Nolte, Tobias;
Hutsebaut, Joost;
Sharp, Carla;
Campbell, Chloe;
Fonagy, Peter;
Bateman, Anthony;
(2023)
The role of epistemic trust in mentalization-based treatment of borderline psychopathology.
Journal Of Personality Disorders
, 37
(5)
pp. 633-659.
10.1521/pedi.2023.37.5.633.
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Abstract
Building on the recently developed notion of epistemic trust as facilitating social learning, in this paper we explore and clarify how interventions from Mentalization Based Treatment (MBT) for severe psychopathology such as Borderline Personality Disorder potentially generate this process in adults with this diagnosis. We suggest first that being mentalized may be a critical cue in social interactions to establish epistemic trust, the individual's willingness to consider new knowledge as trustworthy and relevant and therefore worth integrating into their lives, and second that epistemic mistrust may represent a final common pathway through which aversive relational experiences in the past may exert their influence on psychosocial treatments – both as a disposition of the patient and as a characteristic of the therapist-patient encounter. We argue that our developmental, interpersonal view on the stimulation of epistemic trust in the context of MBT creates a new perspective on the role of the therapeutic relationship, especially in the work with patients with personality disorders in whom the capacity to internalize new information through social learning is undermined by the absence of epistemic trust. By charting the interventions and building blocks of Mentalization-Based Therapy (MBT) from the initial assessment and formulation, through individual and group therapy sessions, to re-engaging with the wider social environment, this paper examines how each of these can potentially establish a “we-mode”, or an interpersonal experience associated with being mentalized. This, in turn, can unlock the barrier posed by epistemic vigilance. In addition, implications for relational mentalizing and rupture and repair within the therapeutic relationship are discussed in terms of fostering the patient’s sense of being recognized and better regulating affect.
| Type: | Article |
|---|---|
| Title: | The role of epistemic trust in mentalization-based treatment of borderline psychopathology |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1521/pedi.2023.37.5.633 |
| Publisher version: | https://doi.org/10.1521/pedi.2023.37.5.633 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Mentalizing, epistemic trust, epistemic stance, borderline personality disorder, attachment, we-mode, childhood adversity, mentalization-based treatment, MBT |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10172851 |
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