Fisher, Shimrit; Fonagy, Peter; Zilcha-Mano, Sigal; (2024) More than Meets the "I": A Panoramic View of Epistemic Trust in Psychotherapy. Psychopathology 10.1159/000541667. (In press).

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Abstract

Introduction: Epistemic trust (ET), the authenticity and personal relevance we assign to interpersonally transmitted knowledge, is considered an essential component of any effective therapy. Despite its clinical significance, comprehensive empirical support is still lacking regarding whether ET is an inherent characteristic of the patient or acts as a catalyst for therapeutic change. Consequently, unlike other critical components, a clear distinction between its aspects – the patient’s attributes, the therapist’s contribution, and their unique therapeutic relationship – remains elusive, leaving our understanding incomplete. The current study examines the constituents of ET in therapy and its related effects through three distinct lenses: a blended snapshot lens, a prognostic lens, and a lens focusing on state-like changes. The constituents of ET were measured as follows: patient attributes were measured using attachment orientation and interpersonal functioning scales; therapist contribution was evaluated through scales assessing the therapist’s use of techniques; and the patient-therapist therapeutic relationship was gauged using the working alliance scale. / Methods: We collected and analyzed data from 116 patients who participated in manualized psychodynamic psychotherapy sessions to investigate the trait-like and state-like components of ET. / Results: The results offer a comprehensive panoramic view with small to medium, but meaningful, correlations between ET and patients’ attributes (ranging from 0.18 to −0.26); therapists’ contributions (ranging between 0.15 and 0.28); and the patient-therapist therapeutic relationship (ranging between 0.17 and 0.23). / Conclusion: While some findings were consistent with our expectations, others were contrary, highlighting the necessity of considering the variations between and within patients as they have distinct theoretical, clinical, and empirical implications. Employing these three distinct lenses helps therapists gain a better understanding of the clinical picture reflected by the patient over different treatment periods. This broad perspective is of prognostic importance and encourages clinicians to adjust the treatment focus to meet the evolving needs of their patients.

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