On the notion of trust in psychotherapy - epistemic and evaluative aspects

Objectives: One of the most consistent findings in the psychotherapy research literature is that the quality of the relationship between the patient and the therapist is a major determinant of psychotherapeutic effectiveness. Yet so far a consistent and assured definition of a helping alliance doesn't exist. Recently P. Fonagy and his research group have introduced the notion of "epistemic trust" to open up a new understanding of the effectiveness of the therapeutic relationship. Methods: The paper outlines Fonagy's et al. notion of "epistemic trust" and compares it to notions of trust devised in the humanities and social sciences from a clinical-psycho dynamic perspective. Results: Fonagy et al. characterize epistemic trust as "trust in the authenticity and personal relevance of interpersonally transmitted information". Thus it enables an individual to safely learn from others and to orient himself within a primarily unknown and an ever changing social world. By contrast the humanities and social sciences offer a more comprehensive perspective insofar as trust is described as both an affective, cognitive and volitive phenomenon embedded within a specific ethical topography (evaluative trust). Conclusions: Taking trust's multidimensionality into account results in a slightly different clinical understanding of confidence building within psychotherapy and postulates a primacy of recognition over cognition in clinical encounter as well.