Epistemic trust and therapeutic alliance in patient-therapist dyads. How trust affects psychotherapy

Introduction: Epistemic trust is a concept of increasing relevance to psychotherapy theory and research, defined as the individual’s ability to regard interpersonally transmitted knowledge as trustworthy, relevant, and socially generalizable. Being a fundamental capacity that enables social learning and allows individuals to benefit from their social environment, epistemic trust it is at the root of change processes. The literature suggests that many types of psychopathology might be characterized by a disruption of epistemic trust and by a permanent state of epistemic hypervigilance. In this perspective, the patient’s experience of the therapist, and the therapist’s ability to promote a growing sense of trust, seem to be vital for the therapeutic relationship. Research objectives: This preliminary study aims to assess levels of epistemic trust, mistrust, and credulity in a clinical group of adults and to estimate their association with the therapeutic alliance. Other variables such as attachment, reflective functioning, transference and countertransference will be measured to evaluate their relationships with both epistemic trust and therapeutic alliance. Method: Between 40 and 60 patient-therapist dyads will made up the sample. Psychotherapists will be of different theoretical orientations and background. All patients should be at least 18 years old, and both patient and psychotherapist should complete the survey between the third and the fifth session. Data will be collected through two online surveys, one for the patient and one for the therapist. A variety of questionnaires will be used to assess the variables taken into exam and to collect data about socio-demographic characteristics, patients’ diagnoses, and additional information about the patient, the therapist and the therapeutic process. Expected results: It is expected that higher levels of epistemic trust will predict a stronger therapeutic alliance as evaluated by both patients and therapists, while higher scores with respect to epistemic mistrust and credulity will be related to a lower quality of the therapeutic alliance, and of transference and countertransference processes. We will also investigate the relationship between trust, mistrust, credulity and the other variables assessed in the study. The results could provide material of great importance for future studies on the therapeutic process and for the planning of effective interventions.