Cultural competency links Case example of working with cultural competence US National Center for Cultural Competence

Cultural formulation

In order to ensure that practitioners, including counsellors and psychotherapists, have taken these factors into account, it is often proposed that transcultural counselling should be preceded by a 'cultural formulation' (see here for an example). The skill in making such formulations is increasingly termed 'cultural competence', and a growing number of training programmes exist for this. This week we will ask you to undertake cultural competence training using the framework of the cultural formulation provided by DSM-IV, and information provided in a chapter by Lu et al There is also a downloadable video. We will ask you to work together on this project, and so, although there is less material to study on the page, we expect you to be more than usually involved in the discussion forums exchanging ideas and information as you develop a cultural formulation on a chosen client.

DSM-IV cultural formulation

What is the individual's cultural identity?

These may be determined by

• the individual's ethnic or cultural reference groups.
• for immigrant and ethnic minorities, the degree of involvement with both the culture of origin and host culture.
• the individual's language abilities, use and preference.

What are the cultural explanations of the individual's illness?

The following may be identified:

• The symptoms through which distress or the need for social support are communicated.
• The meaning and perceived severity of the individual's symptoms in relation to the norms of the cultural reference group.
• Any local illness category used by the individual's family and community to identify the condition.
• The perceived causes or explanatory models that the individual and the cultural reference group use to explain the illness.
• Current preferences for and past experiences with professional and popular sources of care.

What are the cultural factors related to psychosocial environment and levels of functioning?

• This would include stresses in the local social environment, the role of religion and kin networks in providing emotional, instrumental and informational support.
• What are the cultural elements of the relationship between the individual and clinician? Eg differences in the cultural and social status between the individual and the clinician, difficulty in communicating in the individual's first language, eliciting symptoms and their cultural significance.
• How do cultural considerations specifically influence diagnosis and care?

Adapted from DSM-IV by the Government of Queensland

	Before you go to the next page... Here is a worked example of a cultural formulation Here is an expected check-list for a cultural formulation, based on the DSM-IV cultural formulation and one developed in Montreal Choose one of your clients or a friend who has recently had a health problem, and using either formulation A or B, write a brief summary of their cultural identity, how their culture has determined their own explanation of their illness, and how their culture has determined the stressors and coping factors that have aggravated or offset the effects of their illness. Post your summaries to the discussion forum as you write them i.s. post your summary of your client or friend's cultural identity first, and then read and respond to any comments from other members of your tutorial group; then post your summary of their culturally determined explanation of their illness, note responses and respond to responses; and finally, post your summary of culturally determined vulnerability or resilience factors.