Investigating psychologists' conceptions of culture in the case formulation process: a New Zealand context

Abstract

Culture is increasingly seen as playing a role in the conceptualization and practice of mental health. Significant effort has been made in New Zealand to ensure that mental health services are culturally appropriate for Mäori and to a lesser extent other cultural groups. However despite the increasing significance of culture, there is little existing literature about the structures through which culture influences an individual's mental health. There is even less research investigating how the cultural frameworks of both psychologists and clients impact on psychologist's case conceptualization. In the current research 8 clinical psychologists were presented with a vignette and asked to describe in detail, the various steps they would take to develop a formulation and intervention plan. In addition, participants were interviewed about the conceptions of mental health, their views of clients in general and wider contextual influences that impact on their practice. From the results a preliminary descriptive model of psychologist cultural reasoning (PCRM) was developed. The model provides a conceptual map of psychologist and client cultural worldviews, the mediating influences of contextual factors within the mental health system, and their interaction leading to case conceptualization. Significant findings included identifying how psychologist worldviews influence the reasoning strategies employed; the lack of clarity by psychologists about culture and the compartmentalization of culture from clinical aspects; and the use of co-workers for cultural assessment and service delivery. Implications of the findings and directions for future research are discussed. The limitations of the current research are also discussed.