“Blue cloth” psychological symptom measure

Phnom Penh, Cambodia. An NGO here involved in mental health work around the country uses an innovative technique to measure severity of psychological symptoms, one that might make Western psychologists uneasy. “Blue cloth” is, as you might imagine, a blue cloth, a large one maybe 5 ft x 5 ft, with psychological symptoms (headaches, trouble sleeping, irritability) listed down the left side and five different colored pockets arranged in columns to the right, one column for each “level” of symptom severity (e.g., the pockets in the first column respresent no experience of the symptom, whereas the pockets in the last column represent extreme severity–see photo below). Participants in support groups each take turns placing rocks into the pockets that represent how severe the symptoms have been in the past 30 days. NGO staff record each participant’s placement of rocks in order to keep a record of how distressed participants are. The process is repeated 6 months later, and comparing the two profiles is how the NGO measures symptom change over the course of treatment (hopefully the rocks are in the less severe pockets at 6 months).

All this is done in front of other group members. The Director told me that some visiting Western psychologists were nervous about this given the obvious breach of confidentiality within the group. He brought the issue back to the groups. In the alcohol abuse groups members responded that doing the exercise in front of the rest of the

Blue cloth psychological symptom severity measure

Blue cloth psychological symptom severity measure

group was better because they could serve as checks on each others’ reports when they might be inclined to minimize or lie outright. To the visiting Westerners the group setting was a clear threat to the reliability of the data, but to the group members privacy was the threat to reliability. The Director reported that members of other groups were somewhat confused about the Westerners’ objections; weren’t the group members supposed to share these sorts of things in group therapy? Blue cloth became a tool for discussion of symptoms as much as a measure of them.

Undoubtedly public reporting of symptoms within a support group is not the same thing as using a symptom measure that is confidential. But is the information gained from it necessarily less reliable? Is it less clinically valid? Of course, these are empirical questions, to be answered in some clinically-relevant research utopia to come…

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June 2009
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