The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Mattias Strand, M.D. Ph.D, (Region Stockholm & Karolinska Institutet) is a post-doctoral researcher at the Centre for Psychiatry Research at the Karolinska Institute and senior psychiatrist at the Transcultural Centre in Stockholm, Sweden. His main research areas are cultural psychiatry, medical humanities, trauma, and eating disorders.
What is your article “Could the DSM-5 Cultural Formulation Interview Hold Therapeutic Potential? Suggestions for Further Exploration and Adaptation Within a Framework of Therapeutic Assessment“ about?
Our paper is about the so-called Cultural Formulation Interview (CFI) in the DSM-5, which is a person-centered clincial tool for assessing and discussing the importance of cultural issues in health and illness with your patient—a kind of “mini-ethnography” if you will. In the paper, we discuss how the use of the CFI could be further developed by applying a Therapeutic Assessment approach. In brief, Therapeutic Assessment is a collaborative approach to psychological assessment in which the assessment procedure itself is meant to induce therapeutic change. This is achieved by explicitly focusing on the particular questions and queries that patients have about themselves with respect to their mental health or psychosocial well-being, rather than on those issues that the clinician is primarily interested in. We do not offer any definitive answers on how to integrate these models but hope to further the discussion of a therapeutic potential of the CFI.
Tell us a little bit about yourself and your research interests.
I am a psychiatrist and a postdoctoral researcher based in Stockholm, Sweden. I work at the Transcultural Centre, which is a public health resource centre for issues related to migrant health and cultural psychiatry run by Region Stockholm. Before that, I worked for many years as a psychiatrist at the Stockholm Centre for Eating Disorders, which is one of the largest specialist services for eating disorders in the world. Eating disorders are still very much a main focus of my research—my postdoctoral work is about eating disorders in migrant populations and experiences in treatment in these groups.
What drew you to this project?
I was actually introduced to the Therapeutic Assessment framework by a patient of mine a few years ago, and although I am certainly not an expert in that field I see clear similarities to the concept behind the Outline for Cultural Formulation and the CFI in the DSM-5 that I thought would be interesting to explore.
What was one of the most interesting findings?
To me, one of the most interesting similarities between the CFI and Therapeutic Assessment that we stumbled upon in our exploration is that they both start from what we call a “second-person perspective”, in contrast to a narrative first-person perspective or a supposedly obejctive third-person clinician perspective. The second-person outlook acknowledges that in any clinical encounter, or pretty much any situation in which there are two or more people involved, there are inherent limits to how much we can understand about ‘‘the Other’’—100% empathy can never be achieved.
Rather than mere analogy between the world of the clinician and that of the patient, this perspective presupposes difference that cannot fully be overcome. Importantly, however, instead of resignation, these limits of empathy call for greater efforts in jointly exploring the patient’s world and co-constructing meaningful understanding. All of this may perhaps sound self-evident, but in my experience it is very rarely an explicit starting point in psychiatric assessment.
What are you reading, listening to, and/or watching right now?
I am reading an old Swedish book on icons in the Russian Orthodox church. I am mostly watching various rock climbing videos on YouTube and trying to catch at least one movie at the Stockholm International Film Festival this month.
If there was one takeaway or action point you hope people will get from your work, what would it be?
I would hope that the fields of cultural psychiatry and Therapeutic Assessment, which are now fairly distant, could learn from each other. Not least, there are a lot of case studies describing the use of Therapeutic Assessment in situations in which the cultural backgrounds of the patient and the therapist differ in important ways, and I just wish that therapists working within a Therapeutic Assessment framework would also discover the CFI and incorporate it as part of their toolbox.
Thank you for your time!