More important than determining the underlying, perhaps unconscious, reasons for seeking help, is the immediate task of discerning what is distressing the patient and converting that expression in the patient's own words, language, and concepts to the clinician's terminology and frame of reference. Many individuals from ethnic minority groups will express their distress in nonspecific terms: "I feel bad," "I feel upset," "I am nervous" (nervios), and so on. It is thus important to attempt to have the patient elaborate on what they are experiencing, by asking them to say more about their distress without suggesting any specific symptom. This requires patience because among some cultural groups emotional distress is often described in terms of physical symptoms or by referring to a specific disturbed organ or body part. Even with careful attempts to elicit greater subjective elaboration, an individual may not provide the necessary information for the clinician to conclude that a particular affect is being described (i.e., depression). Collateral observation may be needed (e.g. insomnia, lack of interest), as reported by patient or family member.
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