Epistemic Trust as a Psycho-marker for Outcome in Psychosocial Interventions

Although there is increased therapeutic optimism surrounding the treatability of personality disorders, a significant subgroup of patients seems not to benefit sufficiently from treatment. Not completing treatment especially has been associated with poor outcomes, high societal costs and reduced cost-effectiveness of therapy. (B)PD patients therefore are at risk for engaging in different subsequent treatment services, but only benefitting limitedly from these. From a personalized medicine-oriented perspective, one of the most important issues may be to identify prior to treatment which patients may or may not benefit from specialized treatment and why this is the case. If we would have a marker to identify patients at risk for not completing treatment or benefitting only marginally from treatment, this could inform our decision to assign them to highly specialized treatments that may consider the impairments underlying this risk from the start. This paper explores the potential value of the recently introduced concept of epistemic trust as a potential 'psycho-marker' to differentiate between patients who may or may not benefit from different types of treatment. We argue that epistemic trust may be a final common pathway through which aversive relational experiences in the past may exert their influence on the efficacy of a specific treatment. Epistemic trust may be a proximal and measurable factor of this final common pathway, assessable both as a disposition of the patient and as a characteristic of the therapist-patient encounter and therefore a suited candidate to predict (lack of) benefits from (specific) treatment approaches.