Multicultural issues in the clinical interview and diagnostic process.

Abstract

In 2003, the American Psychological Association (APA) published the Guidelines on MulUcullural Education, Training, Research, Practice, and Organlzarlonal Change for Psychologfsrs, which marked APA's first fonnal statement on the substantive influence of cultural and contextual ractors in clinical, research, school, consulting, organizational, teaching, and training settings. The guidelines, developed in response to the demographic shi£ts or the 20th century, outlined the great need for cultural sensitivity and culture-centered adaptations in psychology while encouraging greater awareness and incorporation of sociocultural factors across research and applied settings. Yet, the guidelines provided little instruction on how to use multicultural sensitivity, multicultural interventions, or multicultural competence. As a result, the guidelines remain largely aspirational (Hwang, Myers, Abe-Kim, & Ting, 2008). Furthermore, unlike its briefer and less elaborate predecessor 10 years prior (APA, 1993), these guidelines provided fewer Illustrative examples In the psychological services domain. For instance, in reference to clinical pracdce, Guideline 5 states, Psychologists are encouraged to apply culturally appropriate skills in clinical and other applied psychological practices (APA, 2003, p. 390). However, concrete suggestions for cultivating and using culturally appropriate skills were not presented. Indeed, most or the theoretical and empirical work on how to recognize and address cross-cultural tnnuences in the clinical Interview and dlagncistlc process was printed after the publication or the first multicultural guidelines for psychological services and its reprint In the American Psycl1ologlst In 1993. To illustrate, more than 90% or articles and chapters written on clinical Interview and culture and more than 66% or the literature on culture and diagnosis have been published since 1990, as documented in a PsyclNFO database search. The majority of the instructional literature about how to conduct a culturally sensidve clinical Interview and diagnostic formulation lw largely appeared ln select book chapters and articles. Although there ls wide consensus that sociocultural context is Important to psychological processes, empirical research on effective applications or characteristics or cultural competence is sparse (Sue, 1998). In this chapter, we review the extant literature on the.cultural factors that bear on the clinical interview and diagnostic process with raclaVethnic minorities. First, we review those factors that affect the clinical interview, such as the soclolingulstic factors involved in patient-provider communication, stigma or mental Ulness, perceived mistrust, and bias In clinical decision making. Second, wc discuss cross-cultural issues in psychiatric nosology and the use or the Cultural formulation as a method to use In culturally informed diagnostic interviewing. We limit our review to material covered in book chapters or peer-reviewed journal articles that have explicitly discussed the clinical interview or diagnostic formulation with raciaVethnic minority groups living in the United States. We exclude research and clinical literature that emphasizes specific disorders or assessment tools as a means to limit the potential for dual coverage of material discussed In other chapters of this volume. Our intention is to provide practitioners