The Role of Epistemic Trust in Mentalization-Based Treatment of Borderline Psychopathology

Abstract

Building on the notion of epistemic trust as facilitating social learning, in this article we clarify how interventions from mentalization-based treatment (MBT) for borderline personality disorder generate this process. We suggest first that being mentalized is a critical cue in interactions to establish epistemic trust and second that epistemic mistrust may represent a final common pathway through which aversive relational experiences in the past may exert their influence on treatments—both as a disposition of the patient and as a characteristic of the therapist-patient encounter. By charting MBT interventions from the initial assessment and formulation, through individual and group therapy sessions, to re-engaging with the wider social environment, we examine how each of these can establish a “we-mode,” an interpersonal experience associated with being mentalized that unlocks the barrier posed by epistemic vigilance. In addition, implications for relational mentalizing and rupture and repair within the therapeutic relationship are discussed.