I See You as Recognizing Me; Therefore, I Trust You: Operationalizing Epistemic Trust in Psychotherapy

Epistemic trust (ET) is one's ability to trust others and relies on the information they convey as being relevant and generalizable. This concept has received considerable theoretical and clinical attention, suggesting it is a promising factor in effective psychotherapy, possibly consisting of three elements: sharing, we-mode, and learning. However, for it to be used in clinical practice and research, it is imperative to (a) enhance our clinical understanding of how ET may manifest in the context of treatment and (b) understand how the process of change may occur in the course of treatment. The present study aims to identify patients' trait-like ET characteristics upon initiating treatment and explore the possible state-like changes in ET characteristics throughout treatment. Taking a discovery-oriented approach, we examined how therapists can identify a patient's level of ET at the beginning of treatment. We also examined how, within a treatment for individuals with poor pretreatment ET, the therapist and patient work interactively to bring about a positive change in ET. Identifying the process in which the therapist implements techniques in response to the patient's reactions may enable the active mechanism to be isolated and promote the first formulation of the way changes in ET occur in sequence. Clinical Impact Statement Question: Can epistemic trust be operationalized in psychotherapy as a construct with verifiable elements and components? Findings: Through a case study, we illustrate the operationalization of ET in psychotherapy and its clinical utility. Meaning: Operationalizing ET can provide clinicians with clear guidelines in evaluating patients' ET trait-like characteristics and choosing personalized interventions to achieve state-like changes accordingly. Next Steps: Building a measuring tool according to the operational model to further quantify individual differences in ET at treatment baseline and examine its role as a predictor of therapy outcome or change mechanism.