Li, Elizabeth T.; (2024) Epistemic trust and mistrust in psychology, psychopathology, and psychotherapy. Doctoral thesis (Ph.D), UCL (University College London).

Text UCL Thesis Deposit_PhD Thesis Finalised_Elizabeth T. Li.pdf - Submitted Version Access restricted to UCL open access staff until 1 February 2025. Download (3MB)

Abstract

Background and aim: The epistemic trust model of developmental psychopathology has been an innovative theoretical development that is largely rooted in developmental experimental research on how infants learn. Yet, there is still a paucity of empirical research concerning the application of this approach to the study of psychopathology and psychotherapy. This thesis therefore examined the role of epistemic trust in young people with borderline personality features and psychotherapy for adolescent depression using a multi-method approach in four studies. / Methodology: (1) A narrative review identified, critically appraised, and synthesised existing empirical studies on epistemic trust and vigilance. (2) An experimental study investigated whether disruptions of epistemic trust in young adults were related to borderline personality features. (3) A qualitative study was conducted to develop a typology of depressed adolescents’ experiences in relation to issues of epistemic trust and mistrust through the course of psychotherapy. (4) A qualitative study developed a synthesised rational-empirical model of the resolution of epistemic mistrust and the growth of epistemic trust in psychotherapy for depressed adolescents. / Results: (1) Three bodies of research were identified in the empirical literature: experimental studies on children’s selective trust, experimental studies on epistemic trust in non-clinical adults, and mental health studies following Fonagy and colleagues’ framework of epistemic trust. (2) It was found that borderline features were associated with epistemic mistrust in young adults. (3) A shift from epistemic mistrust to epistemic trust was associated with good psychotherapy outcomes in depressed adolescents. (4) It was found that therapists and patients must work collaboratively to first reach what can be seen as an “epistemic match”, which fosters (relational) mentalizing, and finally reactivates social learning outside therapy to restore epistemic trust. In addition, the importance of a window of opportunity at the early stage of treatment, the interactive nature of the move towards a resolution of epistemic mistrust, and the role of positive extra-therapeutic factors in resolving epistemic mistrust were highlighted by the findings. / Conclusion: Overall, the studies reported in this PhD thesis provide preliminary evidence for an association between epistemic mistrust, BPD and depressive features, as well as the potential role of resolutions of epistemic mistrust in psychotherapy. However, these explorations should be seen as only the start of further empirical work on the theory of epistemic trust in the mental health field.

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