The use of the DSM-IV cultural formulation in a multidisciplinary context: A conversation analysis

The growth of cultural pluralism in North American society has required the mental health community to shown a higher level of cultural sensitivity. Mental health professionals must not only be aware of the social and historical context of their clientele, but also of their profession.  Clinical evaluations provide the information for clinical care.  This information must be examined in a cultural-sensitive framework for assessment and case formulation that permits an accurate diagnosis across the cultural boundaries of both patient and mental-care professional. The Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) sets forth an Outline for Cultural Formulation (CF).  It instructs clinicians not only on how to elicit culturally relevant clinical material, but also on how to assess the importance of the diverse cultural perspectives of patients and their families, thus increasing usefulness of their own cultural knowledge in treatment.  This study is a conversational analysis of the nature and application of knowledge within a clinical, interdisciplinary context.  It uses an expanded version of the CF as a framework, in which the discursive practices of mental health professionals are evolving. It examines the way different disciplines interpret and conceptualize cultural elements and the implications of this framework for interdisciplinary collaboration of assessment, treatment plan and care.