Poornima Bhola

National Institute of Mental Health and Neuro Sciences | NIMHANS · Department of Clinical Psychology

Objective: This exploratory study locates countertransference as a pan-theoretical concept, comprising of thoughts, feelings, and behaviours expressed or experienced by therapists toward their patients. It aimed to understand the patterns of countertransference experienced in working with borderline personality disorder. The associations between co...

Background: High prevalence rates and variations in patterns of non-suicidal self-injury (NSSI) necessitate the identification of profiles of distinct sub-groups of self-injurers. Aim: To identify homogenous sub-groups of NSSI in a community-based sample of emerging adults. Method: Data was collected using a cross-sectional survey design from a sam...

Social Cognition is a crucial transdiagnostic construct with clinical and functional relevance across a range of neuropsychiatric disorders. Most research has focused on schizophrenia and autism spectrum disorders and has informed frameworks for assessing social cognition in schizophrenia. The current review focuses on the more recent developments...

Reflective Practice and Professional Development in Psychotherapy presents reflection as a tool to further self-exploration and aid professional development for psychotherapists and counsellors. It discusses the potential avenues, methods and spaces for self-reflective work. The book extensively cites both global and Indian research and presents th...

In the relational playground of psychotherapy, negotiating therapeutic distance is crucial for the process as well as the outcome of treatment. The challenge of navigating this closeness and distance may be accentuated during emotionally charged interactions in therapy. Therapist and client may get locked in complementary, rigid positions, leading...

Global gender inequality is a persistent challenge, and India grapples with gender disparities in various realms. Targeted initiatives are essential, particularly during adolescents’ formative years, to promote gender equity. Research on gender attitudes and norms in Indian schools is scarce, with even fewer studies evaluating the impact of interve...

Background As students spend most of their time in school, a supportive school environment is essential for adolescents’ personal growth, effective learning, and well-being. Students actively participate in learning when they feel supported, respected, and connected to their school environment. An unhealthy school climate might significantly influe...

Background: The mentalization model of borderline personality disorder (BPD) utilizes a developmental psychopathology lens, emphasizing an unstable or reduced capacity to mentalize—stemming from early attachment disruptions and relational trauma—as the core feature of BPD. While the empirical evidence for the proposed intersections between mental...

Background The importance of evidence-informed health policymaking is widely recognized. However, many low- and middle-income countries lack evidence-informed mental health policies due to insufficient data, stigma or lack of resources. Various policies address adolescent mental health in India, but published knowledge on their evidence-informed na...

Theoretical models of non-suicidal self-injury (NSSI) have highlighted the complex interaction between underlying psychosocial vulnerabilities, but, there is limited empirical support for these conceptualizations. The aim of the study was to examine affective, cognitive and interpersonal factors predicting NSSI among emerging adults. A sample of 1,...

Socio-political inclusivity rests upon access to resources that allow a person to assert their legal identity and voice. In the case of persons with psychiatric disability who are in long-stay mental health facilities, access to welfare benefits, financial services, and executing democratic rights becomes challenging in the absence of streamlined p...

BACKGROUND Information Education Communication (IEC) materials play a vital role in behavior change by raising awareness about health issues. In India, suicide is the leading cause of death in the age group of 15–39 years, exemplifying the pressing need for raising awareness about suicide prevention. This study aimed to develop a brochure on suicid...

Background Non-suicidal self-injury (NSSI) typically begins during adolescence and the process of treatment and recovery can be challenging. We examine NSSI through the lens of the Transtheoretical Model of Change, a framework that views the process of change as five stages, with differing degrees of readiness to change. Methods Thirty participant...

An understanding of the complex intersection of borderline personality vulnerabilities and motherhood calls for an integrative and culture-sensitive lens in assessment and therapeutic interventions. The aim of the study was to explore constructions of motherhood in an Indian context to inform the adaptation of the Parent Development Interview-Revis...

Mental health is a leading cause of ill-health worldwide, disproportionately affects low-and-middle-income countries and, increasingly, is considered relevant across the Sustainable Development Goals (SDGs). Hence, we ask: How can we mainstream mental health in research engaging the range of SDGs? We use the UK Research and Innovation Global Challe...

Background: There is a need to understand developmental and personality vulnerabilities with non-suicidal self-injury (NSSI) among emerging young adults in the community. Conceptual models of non-suicidal self-injury suggest the role of developmental vulnerabilities in mentalization; the ability to understand the mental states of self and others. M...

COVID-19 has significantly impacted the mental health and well-being of college youth across the world. An online survey using checklists and open-ended questions was shared across various institutions in India to capture information about challenges faced, internal and external resources utilized to deal with the stress, existing support systems a...

Abstract The support of peers, or one’s contemporaries, has been implicated as an important factor for the maintenance and enhancement of the health and wellbeing of young individuals (Turner, 2002). The value of peer support lies in the sense of relatedness and connectedness it offers. Such support normalizes experiences of distress that are typi...

Introduction: Symptoms of anxiety and depression in Indian adolescents are common. Schools can be opportune sites for delivery of mental health interventions. India, however, is without a evidence-based and integrated whole-school mental health approach. This article describes the study design for the safeguarding adolescent mental health in India...

This paper examines four different countries with distinct health care systems to explore both global commonalities and national differences in terms of the psychological impact and the clinical psychological response to COVID-19 (Torales et al, 2020). Through four descriptive case examples from Holguin in Cuba, Bangalore in India, Virginia in USA...

In India, General Hospital Psychiatry Units (GHPUs) are the backbone for mental health care. GHPUs have less stigma, facilitate inter-specialty collaboration, and provide integrated mental and physical healthcare. GHPUs offer a predominantly medical model of care and face multiple challenges in offering psychiatric rehabilitation, including a sever...

An understanding of the lived experiences of self-injuring youth can inform our efforts to support and facilitate recovery. This study aimed to explore the experiences of non�suicidal self-injury (NSSI) and the journey of recovery among youth in India. Semi�structured interviews were conducted with five participants aged 18 to 27 years with varied...

Introduction Symptoms of anxiety and depression in Indian adolescents are common. Schools can be opportune sites for delivery of mental health interventions. India, however, is without a whole-school mental health approach. This article describes the study design for the Safeguarding Adolescent Mental Health in India (SAMA) project. The aim of SAMA...

Objectives: Adolescents and young adults form a vulnerable group for the occurrence of non-suicidal self-injury, which is the deliberate and self inflicted injury to one’s body tissues without the intent to die. A detailed understanding of the developmental trajectories in non suicidal self injury is essential for treatment. The present study aimed...

Psychotherapists treat vulnerable persons in the context of a particular patient–therapist relationship in which the most serious and sensitive topics of human existence are talked about. In conducting psychotherapy research, it can be a challenge to align the ethical prerequisites of practicing psychotherapy with the particular methodological requ...

Adolescents and young adults form a vulnerable group for the occurrence of non-suicidal self-injury; the deliberate and self-inflicted injury to one’s body tissues without the intent to die. For many self-injuring youth, this behaviour is persistent and there is limited research on the process and mechanisms of cessation and recovery. Aim: The stu...

Background A number of persons with severe mental illnesses are unable to prepare for, find or keep a job due to factors linked to their illness as well as psychosocial issues. Aim To test the feasibility of a supported employment programme to help persons with severe mental disorders obtain and sustain employment. Methods A supported employment...

Neuresthenia has had its popularity waxing and waning over the years. This review article traces the path and trajectory of the concept of this disorder, how it changed and varied over time, to the current times, when it has been almost forgotten and the concept is heading towards oblivion. Although its place in the diagnostic systems is currently...

Background Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015–2016. Aim To estimate the prevalence, socio-...

Personality disorders represent enduring patterns of difficulties in ways of thinking, feeling, and behaving that deviate from cultural expectations and typically emerge in adolescence or early adulthood. The associated distress and impairment associated with these complex vulnerabilities impact relationships, work, and the sense of self and presen...

Introduction A high prevalence of common mental disorders and the associated treatment gap, particularly in low and middle-income countries such as India, calls for novel mental health approaches with widespread reach. There is a need to enhance our understanding of the barriers experienced by distressed persons as well as to utilize these insights...

Objective: To develop and validate the vocational potential assessment tool and counselling module for persons with severe mental disorders (SMD). Method: The tool and the module were developed through review of existing assessment tools, individual interviews and focused group discussions with key stake holders- persons with SMD, caregivers, ex...

Personality disorders represent enduring patterns of difficulties in ways of thinking, feeling, and behaving that deviate from cultural expectations, and typically emerge in adolescence or early adulthood. The associated distress and impairment associated with these complex vulnerabilities impact relationships, work, and the sense of self and prese...

The review maps recent research on the processes and outcomes of psychotherapy with varied client populations across diverse settings in India. The encouraging but uneven growth in research, spans the use of varied modalities including cognitive behavioural therapies, psychodynamic approaches, and couple and family therapy interventions. Research s...

Background: Understanding the explanatory models of family caregivers is particularly important in interdependent contexts like India, where they often play a significant role in the help seeking behaviours, treatment decision-making and long term care of those diagnosed with mental illness. Aims: This study was planned to explore the diversity of...

Aim: People diagnosed with cancer and in end-of-life care may have a range of needs. These needs may be inadequately expressed, recognized, or responded to by family members and health-care providers. The present study aimed at exploring health-care providers' perceptions of the interpersonal needs, psychological needs, and unfinished business amo...

This paper describes a distinctive one-month certification programme in Mental Health Education. This was designed, conceptualised and executed at the National Institute of Mental Health and Neuro Sciences (NIMHANS), a multidisciplinary tertiary care hospital and training institute for mental health and neurosciences in India. Learning about a topi...

Online mental health services provide a point-of-access to mental healthcare that may otherwise be unavailable or limited, particularly in developing countries. Nevertheless, there is a lack of research into individual differences between those who prefer online mental health services and those who prefer traditional in-person services, and whether...

Background: Social cognition deficits have been implicated in the affect regulation and interpersonal difficulties seen in borderline personality disorder (BPD). The study examined patterns of social cognition abilities, using self-report and task-based measures, among individuals diagnosed with BPD. Methods: The sample included a clinical group of...

The helping professions of psychotherapy and counselling involve a process of lifelong learning and professional development. Multiple influences may serve as pathways to professional development and growth. The study explored practitioner perceptions of a range of influences on their development as therapists. The Development of Psychotherapists C...

Developmental psychopathology models of borderline personality disorder (BPD) have linked early attachment vulnerabilities with reduced capacities for mentalization and consequent disturbances in psychological and interpersonal functioning. Addressing impairments in the ability to understand the mental states (e.g. emotions, needs, thoughts, intent...

BACKGROUND: The growing interest in community-based research on non-suicidal self-injury (NSSI) reflects the high prevalence rates found among vulnerable adolescents and young adults. A significant concern in research with vulnerable populations, and on sensitive topics, is the development of an ethical framework that protects the needs and rights...

Background The complex intersections between non-suicidal self-injurious (NSSI) behaviours; like cutting, burning or self-hitting, and suicide attempts, are an important domain of enquiry among vulnerable adolescents and young adults. A cross-sectional survey in urban schools and colleges assessed the rates of self-injurious behavior among Indian a...

Assumptions about the universality of ethics and the use of dominant ethical frameworks of mental health care may obscure the differences and contextual realities in traditional societies. The ‘culture’ of the encounter between the mental health practitioner and the patient can be viewed through three dominant perspectives; paternalism, autonomy an...

Background: Ethical issues are ubiquitous during therapeutic work, despite the presence of professional ethics codes that guide ethical decision making. This exploratory research looks at how mental health trainees and practitioners, across various mental health disciplines, perceive and experience ethical dilemmas in the therapy space. Method: Th...

Background: Adolescents and young adults form a high-risk group for non-suicidal self-injury but these behaviours are often inadequately understood. Aims: A cross-sectional survey was conducted to explore the perceptions of student self-injury, among school and college teachers in an urban city in India. Methods: A 62-item measure, Teacher Awarenes...

Trainee perspectives about supervision were examined in the relatively unexplored landscape of psychotherapy training and development in India. Ninety-four trainee therapists drawn from eight centers completed a questionnaire, Development of Psychotherapists–Trainee Background and Process Forms, at the end of training. Results indicated significant...

Context: Intentional self-directed acts of injury are the most common among adolescents and young adults. Developmental psychopathology theories that conceptualize pathways to self-injurious behaviors (SIBs) implicate insecure attachment representations and inadequate self-regulatory skills to cope with emotional distress. Aims: The study aimed to...

Counsellors and therapists must provide a safe space and walk the ethical line during their psychotherapeutic interactions with vulnerable clients. Ethical practice is informed by several philosophical positions; deontological, utilitarian, the widely used principle-based framework, feminist care ethics and other post-modern perspectives. Expanded...

This edited volume comprehensively examines the critical ethical challenges that arise in the practice of counselling and psychotherapy. It translates philosophical positions and professional ethical guidelines in a way that can be applied to practice. The various chapters focus on specific ethical issues that emerge in working with a range of diff...

Research on psychosocial interventions looks at answering questions about the effectiveness of counselling and psychotherapy and also attempts to uncover the crucial ingredients and change processes. Maintaining the ethical frame is paramount in the therapy room and this extends to any intervention research which involves human participants. The co...

With the growing technological advancement, the paradigms of client–therapist interaction are also changing. There is an emerging trend of practising e-therapy in India. The chapter discusses the possible ethical issues that might arise in the context of client–therapist interaction in the digital world. It enlists the steps of deciding if a client...

Context: Deficits in social skills may present in a range of psychiatric disorders, particularly in the more serious and persistent conditions, and have an influence on functioning across various domains. Aims: This pilot study aimed at developing a brief measure, for structured evaluation and screening for social skills deficits, which can be e...

Background: The understanding of youth mental health needs and development of service delivery models is a national public health challenge. Objectives: The rates and predictors of emotional and behavioral problems among 1087 youth were assessed in a pre-university college in Bangalore, India. Variations in rates of disturbance, identified by us...

Ethical dilemmas are inevitable during psychotherapeutic interactions, and these complexities and challenges may be magnified during the training phase. The experience of ethical dilemmas in the arena of therapy and the methods of resolving these dilemmas were examined among 35 clinical psychologists in training, through an anonymous and confidenti...

Autobiographical memory narratives that emerge in therapeutic discourse can aid the understanding of the client?s narrative identity and the identification of cen-tral themes or conflicts. The study aimed to examine the structure and thematic content of autobiographical memory narratives of five clients with Borderline Personality Dis-order (BPD),...

Background: The philosophy of recovery emphasises consumer participation and engagement in developing effective rehabilitation services. Assessment of consumer perspectives and concerns lies at the heart of responsive and relevant rehabilitation frameworks. Aim: The study aimed to document and examine patient and caregiver queries, at their firs...

Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals’ self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting a...

Psychiatric rehabilitation can help in making significant changes in all the spheres of functioning. A pre-experimental design was selected to invite four male and one female patient to pilot test a rehabilitation model wherein supported work was offered by the treating facility. There was increase in mean work performance on the Griffith's scale a...

Background: Non-suicidal self-injurious behaviour (NSSI) is a growing concern among youth and rarely reaches the attention of mental health and medical services. Aims: The study explored the occurrence, methods, characteristics and reported reasons for NSSI among a sample of college students in India. Methods: A total of 470 participants from...

Recovery oriented services extend beyond reduction of psychiatric symptoms and focus on helping individuals reconstruct their lives in a meaningful way. This case report describes the rehabilitation interventions with a 37 year old woman with chronic schizophrenia and residual disability during a four-month inpatient stay. These comprised individua...

Background: Psychiatric rehabilitation is an important component in mental health services. The rehabilitation needs of patients with mental illness have been highlighted in various studies. The studies on in-patient referrals to rehabilitation services however are sparse. This study describes the clinical and demographic details and the reasons fo...

Autobiographical memory narratives that emerge in therapeutic discourse can aid the understanding of the client's narrative identity and the identification of central themes or conflicts. The study aimed to examine the structure and thematic content of autobiographical memory narratives of five clients with Borderline Personality Disorder (BPD), du...

The formation of a therapeutic alliance is considered a central issue in therapy, and particularly crucial and challenging in work with adolescents. The relational and technical components of the therapeutic alliance were examined from the perspective of the adolescent client. 40 emotionally disturbed adolescent girls, aged 13 to 16 years, received...

The business process outsourcing (BPO) sector is a contemporary work setting in India, with a large and relatively young workforce. There is concern that the demands of the work environment may contribute to stress levels and psychological vulnerability among employees as well as to high attrition levels. As part of a larger study, questionnaires w...

Due to the burgeoning awareness of students Psychologists in India are coming across this condition with increasing frequency. These guidelines have been prepared to enable the Indian Clinical Psychologists to provide high quality and consistent psychological service in this emerging area of practice and Specific Area of Learning Disability will be...

Practice as a psychotherapist can be both rewarding and challenging, generating a need for therapists to reflect on their professional strengths and vulnerabilities. As part of a larger international study of psychotherapists, information was gathered from 250 therapists in India using the Development of Psychotherapists Common Core Questionnaire (...

There are limited data on child mental health needs in our country. Therefore, an epidemiological study to determine the prevalence rates of child and adolescent psychiatric disorders was initiated as a two-centre (Bangalore and Lucknow) study by the Indian Council of Medical Research. It also aimed to study the psychosocial correlates of the psych...

The increasing focus on child mental health in developing countries like India points to the importance of epidemiological data in developing training, service and research paradigms.This review attempts to synthesise and evaluate the available research on the prevalence of child and adolescent psychiatric disorders in India and highlight significa...