A theory-building case study of resolving epistemic mistrust and developing epistemic trust in psychotherapy with depressed adolescents.

Abstract

Objective: Patients with epistemic mistrust struggle to view others as trustworthy sources of knowledge and often default to negative appraisals in social communication. The three communication systems theory posits that resolving epistemic mistrust involves three systems: the epistemic match, improving mentalizing, and the re-emergence of social learning outside therapy. This study aimed to empirically examine the theory to understand how epistemic trust develops in psychotherapy.

Method: Using a theory-building case study approach, we analyzed therapeutic processes in six depressed adolescents (Mage = 16.58, SD = 1.17) with varying treatment outcomes. Sixty-six audiotaped psychotherapy sessions were reviewed to compare good- and poor-outcome cases, identifying patterns within therapeutic interactions.

Results: Findings provide the first empirical evaluation of the three communication systems theory, offering concrete examples of how it unfolds in clinical practice and suggesting refinements in therapist and patient processes to build epistemic trust. Additional insights into the theory highlight an early "window of opportunity" to foster epistemic openness, the influence of environmental factors outside therapy, and the interactive nature of therapist-patient dynamics.

Conclusion: This study refines the theoretical understanding of epistemic trust in psychotherapy, revealing specific therapist and patient behaviors that may facilitate its development. Implications for clinical practice and future research directions are discussed.