Li, Elizabeth;
Midgley, Nick;
Campbell, Chloe;
Luyten, Patrick;
Li, Tianyu;
(2025)
A theory-building case study of resolving epistemic mistrust and developing epistemic trust in psychotherapy with depressed adolescents.
Psychotherapy Research
10.1080/10503307.2025.2473927.
(In press).
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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.
| Type: | Article |
|---|---|
| Title: | A theory-building case study of resolving epistemic mistrust and developing epistemic trust in psychotherapy with depressed adolescents |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1080/10503307.2025.2473927 |
| Publisher version: | https://doi.org/10.1080/10503307.2025.2473927 |
| Language: | English |
| Additional information: | © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. |
| Keywords: | psychotherapy process; epistemic openness; adolescent depression; therapeutic relationship; therapist responsiveness |
| 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/10205647 |
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