Use of the Cultural Formulation with Refugees

Abstract

This article discusses the experiences of mental health professionals who applied the Cultural Formulation (CF) of the DSM-IV for assessment of psychopathology and treatment needs of refugees in the Netherlands. The CF approach proved to be a useful tool in the assessment and diagnostic phase of clinical treatment. However, patients reported problems with defining their own culture and providing explanations of illness and therapists had difficulty identifying culturally-based difficulties in the clinical relationship. Additional information was needed about working with interpreters, therapists' attitudes towards the culture of the patient and towards their own culture, patients' previous experiences with discrimination and inaccessibility of care, gender issues, and specific cultures and subcultures. A more structured approach to conducting the CF is recommended. We developed the "Cultural Formulation Interview" for this purpose. The adaptations are aimed at improving the CF for use with refugee populations, as well as for more general use in transcultural psychiatry.

Culture and Psychiatric Evaluation: Operationalizing Cultural Formulation forDSM-5

“…In a purposive sample of 20 preceptors from U.S. adult psychiatry residency programs, 70% had at least one class on the OCF, usually during the first two years (Hansen et al, 2013). Similarly, centers providing outpatient services to migrants and refugees in Sweden (Scar-pinati Rosso & Bäärnhielm, 2012) and the Netherlands (Rohlof, Knipscheer, & Kleber, 2009) have used the OCF for standard clinical assessment.…”

“…It is not clear which components of the OCF are particularly relevant for treatment planning and adaptation of clinical approaches and should be emphasized in practice (Mezzich et al, 2009). Use of the OCF with children (Aggarwal, 2010a; Rousseau, Measham & Bathiche-Suidan, 2009), immigrants and refugees (Groen, 2009a; Rohlof et al, 2009), homeless populations (Jadhav, 2001a), those with limited literacy (Jadhav & Jain, 2012), and the elderly (Aggarwal, 2010b; Takeshita & Ahmed, 2004) may require collateral sources of information or local adaptations. The lack of a standard approach to the OCF has hindered generalizable research (Alar-cón, 2009; Mezzich et al, 2009).…”

“…In another case series, an outpatient clinic in Sweden specializing in substance abuse treatment conducted a cultural analysis of 20 consecutively admitted women through the OCF, revealing the centrality in this local context of cultural constructions of gender in patterning drinking behaviors, treatment expectations, and emotional reactions to alcohol consumption (DeMarinis, Scheffel-Birath, & Hansagi, 2009). A group of cultural psychiatrists and medical anthropologists in the Netherlands (Borra, van Dijk, & Rohlof, 2002; Rohlof et al, 2009) independently documented improvements in diagnosis using the OCF in 17 patients of Middle Eastern or South Asian origin and two native Dutch patients. They warned against mechanistic application of the OCF without attending to multiple facets of identity, mismatched treatment expectations between patients and clinicians, and the impact of current predicaments that can be confused for enduring cultural traits, such as difficulties navigating refugees’ political status.…”

“…Refugees may be suspicious of questions about identity, and many migrants may not know how to describe or discuss their identities with clinicians unfamiliar with their geographic, political, and historical backgrounds (Rohlof et al, 2009). Children and adolescents may have different identities than their parents depending on mixed parentage, adoption (Novins et al, 1997; Rousseau, Measham, & Bathiche-Suidan, 2009), and acculturation as a result of migration (Aggarwal, 2010a).…”

The Assessment, Diagnosis, and Treatment of Mental Disorders among Muslims

“…A clear guideline for a Cultural Formulation (CF) is presented in the DSM-IV-TR (APA, 2000). The CF, however, has challenges in its implementation (Rohlof, Knipscheer, & Kleber, 2009;Smart & Smart, 1997;Yamada & Brekke, 2008).…”