Asking About Identity: A Collaborative Approach to Patient Care

Naomi Dambreville, PhD, discussed how clinicians can navigate conversations about identity (like race, ethnicity, religion, gender, and nationality) with psychiatric patients from diverse backgrounds. Dambreville said a common communication misstep in clinical encounters was leading with assumptions rather than asking sufficient follow-up questions. Effective conversations about identity required curiosity and cultural humility rather than positioning the clinician as the sole expert in the room.¹ "It's about having curiosity and cultural humility, and not assuming that we are the expert in the room simply because we have the title of the professional or have the credentials, because everyone is the expert in their own lived experience," Dambreville said.

Dambreville noted that the depth and tone of an identity-focused conversation should be calibrated to the relationship—an initial encounter warranted a different approach than an established therapeutic relationship. Clinicians were encouraged to ask direct, nonjudgmental questions about a patient's background (for example, inquiring about religious identity or immigration history), while being transparent with the patient about why that information was being gathered. This transparency, framed as a collaborative process rather than a hidden agenda, could ease patient concerns about being questioned on sensitive topics. Identity-focused questions should extend beyond fact-gathering to understanding how a patient's background shaped their experience of distress, how their family viewed mental illness, and whether help-seeking was encouraged or discouraged within their cultural context.

Self-reflection was described as central to this process. Clinicians were urged to sit with discomfort, acknowledge power dynamics inherent in the patient-clinician relationship, and recognize that shared identity categories did not guarantee a shared lived experience between clinician and patient.² "We're not just clinician and patient, but we're just kind of people in this world working to better understand someone's experience," Dambreville said.

Dambreville also highlighted the therapeutic value of identifying culturally rooted coping resources—such as religious practice, prayer, or culturally significant food—that could support patients during periods of active distress and be incorporated into treatment planning. Rather than treating identity as incidental to a psychiatric evaluation, Dambreville framed it as integral to understanding how mental illness and healing were experienced across diverse patient populations.

Dr Dambreville is a licensed adult and child clinical psychologist and assistant professor of psychiatry at Mount Sinai Hospital and the Icahn School of Medicine in New York City.

References

1. Trinh NH, Jahan AB, Chen JA. Moving from cultural competence to cultural humility in psychiatric education. Psychiatr Clin North Am. 2021;44(2):149-157.

2. Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117-125.