Epistemic Trust in Psychotherapy: The First Decade

About 

Psychotherapy, like many other uniquely human activities, depends on collaboration.  We are social creatures, defined by our remarkable capacity to collaborate and help each other, an ability that has enabled us not only to survive but also to thrive.  For the last decade we have been arguing that epistemic trust, the trust that allows us to engage in social learning, is vital to enable successful collaboration.  However, such trust cannot be taken for granted, and if our life experiences have instead left us with heightened epistemic mistrust we are vulnerable to isolation and suffering at an individual level and ill-equipped for the very considerable social, cultural, political and environmental challenges now facing us as a species. 
 

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This hybrid conference took place in March 2025

Speakers and Chairs

Liz Allison (University College London, UK)

Biography: Elizabeth Allison DPhil is the Director of the Psychoanalysis Unit in the Research Department of Clinical, Educational & Health Psychology at UCL. She is an Associate Professor and Programme Director of UCL’s MSc in Theoretical Psychoanalytic Studies. She is a psychoanalyst and Member of the British Psychoanalytical Society.  She is the Editor of the Psychoanalytic Controversies section of the International Journal  of Psychoanalysis.  She holds a doctorate in English Literature from the University of  Oxford.

Anthony Bateman (University College London, UK)

Biography: Prof Anthony W Bateman MA, FRCPsych is Consultant to the Anna Freud Centre, London; Visiting Professor University College, London; Honorary Professor in Psychotherapy University of Copenhagen.He developed mentalization based treatment for borderline personality disorder and  other mental health disorders, was an expert member of NICE development group for treatment guidelines for Borderline Personality Disorder in UK and was Chair of the National Guideline Development Group for Eating Disorders. He was President of the European Society for the Study of Personality Disorders (ESSPD) from 2012-2015.

He received a senior scientist award from British and Irish group for the Study of Personality Disorder (BIGSPD) in 2012; in 2015 the annual award for Achievement in the Field of Severe Personality Disorders from the BPDRC in the USA; and in 2023 received the John G Gunderson Distinguished Career Contribution Award from the International Society for Study of Personality Disorder (ISSPD).

He has authored 18 books and over 150 peer reviewed research articles on personality disorder and the use of psychotherapy in psychiatric practice.

Abstract: Antisocial personality in adulthood: engaging a distrusting mind in treatment and change

Treatment in the community of people with characteristics of antisocial personality (ASPD) - failure to conform to social norms with respect to lawful behaviours; irritability and aggressiveness; impulsiveness; disregard for the feelings and safety of others; and disregard for one’s safety and for the consequences of one’s behaviour - is problematic. Such clients do not expect professionals to treat them fairly and give help relevant to them. Equally, clinicians anticipate being treated unfairly or even threatened and made to feel useless, resulting in them failing to offer treatment. This is not a good recipe for effective treatment. Patients show a high drop-out rate from any treatment offered. Everyone distrusts everyone. 

Antisocial behaviour and violence tend to occur when an understanding of others’ mental states is developmentally compromised, most often from early trauma. Three interlinked domains underpin antisocial attitudes and behaviour - mentalizing problems, forms of attachment strategy activation, and pervasive epistemic mistrust. People with ASPD show high levels of distrust and are unable to learn from others. Clients show impaired recognition of basic emotions in themselves and others, compromised capacity to link mental states to behaviour, difficulty with perspective-taking problems and in reading others’ mental states. They perform far worse than controls on subtle tests of mentalizing.

In this session an outline will be given of the intervention process that results from this formulation. First and foremost is establishing a framework that reduces epistemic distrust in the relationship between the clinician and client. Second, it is important to generate a shared focus of relevance to both client and clinician. Third, power imbalances need to be minimised.  Finally, learning from others who are seen as similar needs to be given priority.
 

Dickon Bevington (Anna Freud, London, Cambridge and Peterborough Foundation Trust, Cambridge Children's Hospital, UK) and Liz Cracknell (Anna Freud, UK)

Biography: Dr Dickon Bevington is a child and Adolescent psychiatrist, previously an anthropologist and comparative religionist, with more than thirty years of frontline NHS experience in the UK. He is Mental Health Lead for the Cambridge Children's Hospital that is due to open in 2028, and Medical Director at Anna Freud. As one of the co-founders of AMBIT, a transdiagnostic and systemic application of mentalizing, he has published widely and teaches internationally. 

Biography: Liz Cracknell is Joint Programme Director for AMBIT at Anna Freud. As a Mental Health Nurse and Systemic Practitioner, Liz has specialised in work with young people with multiple needs in both outreach and secure settings, utilising the AMBIT approach. She has contributed to the development of AMBIT and a number of key publications and has delivered AMBIT consultation, training and supervision to hundreds of workers in a range of health, social care, education and justice contexts, in the UK and internationally.

Abstract: Epistemic Trust Injustices: where multiple needs intersect

Due to their experiences many clients, especially those with multiple needs, are adaptively predisposed toward stances of epistemic mistrust or epistemic credulity. AMBIT (adaptive mentalization-based integrative treatment) has focused on delivering effective help to the broad range of populations that all tend to be under-served by conventional service models (models often experienced as ‘hard to reach’ and even harder to trust.) We begin with a brief exploration of “multiple needs”; the intersectionality implicit in this phrase accounts for the many different kinds of types of help required in such situations that are so often poorly integrated with client experiences. Not only are transdiagnostic approaches required, but ones that focus at least as much energy on scaffolding and repairing the fragile or inaccurate mentalizing of workers in the field as on our efforts to elicit or support change in others.

We argue that Epistemic mistrust and credulity are principally caused by social injustice, and their presence in any system then generates further social injustice. ‘Helping services’ too commonly respond in ways that fail to acknowledge that social injustice, perversely compounding injustice with further injustices. These issues relate to direct work with clients, but they are present in AMBIT’s other foci, too: in teams, multi-agency networks, and the processes by which we learn at work. We conclude that workers and helping 
services have a moral duty to recognize and attend to the multiple social injustices associated with epistemic mistrust and credulity.
 

Gerry Byrne (University of Oxford, UK)

Biography: Gerry Byrne is a consultant child and adolescent psychoanalytic psychotherapist, and adult psychotherapist. He is a mentalization-based treatment (MBT) practitioner, supervisor, and tutor (adult, adolescent, parenting and family) for Anna Freud. He is the originator of Lighthouse Parenting, an approach rooted in psychoanalytic and attachment concepts, and aimed at reducing the risk of maltreatment in high-risk families. He was Head of Attachment and Perinatal Services in a NHS Trust and has worked with families in which severe child abuse has occurred for over 33 years. He is founder and director of a not-for-profit community interest company (SOLAS OXFORD) whose mission is to support health and social care professionals working with vulnerable, complex, risk laden clinical populations to enhance the quality and effectiveness of their therapeutic relationships, through bespoke training, supervision, adaptation of treatment programmes, and innovation. He is author of a picture book, All at Sea, published by Walker Books.

Abstract: “Tenderness and absolute trust and communication and truth matter more and
more…”  Iris Murdoch, from The Sea, The Sea
Exploring epistemic trust, empathic attunement* and attentive love** in work with high risk families.

The coercion of parents into engaging with our services (health and/or social care) presents both a serious challenge and a unique opportunity to the establishment of a collaborative therapeutic relationship between us and the parents. It is challenging because parents arrive with deep epistemic mistrust and fear of our services and in denial of the harm they have caused. At best, this is anxiety provoking for us as clinicians, as we fear for their children’s safety. Furthermore, we mistrust the parents when they seek to convince us that they are first of all blameless, and second of all, safe. Often, practitioner and parent are at an impasse. To quote one parent; ‘we (practitioner and parent) are in fixed positions, with no room to move.’

In this talk I will argue that a parent’s epistemic mistrust in their child’s communications, lies at the heart of their difficulties in seeing the child clearly, and therefore, in loving their child sincerely. I will speak to how the Lighthouse MBT-Parenting programme seeks to replace this reciprocal epistemic mistrust with hard-won requited epistemic trust between both parent and child, and parent and therapist.

Chloe Campbell (University College London, UK)

Biography: Dr Chloe Campbell is Deputy Director of the Psychoanalysis Unit, UCL. Her research interests include mentalizing, epistemic trust and attachment theory.  She supervises students on both the Psychoanalysis Unit's Doctoral Programme and teaches and supervises students on the MSc in Theoretical Psychoanalysis and the MSc in Psychological Sciences. She recently created and validated a new measure of epistemic trust, the Epistemic Trust, Mistrust and Credulity Scale. 

Abstract: Why epistemic? How the epistemic trust framework builds on existing models of developmental psychopathology

This talk will explore what we are talking about when we talk about epistemic trust, and how it differs from and aligns with other forms of trust:  interpersonal trust, trusting people’s faces, assessing potential political leaders, etc. I will begin by reviewing the latest findings from the revised Epistemic Trust, Mistrust and Credulity Scale. This overview of recent findings will then form the basis for thinking more theoretically about whether we can meaningfully apply epistemic trust to infancy and the early years of caregiving, to help us disentangle how epistemic trust, mentalizing and attachment processes might relate to one another in the young child’s growing sense of self and selfhood in relation to other minds. Can early childhood experiences of being mentalized be understood as constituting an experience of supporting epistemic agency that relates to but builds on and extends our understanding of early attachment relationships and what they can provide?

Peter Fonagy (University College London, UK)

Biography: Peter Fonagy (PhD, FMedSci, FBA, FAcSS, CBE) is Professor of Contemporary Psychoanalysis and Developmental Science and Head of the Division of Psychology and Language Sciences at UCL. His clinical and research interests centre on issues of early attachment relationships, social cognition, borderline personality disorder and violence. A major focus of his contribution has been an innovative research-based psychodynamic therapeutic approach, mentalization-based treatment, which was developed in collaboration with a number of clinical sites in the UK and USA. He has published over 700 scientific papers, 300 chapters, and authored or co-authored 23 books. 

Peter is a Fellow of the British Academy, the Academy of Medical Sciences, and the Academy of Social Sciences. He has received Lifetime Achievement Awards from the British Psychological Society, the International Society for the Study of Personality Disorder and in 2015 was the first UK recipient of the British Academy Wiley Prize for Outstanding Achievements in Psychology.

Abstract: Social trust and the epistemic crisis of the early 21st century

This presentation explores the concept of epistemic trust and its relevance in understanding the social and cultural challenges of the early 21st century. Social trust, a cornerstone of human collaboration, is deeply tied to our evolved ability to discern trustworthy information sources within our lived social context. We will examine profound evidence from international and historical comparisons that align with this assertion. However, this capacity is profoundly impacted by social environment, for example adverse childhood experiences, leaving individuals more vulnerable to misinformation.

We will examine the transformative effects of digital information dominance, particularly the internet and artificial intelligence, on human lives. These changes are reflected in shifts in the prevalence and nature of mental health issues among children and young people, alongside significant political consequences driven by the widespread use of social media as the primary news source especially for younger generations.

The presentation will argue for the utility of epistemic trust as an explanatory framework for understanding humanity’s biological vulnerability to digital information and the potentially catastrophic implications for civilisation if this vulnerability is exploited. Finally, we will propose actionable steps to ensure the influence of digital technology remains both limited and beneficial, fostering a culture that prioritises trust and collaboration in an increasingly complex information landscape.
 

George Gergely (Central European University - Private University, Austria)

Biography: György Gergely, Ph.D., D.Sc., is currently an Emeritus Professor at the Department of Cognitive Science at Central European University (CEU-PU) in Vienna and co-founder since 2008 of CEU’s Cognitive Developmental Center. He has completed his graduate studies in psychology at University College London (M. Phil., 1980) and Columbia University, New York, where he received 
his PhD at the Experimental Psycholinguistics doctoral programme in 1986). Later he has also completed a clinical graduate training programme at HIETE University, Budapest, and became a Qualified Clinical Child Psychologist in 1997. From 2007 he was an Academic Research Faculty Member at UCL/The Anna Freud Centre, he is a Honorary Full Member of the Hungarian Psychoanalytic Association since 2009, of the Hungarian Mentalization Society (MAME) since 2019, and he has been a member of the Academia Europaea since 2011. In his scientific work he aims to integrate his clinical interests in psychoanalytic theory, attachment theory, and 
mentalization-based psychotherapy with his research work in developmental cognitive science on self development, affect-regulation, and the development of mindreading and communication in infancy. He has published extensively in areas ranging from developmental science, cognitive neuroscience, cognitive and socio-emotional development, comparative psychology, mentalization and developmental psychopathology, and clinical disorders of the social mind. His research appeared in high-impact scientific journals (including Nature, Science, PNAS, Dev. Science, Psych. Science), his clinical papers were published in high-impact peer-reviewed journals (including Journal of Child Psychology and Psychiatry, International Journal of Psvcho-Analvsis, JAPA, Psychiatric Clinics of North America).

In 2002 he co-authored (with Peter Fonagy, Elliot Jurist, and Mary Target) a book on Affect-regulation, Mentalization, and the Development of the Self (first published by Other Press: New York) which since then has been translated into several languages, won the Gradiva Prize for best book on clinical theory in 2003 (NAAP, USA) and the Goethe Award for Psychoanalytic Scholarship in 2003. Professor Gergely’s scientific contributions have been acknowledged by several international awards (e.g., Guggenheim Fellowship, the IPA’s Biannual Award for Exceptional Contribution to Research, the Sylvia Brody Prize for Excellence in Psychoanalytic Developmental Research (NYPA), the APA’s Beach Comparative Psychology Award, or the prestigious 2011 Jean-Nicod Prize for leading philosophically-oriented cognitive scientists (CNRS-EHESS-ENS, Paris).

In 2007-2008 he was Resident Fellow at the Center for Advanced Studies in the Behavioral Sciences (CASBS), Stanford, USA, and in 2012 he was a SAGE Distinguished Fellow in Residence at the Sage Center for the Study of the Mind at UC Santa Barbara. His current research focuses on the evolved cognitive architecture of the ‘social mind’ and the core cognitive systems underlying social cooperation, ostensive communication and communicative mindreading in human infants. In his clinical research he has investigated dysfunctions of mind monitoring in Autism Spectrum Disorder and mentalization deficits in Borderline Personality Disorder. He has carried out his recent research work as Principal Investigator of the ERC’s Synergy Project Grant (SOMICS, #609819) on “Constructing Social Minds: Coordination, Communication, and Cultural Transmission”. 

Abstract: Mentalization, Communication and Epistemic Trust: Cognitive Developmental and Psychotherapeutic Approaches

During the last two decades we have witnessed significant transformations of the dynamically developing theory and clinical methodology of MBT. These changes reflect the interdisciplinary origins of this novel psychotherapeutic approach and its fruitful 
integration of recent advances in cognitive developmental science and evolutionary-based models of human social cognition. In my talk I shall highlight and compare some significant differences in how the functional organization and developmental role of the mechanisms of epistemic trust and epistemic vigilance are conceptualized in cognitive developmental theory in contrast to their clinical applications by MBT to model the dynamics of interventions and the mechanisms of therapeutic change. I’ll argue that the promising developments in the current theory and practice of MBT will be further enhanced and solidified by clarifying and making explicit the conceptual differences that result from applying the rich theoretical constructs of epistemic trust and epistemic vigilance to account for different psychological domains such as when modelling developmental psychopathology or the psychotherapeutic process and its mechanisms of therapeutic change.  

Vittorio Lingiardi (Sapienza University of Rome, Italy) and Marianna Liotti (Sapienza University of Rome, Italy)

Biography: Vittorio Lingiardi, PhD, is a psychiatrist, psychoanalyst, and Full Professor of Psychodynamic Psychology at Sapienza University of Rome. His research focuses on personality disorders, psychotherapy processes, defense mechanisms, therapeutic alliance, gender identity, and sexual orientation. He has authored numerous publications in international journals and books and, 
together with Nancy McWilliams, he serves as chief editor of the Psychodynamic Diagnostic Manual. In 2023, he was honored with the Sigourney Award.

Biography: Marianna Liotti, PhD, is a psychologist, psychotherapist, and post-doctoral researcher at the Department of Dynamic, Clinical, and Health Psychology at Sapienza University of Rome. Her academic work focuses on epistemic trust, mentalization, attachment, personality, and trauma. She has authored several publications in international journals and has been involved as a consultant in the development of the Psychodynamic Diagnostic Manual, Third Edition (PDM-3).

Abstract: Navigating Epistemic Trust in the Therapeutic Relationship: Instrument Validation and Research Insights

Authors: Marianna Liotti [1], Annalisa Tanzilli [1], Alice Fiorini Bincoletto [1], Vittorio Lingiardi [1]

Affiliations: [1] Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Italy

Epistemic trust (ET) - the capacity to perceive interpersonally transmitted knowledge as reliable, relevant for the self, and generalizable to other contexts— has emerged as one of the most promising constructs in contemporary efforts to understand psychopathology, as well as therapeutic processes and outcomes. Disruptions in ET, often rooted in early adverse relational experiences, can hinder effective psychotherapy by fostering resistance to new knowledge and limiting the depth and efficacy of the therapeutic alliance, thereby undermining the transformative potential of relational experiences.

This presentation introduces the development and validation of the Epistemic Trust in the Therapeutic Relationship Questionnaire (ETTR-Q), the first self-report instrument specifically designed to assess patients’ epistemic stance toward their therapist. The validation study involved 416 psychotherapy patients aged 18 to 65 years, all actively engaged in weekly sessions for at  least one month. Exploratory factor analysis (EFA) confirmed a clear three-factor structure, aligning with theoretical expectations. The instrument demonstrated high internal consistency (Cronbach’s alpha > .80 for all subscales). Convergent validity was supported through significant correlations with the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ), as well as with measures of reflective functioning, mentalized affectivity, attachment, personality, and retrospective assessment of early adversities. The ETTR-Q also exhibited strong associations with the quality of the therapeutic alliance, further underscoring its clinical relevance. By capturing  patients’ epistemic stance toward their therapist, the ETTR-Q enriches our theoretical understanding of ET and offers a valuable lens to both clinicians and researchers to understand how psychotherapy can transform patients’ epistemic positions. 

Patrick Luyten (University College London, UK, and KU Leuven, Belgium)

Biography: Patrick Luyten, PhD is Professor of Clinical Psychology at the Faculty of Psychology and Educational Sciences, University of Leuven (Belgium) and Professor of Psychodynamic Psychology at the Research Department of Clinical, Educational, and Health Psychology, University College London (UK).  Dr Luyten’s research is fundamentally translational, as he is interested in translating knowledge concerning the mechanisms involved in the causation of psychopathology to the development of new interventions, the evaluation of their (cost)-effectiveness, and their dissemination to and implementation in routine clinical care. 

Tobias Nolte (University College London, UK)

Biography: Tobias Nolte, MD, physician and psychoanalyst, is a clinical research fellow at University College London and senior researcher at Anna Freud. He works as a psychoanalyst in private practice and co-leads the MBT stream at the Halliwick Unit, St Ann's Hospital. He is a supervisor in mentalization-based therapy. His research interests include: Neuroimaging of mentalizing processes, personality disorder research and treatment, epistemic trust and early mother-child interactions. He co-directs a research and training program that applies mentalization-based principles in educational settings.

Abstract: Research on Epistemic Trust in Clinical Areas: Lessons Learnt and Future Directions

In this talk I will summarize the various strands of research related to epistemic trust in clinical populations. More specifically, I will outline emerging associations between psychopathology and childhood maltreatment both in populations with mild to moderate levels of distress as well as in high-risk samples. My focus will be on a couple of unpublished large datasets that allow for the disentangling of the impact of relational and intentional (vs. non-relational) trauma as well as age at traumatization, trauma type and trauma accumulation on epistemic disruption.

In the second part, I will introduce some first findings on patients’ epistemic stance and their expectations and experience of psychosocial interventions.

I will conclude with some key research desiderata that can shape future research in order to further advance clinical applications of interpersonal process around social learning.

Svenja Taubner (University of Heidelberg, Germany)

Biography: Svenja Taubner is a clinical psychologist/ psychoanalyst who serves as full professor and director at the Institute for Psychosocial Prevention and Psychotherapy at the University of Heidelberg in Germany. She studied Psychology in Bremen, held scientific positions at the Universities Bremen, Ulm, Kassel, Berlin (all in Germany) before she was appointed full professor at the University of Klagenfurt, Austria. Among her many interests are clinical applications, development and research on mentalization based treatments, transgenerational transmission of trauma and the psychological understanding and treatment of aggression. She is president of the MBT-D-A-CH (MBT association in German-speaking countries) and member of the national German Scientific Psychotherapy Chamber. 

Abstract: “Nobody trusts me" - changes in epistemic trust in adolescents with Conduct Disorder

Epistemic trust leads to the attitude that learning from others is in our best interest. However, adolescents with conduct disorder (CD) – for several reasons – have low trust in the interpersonal exchange of knowledge. On the one hand, they perceive others often as untrustworthy and on the other hand expect not to be trusted (Talia et al., 2021). Thus, aggressive behavior that is typical in CD, can be interpreted as adaptive strategy to influence or force other that would not listen otherwise. This may explain the low trust in the word that is often exhibited by adolescents with CD. Furthermore, the decreased fear to lose one’ s reputation by using violence may be connected this assumption to be overheard. The talk will connect mentalization and aggression theory with epistemic trust to explain the low engagement of this group of patients in psychosocial interventions such as psychotherapy. A new approach for the treatment of adolescent CD based on mentalization-based therapy is presented. Using data from a pilot study changes in epistemic trust and their connection to changes in aggressive behavior will be demonstrated in selected cases. 

Early Career Researchers

Chrissy Engelen (University College London, UK, and KU Leuven, Belgium)

Biography: Chrissy Engelen is a PhD candidate and teaching assistant at KU Leuven’s Faculty of Psychology and Educational Sciences in Belgium. She is part of the clinical psychology research unit, where her work centers on mentalizing and epistemic trust, particularly their roles in the development of children and adolescents at risk. Additionally, Chrissy is a clinical psychologist at PraxisP, KU Leuven’s practice center for psychology and educational sciences, where she works with both the Psychodynamic Children and Youth team and the Psychodynamic Adult Psychotherapy team. Her clinical focus is on supporting young people transitioning into adulthood.

Abstract: What it is like to be young: the role of epistemic trust in the online behavior of vulnerable adolescents

Our world is changing rapidly, with evolving technology providing access to a wealth of information and potential connections with millions of people around the world. The average age of smartphone ownership is decreasing; a recent Belgian study found that children now receive their first smartphone on average when they are 8.4 years. As a result, young people are increasingly  exposed from an early age to information on the internet and social media. To navigate this complex and relatively unfiltered landscape, they need a balance between epistemic trust and vigilance to determine which information is trustworthy.

Young people growing up in so-called ‘risky environments’ are likely to develop a more problematic epistemic stance towards social information, marked by a combination of both epistemic mistrust and credulity. This may lead to all kinds of risky online behaviors, such as sexting and cyber-victimization, and equally problematic behaviors offline, such as a tendency to engage in abusive relationships. These patterns may increase vulnerability to psychological disorders related to impairments in social relationships, particularly emerging personality disorder.

Despite these concerns, little research has examined the relationship between trauma, SES, epistemic trust, and online behavior in adolescents at risk for personality disorder. Here, we report findings from a large online study in Belgium among adolescents aged 16-24 years, focusing on the role of impairments in young people’s epistemic stance in the relation between social media use and emerging personality disorder features.

Shimrit Fisher (University of Haifa, and the Ruppin Academic Centre, Israel)

Biography: Shimrit Fisher is a licensed clinical psychologist and psychotherapy researcher. She has just completed her PhD in Clinical Psychology at the University of Haifa. Her research focuses on psychotherapy processes, specializing in epistemic trust. She led the development and validation of an observer-based coding system to measure epistemic trust in psychotherapy, a work she presented at numerous international conferences, such as the Society for Psychotherapy Research (SPR) and the European Society for the Study of Personality Disorders (ESSPD). Beyond her research, she is a teaching fellow at several academic institutions, where she teaches methodological and clinical courses and supervises clinical psychology students. In addition, she maintains a private clinical practice, working with patients struggling with personality disorders, self-harm and suicidality, depression, and anxiety in children, adolescents, and adults.

Abstract: Hocus Focus: A Multi-Lens Perspective of Epistemic Trust in Psychotherapy

Epistemic trust in psychotherapy has gained significant attention, underscoring its central role in effective therapy. Despite its clinical importance, our understanding remains incomplete and limited regarding whether ET is an intrinsic patient characteristic or a catalyst for therapeutic change. This raises important questions: Is ET a stable characteristic that manifests across various relationships, including the therapeutic one? Does it reflect the therapist’s contribution, or does it develop uniquely within the therapeutic relationship? This study addresses these questions using a multi-lens, panoramic approach that applies three perspectives to examine ET’s constituents in therapy and its related effects. The first perspective provides a between-subject "snapshot" of ET at the outset of therapy. The second investigates how the patient’s early ET levels predict subsequent changes in the therapeutic process. The third focuses on within-patient changes in ET throughout therapy, highlighting the evolving dynamics of the patient-therapist relationship. We utilized data from a randomized controlled trial (RCT) of psychodynamic psychotherapy for depression to investigate ET using the newly developed Epistemic Trust Rating System (ETRS). Statistical analyses explore both between-patient variability and within-patient changes in ET, distinguishing its trait-like and state-like components. By employing these three distinct lenses, the study not only highlights the importance of the patient’s openness to learning from the therapist and the therapeutic relationship but also extends this perspective by exploring what therapists can learn about their patients. This approach offers valuable insights into the clinical landscape reflected by the patient across different phases of treatment.

Beril Kumpasoğlu (University College London, UK)

Biography: Güler Beril Kumpasoğlu is a clinical psychologist and a dual PhD student, studying Psychoanalytic Studies at University College London (UCL) and Clinical Psychology at Ankara University. She holds a BSc and an MSc in Clinical Psychology from Middle East Technical University (METU) in Turkey. Her research at UCL investigates the role of epistemic trust in the treatment and understanding of common mental health disorders. Concurrently, at Ankara University, her work focuses on the influence of epistemic trust on the relational aspects of psychopathology. Her academic interests extend to transdiagnostic factors in psychopathology, social cognition and the cultural dimensions of psychotherapy.

Abstract: Exploring Epistemic Trust in the Treatment of Common Mental Health Disorders

Enhancing mentalizing capacities and cultivating epistemic trust are suggested as crucial elements of effective psychotherapy, facilitating patients' engagement in transformative social learning processes. While state-like changes in epistemic trust and mentalizing within psychotherapy are linked to treatment effectiveness, these traits' enduring characteristics may also be crucial for a patient's ability to benefit from therapy. This presentation will discuss an empirical study examining the impact of baseline mentalizing abilities and epistemic characteristics on treatment outcomes among adults receiving psychotherapy for common mental health disorders within the NHS Talking Therapies framework. Conducted in a naturalistic setting, this study mirrors standard clinical practices, thereby providing results that may better reflect real-world therapeutic outcomes. It investigates how initial levels of mentalizing, and epistemic trust affect the therapeutic process and evaluates their potential as predictors of clinical improvement. The findings will be discussed in the context of the study's methodological limitations, providing insights that could guide future research. Additionally, practical implications for enhancing therapeutic strategies within clinical settings will be explored, aiming to optimize treatment effectiveness by integrating our understanding of these psychological constructs into clinical practice.

Yagizcan Kurt (Anna Freud, UK, and University College London, UK)

Biography: Yagizcan is a clinical psychologist and PhD student in the Research Department of Clinical, Educational, and Health Psychology at UCL. As a psychodynamic therapist, he works with adults facing a wide range of mental health challenges. His research primarily explores personality pathology through the lens of developmental psychopathology, employing a multi-method approach that includes meta-analyses, experimental psychopathology tasks, and self-report studies. Yagizcan’s main research interests centre on attachment, mentalizing, and epistemic trust, examining how adverse childhood experiences influence these factors and contribute to personality pathology, particularly borderline personality features.

Abstract: Understanding Interpersonal Mistrust in Borderline Personality Disorder

Despite the long-standing recognition of interpersonal trust as a critical issue in individuals with borderline personality disorder (BPD), systematic empirical evidence linking interpersonal mistrust and BPD remains limited. Several theoretical approaches—including cognitive theory, mentalizing theory, schema theory, object relations theory, and attachment theory—highlight interpersonal mistrust as a key factor explaining the interpersonal relationship problems in these individuals. Clinical wisdom also underscores that interpersonal mistrust is central to BPD. While empirical studies support these theoretical assertions, conflicting findings in the literature regarding the role of interpersonal mistrust in BPD persist. As part of this panel, I will present the findings of two separate meta-analyses investigating the association between interpersonal mistrust and BPD. We will explore the similarities and differences between interpersonal mistrust and epistemic mistrust and discuss the gaps and practical implications of these meta-analytic findings for both research and clinical practice.

Elizabeth Li (Anna Freud, UK, and University College London, UK)

Biography: Dr Elizabeth Li completed her PhD in Developmental Psychopathology and Psychotherapy at UCL and the Anna Freud Centre, further enriching her expertise through an exchange scholar program at Yale University. Her research interest centres around the interplay of early adversity, psychological mechanisms, mental disorders, and the process and outcomes of psychotherapy. Elizabeth currently serves as Module Lead or Co-Lead for four psychology and mental health modules at UCL, a Senior Course Tutor and Research tutor at UCL/Anna Freud postgraduate studies, and Associate Lecturer at Birkbeck, University of London. She is also a Project Manager at Anna Freud. Elizabeth has received awards, research grants, and funding from the Society for the Advancement of Psychotherapy (APA Division 29), the British Association for Counselling and Psychotherapy (BACP), the International Psychoanalytical Association (IPA), and multiple British charity trusts. To date, Elizabeth has published 10 papers on topics related to early adversity, psychological mechanisms, mental disorders, and psychotherapy in journals such as Child Abuse & Neglect, Psychotherapy Research, Journal of Counseling Psychology, and Frontiers in Psychiatry.

For more information, please see https://profiles.ucl.ac.uk/74270-elizabeth-li 

Abstract: A Theory-Building Case Study of Resolving Epistemic Mistrust and Developing Epistemic Trust in Psychotherapy with Depressed Adolescents

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. A total of 66 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 facilitate 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.

Keywords: psychotherapy, epistemic trust, adolescent depression, theory-building case study, therapist responsiveness

Karen Yirmiya (Anna Freud, UK, and University College London, UK)

Biography: Dr Yirmiya is a postdoctoral researcher at the Clinical, Educational and Health Psychology at University College London and the Anna Freud. She received her Ph.D. from Bar-Ilan University, Israel, in 2022. Her doctoral research investigated the role of caregiving, microbiome, and stress- and affiliation-related in mental health problems among adolescents who have experienced chronic war-related trauma. Currently, she takes a central role in two therapeutic intervention randomized clinical trials. One focuses on attachment-based intervention to improve perinatal mental health and enhance the quality of the parent-infant relationship, while the other explores mentalization-based intervention in a cohort of adult male offenders. Her work employs a longitudinal, multi-disciplinary approach, combining biomarkers and psychological measurements to gain a deeper understanding of the risk and resilience trajectories of developing psychopathologies. As a clinical psychologist, Dr Yirmiya specializes in infancy and early childhood therapy.

Abstract: Trust in AI as a therapeutic partner: General and epistemic considerations

Epistemic trust, the confidence in the authenticity, relevance, and reliability of information conveyed by another, is essential for fostering therapeutic change. While general trust in AI has been increasingly studied, the role of trust in AI-based therapeutic tools is only beginning to emerge as an area of interest. In my talk, I will present both theoretical and applied studies on the potential and limitations of AI as a therapeutic partner, focusing on its ability to facilitate epistemic trust within the framework of mentalization-based treatment. Studies examining individuals’ willingness to trust and assimilate knowledge from AI in relational contexts will be presented, along with the role of user characteristics, system features, and contextual factors in building such trust. How, and to what extent, AI-based interventions might foster epistemic trust to enable meaningful therapeutic change will be discussed, with a focus on simulating relational engagement and ensuring responsible human professional involvement. Although AI is often described as an “epistemic technology”, capable of manipulating and delivering knowledge, it lacks critical human qualities such as understanding, goodwill, genuine affective engagement, volition, and moral agency. Consequently, AI cannot foster traditional human trust, which relies on value-based dispositions, but may instead cultivate “virtual trust” or “quasi-trust,” emphasizing reliability over emotional or moral dimensions. Based on the current knowledge, the implications of using AI in psychotherapy will be explored, addressing critical challenges and identifying promising opportunities. By integrating insights from mentalization theory and trust research, this talk will propose a roadmap for advancing human-AI collaboration in mental health settings.

Image credit: Griffith University, Public domain, via Wikimedia Commons