Epistemic Trust and Mentalizing in Adolescent Therapeutic Alliances

This thesis explores the role of epistemic trust in adolescent therapeutic alliances. The literature review in Chapter 1 draws together research in these areas with related concepts of attachment, mentalizing and social network engagement. This encompassing framework is used to understand presentations characterised by difficulties in these domains, including borderline personality disorder and psychopathy. Hypotheses are formed regarding reasons for difficulty engaging in a therapeutic alliance and avenues for future research are outlined. The empirical study in Chapter 2 carries forward some of these hypotheses to test, using a novel approach to understand therapeutic alliance judgments in adolescents currenting engaging in therapy. These judgments are studied in relation to epistemic trust and mentalizing and contrasted with clinician ratings of the alliance. This is considered in the context of broader patterns of structural and functional social network support. The scope and analysis of the study was revised following data-collection restrictions due to the COVID-19 lockdown. Hence, the empirical paper offers only preliminary evidence of associations between broad study concepts. Most notably epistemic trust related to client presumed clinician alliance judgments, suggesting that some clients may not view clinicians as trustworthy. The findings require greater exploration and replication in larger samples. The critical reflection in Chapter 3 explores some of the future research potential, as well as challenges encountered in the research process. Space is given to consideration of the importance of engagement and cultivating trust in the current global context and with future service development in mind