Why Counsellors Should Use a Multicultural Assessment Approach

A multicultural assessment is a useful counselling tool for understanding how culture affects a client’s thoughts, behaviours, and emotions. It’s an important part of multicultural psychology, which is often called the “fourth force” of psychology, and is helpful for treating a diverse range of clients.

To support clinicians using this approach, the APA and DSM-5 Cross-Cultural Issues Subgroup produced the Cultural Formulation Interview (CFI). This multicultural assessment consists of 16 questions that help clinicians gather information about the impact of culture on their client’s presenting issues.

Our clients exist at the intersection of many identities…everyone operating under a multifactorial set of overlapping systems.

What is culture?

The CFI defines culture as the values, worldviews, orientations, and assumptions that are learned and transmitted across generations. These systems of knowledge, concepts, rules, and practices undergo evolving changes and are dynamic.

Our clients exist at the intersection of many identities. Everyone is operating under a multifactorial set of overlapping systems that include, but are not limited to, components of:

• Race/ethnicity
• Gender identity
• Sexual orientation
• Socioeconomic status
• Language
• Religion
• Generational effects

Why is the CFI an effective multicultural assessment?

The CFI is designed to be administered alongside an initial assessment interview. It takes a person-centered approach by allowing clients to share their perspective on the problem and how others may impact its course. It also considers the influence of the client’s cultural background, help-seeking behaviours, and expectations for treatment. Individual questions are selected with clinical judgement and can be used at any point in an initial interview.

The first set of CFI questions broadly assess a client’s cultural identity, preferred cultural identifications, and the degree of connection to their cultural identity. The latter questions are helpful for diagnostic clarification, conceptualizing symptoms, judging their severity, and charting the course of treatment.

Because of the value placed on a client’s perspective, there is a reduced likelihood of stereotyping and microaggressions. Since the CFI is based on a client’s view of their own experiences, there are no right or wrong answers. Lastly, the CFI has been found to be clinically useful across several countries, which suggests it can be beneficial for all clients – not just cultural minorities.

The Cultural Formulation Interview is a useful tool for helping clinicians structure their initial interviews with a diverse range of clients.

The CFI is divided into four main domains:

1. Cultural Definition of the Problem

The client is asked for a description of their presenting problem and main concerns. There is a focus on eliciting a comprehensive understanding of the presenting problem from the client’s perspective. The client is also asked how they frame their presenting problems when talking to their social network and what aspects they find the most concerning.

2. Cultural Perceptions of Cause, Context, and Support

These questions attempt to assess the meaning of their presenting problems and begin to explore their etiological beliefs. The client can also discuss what they believe has helped improve or worsen their presenting problem. This domain also considers the client’s current stressors and the role of cultural identity as a potential protective or confounding factor. 

3. Cultural Factors Affect Self-Coping and Past Help-Seeking

The client is asked to identify areas of resilience and effective self-coping. This discussion includes identification of culturally accepted types of treatment which can range from medical treatment, support groups, religious/spiritual counselling, and folk healing, to mental health treatment. This information can also help clients articulate their expectations for treatment outcomes and for clinicians to assess potential adherence to treatment.

4. Cultural Factors Affecting Current Help-Seeking

The final set of questions assess the client-therapist match, quality of rapport, and therapeutic alliance. Responses from these questions help clients identify potential barriers to treatment as well as their preferences, which may be clinically useful for treatment planning.

Altogether, the Cultural Formulation Interview is a useful tool for helping clinicians structure their initial interviews with a diverse range of clients. The questions are an effective way to explore a client’s culture and its effect on their thoughts, behaviours, and emotions within the context of their presenting problems.

As psychotherapy is becomes more accessible, it is imperative that clinicians gain the competence to treat a diverse patient population. The CFI is a multicultural assessment that can support clinicians in their journey towards cultural competence.

It is imperative that clinicians gain the competence to treat a diverse patient population.

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