Although there are many ways to produce a cultural formulation that facilitates a culturally sensitive diagnosis and treatment for asylum seekers and refugees in mental health care, it is essential to gain trust and 'recognize' the patient. One way to achieve this recognition is through a cultural interview, in which cultural references of the health care provider and the patient are exchanged. This paper presents an example of such a process with a Somali migrant to the Netherlands, whose passivity and inactivity puzzled the psychiatrist. Gaining his trust and recognizing his cultural roots as a member of a Somali ethnic group revealed more about his motives, concepts and attitude. This example suggests the importance of cultural identity as a way to explore the meanings of the illness and the interrelationship between the patient and health care provider. The cultural identity of the patient is a basis on which meanings can be exchanged in an ongoing way and starting points for effective treatment can be found.