Abnormal Psychology. William J. Ray

      A structured interview is an evaluation technique that is tightly systematized in terms of the questions asked. The idea is that by asking clients the same set of questions, it is possible to have better consistency across interviewers. Likewise, because every client receives the same questions, it is assumed that there will be more consistency across clients.

      structured interview: an evaluation technique that is tightly systematized in terms of the questions asked, allowing for better consistency across interviewers and clients

      Structured Clinical Interview for DSM Disorders

      The current classification manual used by most clinicians in North America is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) (American Psychiatric Association [APA], 2013).The DSM will be discussed in some detail later in this chapter. Based on the DSM–5, with its specific criteria for each category of psychological disorder, it is possible to ask questions in an interview that directly probe for the existence of these criteria. The Structured Clinical Interview for DSM Disorders (SCID) sets forth these questions along with a decision tree for directing follow-up questions. For example, if you want to determine if a person displayed an obsessive–compulsive disorder, you would begin with a general question concerning whether the individual experiences thoughts that kept recurring. If the person said yes, you would then ask what those thoughts were. The decision tree would help you to determine if these thoughts were seen by the individual as something produced in his or her own mind or imposed on the person by an outside agent. Thoughts experienced as not from oneself would be more characteristic of a psychotic disorder, whereas those recognized as coming from one’s own mind might indicate a possible obsessive–compulsive disorder. Individuals with anxiety may also experience worries as thoughts coming into their mind, and the SCID would help to determine whether the person experiences obsessive–compulsive disorder or anxiety. The next set of questions would help the professional determine whether compulsions were also present. The SCID would instruct the interviewer to ask if there was anything the person had to do over and over again such as constant hand washing or checking a door lock several times.

      Structured Clinical Interview for DSM Disorders (SCID): an interview that directly probes for the existence of the criteria for disorders within the current classification manual, the DSM–5

      Assessing Cultural Dimensions

      Over the past 40 years, there has been an increasing awareness that mental illness takes place within the context of a particular culture (Henderson et al., 2016; Marsella & Yamada, 2007). Initially, there was a realization that specific disorders such as depression, schizophrenia, and stress-related disorders are understood differently in different cultures (Draguns, 1973; Draguns & Tanaka-Matsumi, 2003). That is to say, a fuller understanding of mental illness requires an understanding of context. Although every culture has words for severe mental illness such as psychosis, mood disorders such as depression, and anxiety, there is also variation in what is considered normality and deviance. Cultural LENS: Empirically Supported Research Approaches and Cultural Competence notes that culture not only informs one as to how to view one’s distress but also influences how that distress is expressed.

      Cultural Formulation Interview (CFI): a set of questions developed to help mental health professionals obtain information concerning the person’s culture and its influence on behavior and experience

      With DSM–5, a Cultural Formulation Interview (CFI) has been developed to help mental health professionals obtain information concerning the person’s culture. In general, the CFI focuses on five domains. These are described in DSM–5 as follows:

       Cultural identity of the individual—This domain in DSM–5 describes how the individual sees himself or herself in terms of ethnic, racial, or cultural identity. It can also include how connected the person is with the culture of origin.

       Cultural conceptualizations of distress—This domain refers to how the person’s culture would influence his or her experience of the disorder. For example, different types of symptoms might be more acceptable in one culture than another. Also, some individuals may be unwilling to describe the experience they are having in certain aspects of their lives.

       Psychosocial stressors and cultural features of vulnerability—Psychological concerns, as noted in Cultural LENS: Empirically Supported Research Approaches and Cultural Competence, vary by culture. Likewise, the amount of support offered by the family and community also vary. In conducting an interview, the mental health professional needs to obtain an overall picture of the individual’s social environment with an emphasis on how cultural elements affect the presentation of a particular distress or disorder.

       Cultural features of the relationship between the individual and the clinician—This domain emphasizes how the relationship between an individual and a mental health professional can be influenced by cultural factors. If a person has experienced negative situations with those of authority in the world outside of the interview, this could influence how the person relates to the mental health professional. Likewise, if the culture places a high regard on health professionals, then the person may not correct or interrupt with additional information during the interview. This domain would also include how the person expects to be treated by the mental health professional and expectations for future treatment.

       Overall cultural assessment—This domain represents an overall assessment and implications of what was identified in the previous domains. Treatment preferences can be described that may be incorporated into the treatment plan.

      Understanding the cultural context of a disorder helps increase the validity of the assessment and diagnosis procedure. The CFI asks 16 questions related to culture indirectly. For example, the mental health professional would ask the person how his or her family, friends, or community view what is causing the problems. In this manner, people can describe their understanding of their problems with a direct or indirect reference to their culture.

      Cultural Lens

      Empirically Supported Research Approaches and Cultural Competence

      There is a movement in the training of mental health professionals to emphasize cultural competence.

      © iStockphoto.com/Pamela Moore

      Beginning in the 1950s and 1960s, there was a movement among researchers and clinicians to evaluate the effectiveness of both medical and psychological assessment and treatment in a scientific manner. In medicine, this came to be known as evidence-based medicine. In psychology, the terms empirically based treatments and empirically based principles refer to assessment and treatments and their aspects for which there is scientific evidence that the procedure is effective.

      Recently, a movement in the training of mental health professionals has begun to emphasize cultural competence (Delvecchio Good & Hannah, 2015). In this approach, the focus of interventions begins with the person who is being served. That is, a clinician should consider and understand the worldview of the individual she is treating. This includes the client’s willingness to describe internal thoughts and feelings, how he understands how a particular disorder affects him, what he expects from his treatment, as well as his relationships with significant others. For example, in one study, Latinos with depression were less likely to take antidepressants since they had cultural concerns about addiction or dependence (Vargas et al., 2015).

      The existence of these two movements has led to a debate concerning the degree to which a particular psychological disorder should be considered from a more universal standpoint (represented by empirically based principles) as opposed to a manifestation of cultural processes (represented