The Cultural Interview
Hans Rohlof, Noa Levy, Lineke Sassen, Stephanie Helmich

The Cultural Interview was designed to get cultural information from a client. At the end of a interview it is possible to write a cultural formulation of this client.
The interview takes between one and one and a half hour, and can be performed by relatively untrained persons.

In its original form it is designed in 2000 by Noa Loevy and Lineke Sassen, who were psychologists-in-training in Centrum '45- de Vonk (centre for psychiatric care of traumatised refugees) in Noordwijkerhout, the Netherlands. Hans Rohlof, psychiatrist, was their critical supervisor. Hans Rohlof and Stephanie Helmich, psychologist-in-training created in 2001 a second version of the interview, and translated it into English (with special thanks to the partner of Stephanie, who is native speaker in English). The last version was created by Hans Rohlof in 2008.

The copyright stays with the authors. This is not meant to restrict scientific development or to earn money, but to keep in contact with users of the interview. Everybody who wants to use the interview is invited to e-mail the first author, and to ask permission to use it. In this way, we keep in contact with all users, and can eventually make arrangements for scientific research. Also, improvements and alterations can be proposed. In future, changes in the interview will be published on this web page.

The interview is following here. The . The interview is published in an earlier version in the (Dutch-language) book: Cultuur, classificatie en diagnose (2002, Bohn Stafleu van Loghum, Houten).


The Cultural Formulation Interview

English version
Hans Rohlof, Noa Loevy, Lineke Sassen & Stephanie Helmich

Summary and case history
Filled in using the dossier before the interview
1. Biography (personal and social details)
2. History of current symptoms
3. Earlier treatments
4. Psychiatric illness within the family
5. Course of illness

Introduction
Aim: explaining the interview and setting the tone
"People from all over the world come to our clinic. Every country and every culture has its own way of life. You only really notice when you leave your own country and go to live in a foreign country. People look different, speak another language, behave and express themselves in different ways. We can sometimes get the feeling that we are not understood. Have you ever had that feeling?
[If yes, listen briefly to explanation - "we will deal with this later on in the interview".
If no, "Maybe you will understand what I mean when we discuss it later."]
Problems in communication are sometimes partly the result of a lack of knowledge of cultural differences. Since we would like to help you as best we can, it is important for us to understand something of your country and your culture. By this we mean your way of life, which days you celebrate, what it means for you to be ill etc. I will now ask you a few questions about your culture and your symptoms".

A. Cultural identity of the individual
" What is your native language?
" What language do you speak at home/ with your friends/ in your dreams?
" What other language(s) do you speak?
" How well do you speak Dutch? How does it feel to always have to speak Dutch? Does it sometimes cause problems?
" To which ethnic group do you officially belong? Do you feel that you do belong to this ethnic group, or to another one? Does this ever change? (E.g. do you always feel that you are ..... or sometimes something else?)
" Do you miss other people having the same cultural background as yourself? (If yes:) Explain/ Why?
" What aspects of your culture are most important to you. (E.g. family structures, norms and values, feast days, faith...)
" Do you have children? " (If they have children) Do you bring up your children in the same way that you were brought up? Explain. " (If no children:) Would you bring up your children in the same way? Explain.
" To what extent can you follow your culture's way of life here in the Netherlands?
" Are their aspects of your culture that bother you are that you find less attractive?
" Do you feel involved with Dutch culture (E.g. do you interact much with Dutch people, do you go to Dutch social events, do you read Dutch literature, are you interested in how thing work in Dutch society, are there things in the Dutch culture which you are adopting.....)?
" If so, what aspects of Dutch culture do you like, and what aspects bother you?
" In general, do you feel yourself more a foreigner or a Dutchman?

B. Cultural explanations of the individual's illness
(Record explanation in individual's native language)
Now, about your symptoms,
" What are your worst symptoms? What do you call them in your own language?
" How do you think your symptoms started? (If only single answer: do you think that there are alternative/more explanations for your symptoms?)
" How do your friends, family and those around you explain your symptoms?
" How would people of your culture explain your symptoms?
" Do you feel understood by your friends, family and those around you?
" Have you felt up to now that the staff here understand you? Would you expect them to?
" If someone in your home community was sick, or had roughly the same symptoms as you, how would those around them try to help (e.g. pray for them, leave them to rest, care for them)?
" Are you being cared for in that way now?
" Do people where you come from sometimes make use of alternative, native or faith healers, or do people go to a normal doctor or hospital?
" What kind of help have you had up to now for your symptoms (both normal and alternative)? What helped most?
" Did you ever experience a feeling of being discriminated in health care? For instance: did you have the feeling that you got less help because you come from abroad? Or was it difficult for you to get the proper care?
" What kind of treatment would you like to receive now? Do you think psychiatric care is appropriate for your complaints or for your situation? What would you personally prefer? Do you prefer a male or a female therapist? ( Examples: Talking about events in the past, adapting to the present, make plans for the future, talking about your emotions, receive advice, exercises, medicines,...)

C. Cultural factors in psychosocial surroundings and in functioning
Now, let's discuss your daily life here rather than your daily life in your native country
" What is your current situation - are you married, do you have a family here?
" What is your position in you family? Is this different to the situation in your country of origin? Explain. " Is there someone in your family who people go to for advice?
" If married: How is your relationship with your wife? Is this different to what it was in your country of origin? Explain.
" If has a family? How is your relationship with your family? Is this different to what it was in your country of origin? Explain.
" Have there been important changes in your social position in recent years? If yes: what does this mean for you?
" If you have a practical problem, such as something you do not understand (e.g. train journeys, the immigration service, a letter from your lawyer) whom would you ask about it? From whom would you get the information?
" If you had (emotional) difficulties in your own country, what did you do? To whom did you go?
" Is there someone in the Netherlands from whom you receive (emotional) support (e.g. when you are sad)? Is this person family of yours? How often do you make use of this opportunity?
" Is there someone in the Netherlands with whom you talk about your symptoms and traumatic experiences? If yes: Why him/ her? Is there someone you would like to talk to? Explain. Some people are greatly strengthened by their faith,
" Are you religious?
" Do you pray? How often?
" Do you feel that prayer helps you? In what way?
" Has your faith changed since the experiences you had?
" Do you still pray as often as you did?
" Do your prayers help you as much as they did?
" Do you go to a place of worship (church, mosque etc) in the Netherlands? Do you always go to the same one? How often do you go?
" Do you know the people there?
" Do those people help you? Is there someone in particular who helps you? In what way do they do that?

D. Cultural elements in the relationship between the individual and the carer
" To which social class did you belong in your country of origin? Did you live in a town or in the countryside? What education have you had?
" Some people consider clinical staff to be their equals, sometimes even their friends. Others feel that the staff are above them, or beneath them. How do you see this? Do you that the medical staff and social workers are equal to you, beneath you or above you? When they advise something or prescribe medicines do you feel that you must take the advice or use the medicines?
" If you had a free choice in selecting the personnel treating you, would you prefer male or female personnel? (As a choice: ) Why? (trust, shame, more likely to understand, easier to express yourself...)
" If you had a free choice in selecting the personnel treating you, would you prefer personnel with a similar cultural background to yourself, or do you not think that this matters? (As a choice: ) Why? (trust, shame, more likely to understand, easier to express yourself...)
" How do you feel about the fact that you don't receive therapy in your own language? Would you like to be given therapy in your own language? Would it help you feel that you were being understood properly?
" If an interpreter is being used: How does it feel to work with an interpreter? If you could choose would you prefer a male or a female interpreter . Do you prefer a specific interpreter, an interpreter who is Dutch or of your nationality, or of another?

This is the end of the interview. Thank you very much indeed, I personally found it very interesting to learn about how these things work outside the Netherlands and I hope that we can use what you have told me to understand and help you better. Is there anything else that has not been mentioned in this discussion an which you would like to tell me about?

To be completed by interviewer after interview (optional, some matters will only become clear during the course of the treatment):
" Communication problems experienced within the patient's own language (use of terms/concepts and motivation/interest
" Extent to which symptoms have a cultural meaning for the patient
" To what extent is the patient prepared to engage in a working relationship with the therapist?
" Degree of closeness (personal contact)
" Pathology or otherwise of behaviour.

E. Observations during the interview
What was the contact with the client like? What kind of impression did he/she make? Record other notable issues from the conversation

F. Summary
Summary of the most important issues raised during the interview

G. Advice for further treatment
Possible problems in the area of cultures which could be an obstacle communicating with patient and specifying the diagnosis and the treatment. At the same time things can be noted which can be looked at in treatment.

Research version NL&LS 2000: second version NL&HRO 2000: third version SH&HRO 2001; fourth version HRO & SH 2003; fifth version HRO 2008; copying or reproduction without express permission is not allowed.

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