Abstract: Cognitive behaviour therapy (CBT) has been found to be effective in treating mental health problems in the UK, but little has been done to evaluate the potential of CBT in developing countries. This paper aims to discuss the development and implementation of a CBT training course for clinicians working in Tanzania's main psychiatric hospital in the capital city, Dodoma. A 12-session training course in CBT was delivered to nine clinicians. An outcome evaluation was conducted using multiple measures and methods, taken before and after the training. Information on cultural adaptations of the training was obtained. All participants completed the course, but there were several obstacles to full completion of the evaluation measures. Despite this, there were significant improvements in clinicians’ basic understanding of CBT concepts, and their ability to apply the CBT model to formulate and recommend treatment strategies in response to a clinical case. Qualitative information indicated the potential of developing CBT training and implementation further. As a pilot study, this investigation shows the promise that CBT holds for mental health services in Tanzania. Further research into the training and clinical effectiveness of CBT in Tanzania is indicated.

In this article, we address the question of how organizational practices are diffused within networks of practice. We do so by drawing on the results of an ethnographic study of the diffusion of a complex mental health care treatment modality - the Democratic Therapeutic Community - that involved the attempted spread of novel work practices within a professional network of psychiatrists and their associated multi-disciplinary teams at two new clinical sites. We orientate the study within the networks of practice (NOP) literature on the diffusion of new work practices, considering in particular the issue of organizational power, which has been neglected hitherto. After presenting our ethnographic material, we draw attention to the role of clinical ideology, derived from founders and upheld by new, local clinical leaders in the appropriation process. By bringing in a concern for organizational power, we add to the existing literature through stressing the importance of ideological power, in supplying collective meaning, and the influential role of founders as creators and 'institutionalizers' of underlying ideologies.

Objective: To assess the outcome for patients receiving specialist democratic therapeutic community treatment for personality disorder (PD) when they also have eating disturbance.Method: Prospective, naturalistic study. Personality psychopathology and disturbed eating attitudes of 135 male and female referrals to tertiary treatment for PD were assessed at referral. Seventy-five referrals were admitted for treatment and 60 were not. Participants were reassessed at 1-year follow-up.Results: There was a significant effect of treatment on dieting but not other aspects of eating disturbance. However, patients with eating disturbance were not more likely than those without to terminate treatment early or to have poorer outcome in terms of their personality pathology. Severity of baseline personality pathology did not predict treatment response.Conclusion: Clients with comorbidity should be considered for treatment of the personality disorder prior to treatment for the eating disorder. Copyright (c) 2006 John Wiley & Sons, Ltd and Eating Disorders Association.

Context The evaluation of training is problematic and the evidence base inconclusive. This situation may arise for 2 main reasons: training is not understood as a complex intervention and, related to this, the evaluation methods applied are often overly simplistic. Method This paper makes the case for construing training, especially in the field of specialist medical education, as a complex intervention. It also selectively reviews the available literature in order to match evaluative techniques with the demonstrated complexity. Conclusions Construing training as a complex intervention can provide a framework for selecting the most appropriate methodology to evaluate a given training intervention and to appraise the evidence base for training fairly, choosing from among both quantitative and qualitative approaches and applying measurement at multiple levels of training impact.

Self-report measures pertinent for personality disorder are widely used and many are available. Their relative merits are usually assessed on nomothetic psychometrics and acceptability to users is neglected. We report reactions of lay, patient and professional groups to the Personality Diagnostic Questionnaire (PDQ-IV); Millon Clinical Multiaxial Inventory (MCMI-III); the Borderline Syndrome Index (BSI); Rosenberg's Self-Esteem Scale (RSE) and the Social Functioning Questionnaire (SFQ). These were sent to 148 professionals, ex-patients and lay people for comment. Thirty-six per cent were returned. Pattern-coding by three raters revealed problematic themes across all measures, including inappropriate length, vague items and language, cultural assumptions and slang, state-bias and response-set. Measures can be depressing and upsetting for some participants (both patients and non-patients), hence administration of measures should be sensitive. Treatment may make people more self-aware, which may compromise validity for outcome research. This evaluation raises issues and concerns, which are missed in traditional psychometric evaluation.