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Presented by Elizabeth Li
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The theory of epistemic trust marks a notable shift from viewing impairments in attachment and mentalizing to considering social communicative inflexibility to be key in understanding psychopathology. Epistemic mistrust is thought to capture an underlying propensity for any kind of psychopathology, as those who are in a state of epistemic mistrust tend to adopt negative appraisal mechanisms as a default in social communication. Accordingly, generating epistemic trust in individuals to increase their capacity to benefit from benign aspects of the social environment may be a generic mechanism for change in effective psychotherapy. Fonagy, Luyten, Allison, and Campbell (2019) proposed a framework of three communication processes that generate epistemic trust in psychotherapeutic interventions to achieve the effectiveness of psychotherapy.
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This study examines Fonagy and colleagues鈥� rational model of the three communication systems by exploring how is epistemic mistrust resolved in psychotherapy in a purposive sample of six depressed adolescents. I compared the good-outcome cases (N = 4) with the poor-outcome cases (N = 2) to develop a synthesised rational-empirical model that resolves epistemic mistrust in psychotherapy. I argue that the early sessions where the therapist activates the patient鈥檚 epistemic openness are the key to treatment success. Improving mentalizing and re-emerging social learning outside therapy occur naturally following the epistemic match and the three aspects of the communication process follow a reiterative (instead of linear) sequence. Our empirical evidence supports Fonagy and colleagues鈥� theory that the process of resolving epistemic mistrust is a shared mechanism for change and restored epistemic trust is a common outcome in successful psychotherapy, regardless of therapeutic orientations (i.e., CBT, Short term psychodynamic psychotherapy, Brief psychosocial intervention).
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