Careful assessment of the cultural context of psychiatric problems must form a central part of any clinical evaluation. Lack of awareness of important differences can undermine the development of a therapeutic alliance, and the negotiation and delivery of effective treatment. Exploring the cultural context and meanings of identity, illness experience and coping is an essential component of mental healthcare. It is important to inquire into explicit cultural models using the sorts of questions devised for the explanatory model interview. In the end, patients are the experts in their own experiential worlds, and cultural context must be reconstructed simultaneously from the inside out (through the patient's experience) and from the outside in (through an appreciation of the social matrix in which the patient is embedded). The cultural formulation and the basic strategies of cultural competence represent useful initial approaches to exploring clinically relevant dimensions of patients' cultural backgrounds.