FIsher, Shimrit;
Guralnik, Timur;
Fonagy, Peter;
Zilcha-Mano, Sigal;
(2024)
The Development of the Epistemic Trust Rating System (ETRS).
Psychotherapy Research
10.1080/10503307.2023.2299213.
(In press).
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Abstract
Objective: The present study introduces and validates the Epistemic Trust Rating System (ETRS), an observer-based measure designed to assess epistemic trust (ET) within psychotherapy. ET in psychotherapy has gained much theoretical attention as a critical component in the therapeutic context, given its inherent link to social communication. However, its empirical validation remains pending, largely due to the absence of a refined instrument to gauge ET levels within the therapy environment. Therefore, this study aimed to translate ET's theoretical construct into tangible markers within the therapeutic context. Method: One hundred eighteen patients enrolled in a randomized controlled trial received psychodynamic psychotherapy for depression. Incorporating top-down theoretical considerations with bottom-up empirical observations yielded an overall ETRS score accompanied by three distinct sub-scales, each assessing a singular ET element: one gauges the patient's propensity to share; another measures the degree to which 'we-mode' moments are achieved within the session; and the third evaluates the patient's receptiveness to learning. Results: The findings demonstrate the psychometric robustness of the ETRS, with good internal consistency, interrater reliability (ICC(1,8)=.86-.90), and convergent (r=.23-.29) and discriminant validity (r=-.10). Conclusion: The current study highlights the ETRS as a promising tool bridging theory and empirical exploration, enhancing our understanding of epistemic trust in psychotherapy. Clinical and Methodological Significance of this Article: This study provides evidence of the reliability and validity of the ETRS, an observer-based measure of epistemic trust in therapeutic relationships. The ETRS demonstrates its potential to be a valuable asset for future research endeavors aimed at unraveling the significance of epistemic trust in the processes and outcomes of psychotherapy. Measuring a complex, multifaceted construct like epistemic trust narrows the existing gap between theoretical concepts and empirical assessment. This measure can equip therapists with a means to customize their approach to meet their patients' individual needs, potentially improving therapeutic outcomes.
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