Cultural formulationThe core of the study was a cultural formulation of the clients exceptional traits and states. There is no reason not to include clinical cultural traits as well (which was psychiatric and thus medical), as, in the end, clinicians benefited in much the same ways clients did. The components of the multicultural formulation where drawn from personal histories (that included the traumatic results of war for at least 40% of the participating clients), and current issues (which for the war-traumatized includes the anxiety of waiting for official decisions). Current factors for the clients were the effects of immigration on family structure and supports, friction between generations, personal identity issues with respect to society and gender, and spiritual losses. On the clinical side, biases were mediated not just by differing cultural values, but by the clinicians views of clients’ poverty, unemployment, politics, and even race. Both clients and clinicians felt the mismatch of differing approaches to medicine such that clinicians were frustrated by their inability to match clients’ descriptions of symptoms with DSM-provided data, and clients were disappointed by the clinicians’ inability to provide what they have come to expect from medicine.
How CSS worksWhen clinicians contacted the study team for CSS assistance, a signal was sent to the clients of the clinicians’ concern that instantly benefited the alliance. As the CSS helpers provided symptomatic translations and understandings, previously puzzling symptoms were put in contexts that could be related to the DSM. Clinicians also immediately benefited personally as their frustrations and biases gave way to appreciation for the sophistication of their clients' cultures. In the cases where only clinicians met with the CSS helpers, clinical alliances were built around the issues and thus motivated action.
How CSS can be appliedThe core value of the CSS study is the “formulation” that seeks to model a relationship between both the cultural values clinicians and clients by embracing both. The client can then benefit along parallel tracks of care: traditional cultural approaches (which may have a social dimension) and current mainstream clinical that may better treat symptoms. A first step is for the clinician to signal the client of interest in client’s cultural approach by attempting to fully comprehend it. The clinician might note each component of the client's view of problems so that a holistic model can be constructed such that correlations can be identified to link the clients’ approach to mainstream diagnosis and treatment structure.
Conclusions and after-effectsThe study had interesting after-results including the recruitment of the researchers as therapists, as some of the participating clinicians chose to "dump" their clients on them. This brought added attention to the transitional needs of multicultural clients as newly-provided understandings resulted in new diagnosis and treatments. Another need stressed by the study was for the clients' self-determination in determining the duality of treatments; many who might have benefited from CSS had likely left therapy or never attempted it because of the cultural rifts, both social and medical.
The service is not cheap because, to be successful, the consultants have to be well-trained; the study showed that low-cost substitutes, such using menial-level hospital workers as translators provided poor returns, and is thus not cost-effective. Further, clients may reject CSS support from community members as they are concerned that their privacy will not be protected. A similar concern is that many clients “dropped out” or never sought help because of the problems caused by multicultural rifts. An issue of concern for the refugees was their fear that a poor diagnosis would affect their status-seeking efforts. Beyond cultural and clinical support through cultural services is the need to promote the guarantee of ethical protections to the immigrant sub-cultures.
Complimenting cultural values benefits allWhen components are found to be different, the approach should be complimentary; a holistic value is matched with a clinical procedure such that clinical does not replace the cultural, but confirms and enhances it. According to the study, a complimentary and mutually embracing approach benefitted clinicians as well as clients. It also opens the possibility that the cultural connection can benefit mainstream medicine with the dissemination other-culture knowledge.