prevented you from getting the help you need? |
PREFERNCES
(Social Network, Caregivers, Religion and Spirituality, Older Adults, Coping and Help Seeking)
| Clarify individual’s current perceived needs and expectations of help, broadly defined.
Probe if individual lists only one source of help (e.g., “What other kinds of help would be useful to you at this time?”). Now let’s talk some more about the help you need. |
14. What kinds of help do you think would be most useful to you at this time for your [PROBLEM]?
15. Are there other kinds of help that your family, friends, or other people have suggested would be helpful for you now? NO. I have not engaged anyone for help in this case including my husband Bob. So basically, I am relying on this counseling session to have my marriage and family problems resolved. |
CLINICIAN-PATIENT RELATIONSHIP
(Clinician-Patient Relationship, Older Adults)
| Elicit possible concerns about the clinic or the clinician-patient relationship, including perceived racism, language barriers, or cultural differences that may undermine goodwill, communication, or care delivery.
Probe details as needed (e.g., “In what way?”). Address possible barriers to care or concerns about the clinic and the clinician-patient relationship raised previously. |
16. Have you been concerned about this and is there anything that we can do to provide you with the care you need? |
Part two: Cultural Diversity Reflection
Multicultural competence is one key characteristic that defines a professional counselor (Redekop & Wlazelek, 2012). In reference to the Vargas family, the members are diverse in terms of age, gender, education, and work. In counseling this family, a counselor needs to put aside any gender bias when listening to Elizabeth’s and Bob’s viewpoints. With this multicultural competence, the therapist will be able to gain sensitivity, awareness, and insight into the real problem disturbing the Vargas family. All Vargas family members will be listened to at equal measure.
In a professional view, Both Bob and Elizabeth have good experience dealing with children. However, Elizabeth spends more time with Frank and Heidi than their father Bob. The counselor therefore would seek to listen keenly to the reasons that Elizabeth gives pertaining Frank’s change of behavior both at home and in the school. Regardless of gender, the counselor would have to understand both Bob’s and Elizabeth’s viewpoints towards Frank. While doing this, the counselor will discard personal cultural values, beliefs, and viewpoints towards children (Redekop & Wlazelek, 2012).
Again in this session, the counselor will have to use the culturally acceptable intervention strategies. This will help to respect the cultural values, views, beliefs, and indigenous thoughts of the Vargas family as a client (Redekop & Wlazelek, 2012). In responding about the best techniques to treat the family, the counselor will first have to understand the impact of his intervention strategies on the cultures of these clients. In engaging the clients, the counselor will have to use verbal and nonverbal language that eliminates any diversity associated prejudice and bias.
References
- Redekop, F., & Wlazelek, B. (2012). Counselor dispositions: An added dimension for admissions decisions. Ideas and Research You Can Use, 2(1), 1-10