Fisher Shimrit, Fonagy Peter, Zilcha-Mano Sigal
Department of Psychology, University of Haifa, Haifa, Israel.
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Psychopathology. 2025;58(2):80-93. doi: 10.1159/000541667. Epub 2024 Oct 28.
Epistemic trust (ET), the authenticity and personal relevance we assign to interpersonally transmitted knowledge, is considered an essential component of any effective therapy. Despite its clinical significance, comprehensive empirical support is still lacking regarding whether ET is an inherent characteristic of the patient or acts as a catalyst for therapeutic change. Consequently, unlike other critical components, a clear distinction between its aspects - the patient's attributes, the therapist's contribution, and their unique therapeutic relationship - remains elusive, leaving our understanding incomplete. The current study examines the constituents of ET in therapy and its related effects through three distinct lenses: a blended snapshot lens, a prognostic lens, and a lens focusing on state-like changes. The constituents of ET were measured as follows: patient attributes were measured using attachment orientation and interpersonal functioning scales; therapist contribution was evaluated through scales assessing the therapist's use of techniques; and the patient-therapist therapeutic relationship was gauged using the working alliance scale.
We collected and analyzed data from 116 patients who participated in manualized psychodynamic psychotherapy sessions to investigate the trait-like and state-like components of ET.
The results offer a comprehensive panoramic view with small to medium, but meaningful, correlations between ET and patients' attributes (ranging from 0.18 to -0.26); therapists' contributions (ranging between 0.15 and 0.28); and the patient-therapist therapeutic relationship (ranging between 0.17 and 0.23).
While some findings were consistent with our expectations, others were contrary, highlighting the necessity of considering the variations between and within patients as they have distinct theoretical, clinical, and empirical implications. Employing these three distinct lenses helps therapists gain a better understanding of the clinical picture reflected by the patient over different treatment periods. This broad perspective is of prognostic importance and encourages clinicians to adjust the treatment focus to meet the evolving needs of their patients.
Epistemic trust (ET), the authenticity and personal relevance we assign to interpersonally transmitted knowledge, is considered an essential component of any effective therapy. Despite its clinical significance, comprehensive empirical support is still lacking regarding whether ET is an inherent characteristic of the patient or acts as a catalyst for therapeutic change. Consequently, unlike other critical components, a clear distinction between its aspects - the patient's attributes, the therapist's contribution, and their unique therapeutic relationship - remains elusive, leaving our understanding incomplete. The current study examines the constituents of ET in therapy and its related effects through three distinct lenses: a blended snapshot lens, a prognostic lens, and a lens focusing on state-like changes. The constituents of ET were measured as follows: patient attributes were measured using attachment orientation and interpersonal functioning scales; therapist contribution was evaluated through scales assessing the therapist's use of techniques; and the patient-therapist therapeutic relationship was gauged using the working alliance scale.
We collected and analyzed data from 116 patients who participated in manualized psychodynamic psychotherapy sessions to investigate the trait-like and state-like components of ET.
The results offer a comprehensive panoramic view with small to medium, but meaningful, correlations between ET and patients' attributes (ranging from 0.18 to -0.26); therapists' contributions (ranging between 0.15 and 0.28); and the patient-therapist therapeutic relationship (ranging between 0.17 and 0.23).
While some findings were consistent with our expectations, others were contrary, highlighting the necessity of considering the variations between and within patients as they have distinct theoretical, clinical, and empirical implications. Employing these three distinct lenses helps therapists gain a better understanding of the clinical picture reflected by the patient over different treatment periods. This broad perspective is of prognostic importance and encourages clinicians to adjust the treatment focus to meet the evolving needs of their patients.
认知信任（ET），即我们赋予人际传播知识的真实性和个人相关性，被认为是任何有效治疗的重要组成部分。尽管其具有临床意义，但关于ET是患者的固有特征还是治疗变化的催化剂，仍缺乏全面的实证支持。因此，与其他关键组成部分不同，其各个方面——患者的属性、治疗师的贡献以及他们独特的治疗关系——之间的明确区分仍然难以捉摸，这使得我们的理解并不完整。本研究通过三个不同的视角审视治疗中ET的构成要素及其相关影响：混合快照视角、预后视角以及关注类似状态变化的视角。ET的构成要素测量如下：使用依恋取向和人际功能量表测量患者属性；通过评估治疗师技术使用情况的量表评估治疗师的贡献；使用工作联盟量表衡量患者与治疗师的治疗关系。
我们收集并分析了116名参加标准化心理动力心理治疗疗程的患者的数据，以研究ET的特质性和状态性成分。
结果提供了一个全面的全景图，ET与患者属性（范围从0.18至 -0.26）、治疗师的贡献（范围在0.15至0.28之间）以及患者 - 治疗师治疗关系（范围在0.17至0.23之间）之间存在小到中等但有意义的相关性。
虽然一些发现与我们的预期一致，但其他发现则相反，这凸显了考虑患者之间和患者内部差异的必要性，因为这些差异具有不同的理论、临床和实证意义。运用这三个不同的视角有助于治疗师更好地理解患者在不同治疗阶段所反映的临床情况。这种广阔的视角具有预后重要性，并鼓励临床医生调整治疗重点以满足患者不断变化的需求。
认知信任（ET），即我们赋予人际传播知识的真实性和个人相关性，被认为是任何有效治疗的重要组成部分。尽管其具有临床意义，但关于ET是患者的固有特征还是治疗变化的催化剂，仍缺乏全面的实证支持。因此，与其他关键组成部分不同，其各个方面——患者的属性、治疗师的贡献以及他们独特的治疗关系——之间的明确区分仍然难以捉摸，这使得我们的理解并不完整。本研究通过三个不同的视角审视治疗中ET的构成要素及其相关影响：混合快照视角、预后视角以及关注类似状态变化的视角。ET的构成要素测量如下：使用依恋取向和人际功能量表测量患者属性；通过评估治疗师技术使用情况的量表评估治疗师的贡献；使用工作联盟量表衡量患者与治疗师的治疗关系。
我们收集并分析了116名参加标准化心理动力心理治疗疗程的患者的数据，以研究ET的特质性和状态性成分。
结果提供了一个全面的全景图，ET与患者属性（范围从0.18至 -0.26）、治疗师的贡献（范围在0.15至0.28之间）以及患者 - 治疗师治疗关系（范围在0.17至0.23之间）之间存在小到中等但有意义的相关性。
虽然一些发现与我们的预期一致，但其他发现则相反，这凸显了考虑患者之间和患者内部差异的必要性，因为这些差异具有不同的理论、临床和实证意义。运用这三个不同的视角有助于治疗师更好地理解患者在不同治疗阶段所反映的临床情况。这种广阔的视角具有预后重要性，并鼓励临床医生调整治疗重点以满足患者不断变化的需求。
