DSM 5 CULTURAL FORMULATION

INTERVIEW QUESTIONS
 Cultural Formulation Interview (CFI)
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 INTRODUCTION FOR THE INDIVIDUAL:
presenting clinical problem from the point of view of I would like to understand the problems that bring you here so that I can
the individual and other members of the individual’s help you more effectively. I want to know about your experience and
social network (i.e., family, friends, or others involved ideas. I will ask some questions about what is going on and how you
in current problem). This includes the problem’s are dealing with it. Please remember there are no right or wrong an-
meaning, potential sources of help, and expectations swers.
for services.

CULTURAL DEFINITION OF THE PROBLEM

CULTURAL DEFINITION OF THE PROBLEM

(Explanatory Model, Level of Functioning)
Elicit the individual’s view of core problems and key 1. What brings you here today?
concerns. IF INDIVIDUAL GIVES FEW DETAILS OR ONLY MENTIONS
Focus on the individual’s own way of understanding the SYMPTOMS OR A MEDICAL DIAGNOSIS, PROBE:
problem. People often understand their problems in their own way, which may
Use the term, expression, or brief description elicited in be similar to or different from how doctors describe the problem. How
question 1 to identify the problem in subsequent would you describe your problem?
questions (e.g., “your conflict with your son”).

Ask how individual frames the problem for members of 2. Sometimes people have different ways of describing their problem to
the social network. their family, friends, or others in their community. How would you
describe your problem to them?

Focus on the aspects of the problem that matter most to 3. What troubles you most about your problem?
the individual.

CULTURAL PERCEPTIONS OF CAUSE, CONTEXT, AND SUPPORT

CAUSES
(Explanatory Model, Social Network, Older Adults)
This question indicates the meaning of the condition for 4. Why do you think this is happening to you? What do you think are the
the individual, which may be relevant for clinical care. causes of your [PROBLEM]?

Note that individuals may identify multiple causes, de- PROMPT FURTHER IF REQUIRED:
pending on the facet of the problem they are consid- Some people may explain their problem as the result of bad things
ering. that happen in their life, problems with others, a physical illness, a
spiritual reason, or many other causes.

Focus on the views of members of the individual’s social 5. What do others in your family, your friends, or others in your com-
network. These may be diverse and vary from the indi- munity think is causing your [PROBLEM]?
vidual’s.

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 Cultural Formulation Interview (CFI)

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 6. Are there any kinds of support that make your [PROBLEM] better,
on resources, social supports, and resilience. May such as support from family, friends, or others?
also probe other supports (e.g., from co-workers, from
participation in religion or spirituality).

Focus on stressful aspects of the individual’s environ- 7. Are there any kinds of stresses that make your [PROBLEM] worse,
ment. Can also probe, e.g., relationship problems, such as difficulties with money, or family problems?
difficulties at work or school, or discrimination.

ROLE OF CULTURAL IDENTITY

(Cultural Identity, Psychosocial Stressors, Religion and Spirituality, Immigrants and Refugees, Older Adults, Children and Adoles-
cents)
Sometimes, aspects of people’s background or identity can make
their [PROBLEM] better or worse. By background or identity, I
mean, for example, the communities you belong to, the languages
you speak, where you or your family are from, your race or ethnic
background, your gender or sexual orientation, or your faith or reli-
gion.

Ask the individual to reflect on the most salient elements 8. For you, what are the most important aspects of your background or
of his or her cultural identity. Use this information to identity?
tailor questions 9–10 as needed.
Elicit aspects of identity that make the problem better or 9. Are there any aspects of your background or identity that make a
worse. difference to your [PROBLEM]?
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; 10. Are there any aspects of your background or identity that are causing
conflict across generations or due to gender roles). 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]?

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This material can be reproduced without permission by researchers and by clinicians for use with their patients.
 Cultural Formulation Interview (CFI)

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 12. Often, people look for help from many different sources, including
health treatment, support groups, work-based coun- different kinds of doctors, helpers, or healers. In the past, what kinds
seling, folk healing, religious or spiritual counseling, of treatment, help, advice, or healing have you sought for your
other forms of traditional or alternative healing). [PROBLEM]?
Probe as needed (e.g., “What other sources of help PROBE IF DOES NOT DESCRIBE USEFULNESS OF HELP RE-
have you used?”). CEIVED:
Clarify the individual’s experience and regard for pre- What types of help or treatment were most useful? Not useful?
vious help.

BARRIERS
(Coping and Help Seeking, Religion and Spirituality, Older Adults, Psychosocial Stressors, Immigrants and Refugees, Social Net-
work, Clinician-Patient Relationship)
Clarify the role of social barriers to help seeking, access 13. Has anything prevented you from getting the help you need?
to care, and problems engaging in previous treatment. PROBE AS NEEDED:
Probe details as needed (e.g., “What got in the way?”). For example, money, work or family commitments, stigma or dis-
crimination, or lack of services that understand your language or
background?

CULTURAL FACTORS AFFECTING CURRENT HELP SEEKING

PREFERENCES
(Social Network, Caregivers, Religion and Spirituality, Older Adults, Coping and Help Seeking)
Clarify individual’s current perceived needs and ex- Now let’s talk some more about the help you need.
pectations of help, broadly defined. 14. What kinds of help do you think would be most useful to you at this
Probe if individual lists only one source of help (e.g., time for your [PROBLEM]?
“What other kinds of help would be useful to you at this
time?”).
Focus on the views of the social network regarding help 15. Are there other kinds of help that your family, friends, or other people
seeking. have suggested would be helpful for you now?

CLINICIAN-PATIENT RELATIONSHIP
(Clinician-Patient Relationship, Older Adults)
Elicit possible concerns about the clinic or the clini- Sometimes doctors and patients misunderstand each other because
cian-patient relationship, including perceived racism, they come from different backgrounds or have different expectations.
language barriers, or cultural differences that may 16. Have you been concerned about this and is there anything that we
undermine goodwill, communication, or care delivery. can do to provide you with the care you need?
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 pre-
viously.

Page 3 of 3
Copyright © 2013 American Psychiatric Association. All Rights Reserved.
This material can be reproduced without permission by researchers and by clinicians for use with their patients.