Epistemic trust and therapeutic alliance

This continuing medical education (CME) article centres on the concept of epistemic trust. It describes a presumably enduring but not fixed, developmental achievement of having basic trust in a person as a secure source of information that is rooted in early secure relationship experiences. The concept of epistemic trust is therefore also seen as the central characteristic for relational work and change processes in mentalization-based therapy but is also applied in other therapeutic approaches. The developmental, interpersonal view of (re)establishing epistemic trust in the context of psychotherapy opens up a new perspective on the role of the therapeutic relationship, especially for therapeutic work with patients with structural-related difficulties, such as personality disorders. It will be shown how the ability to allow and internalise new information (and thus also new relationship offers) through social learning is undermined by mostly trauma-related epistemic disruption. This is followed by a discussion of the main features of a cross-school therapeutic stance that is helpful in meeting these therapeutic challenges. In addition, the most important empirical findings on epistemic trust are summarized.