Fonagy and his colleagues have recently proposed that deficits in epistemic trust are a centerpiece of severe personality disorder and that therapists’ efforts to build epistemic trust are central to the psychotherapeutic process. Their model builds on solid developmental research but lacks clarity and precision in delineating the process of building trust. This is a unidirectional process whereby the therapist provides "ostensive cues that enable the patient to temporarily suspend hypervigi-lance or epistemic mistrust. A bidirectional model that takes into account the patient’s ostensive cues or tests of the therapist would provide greater precision, clinical rigor, and empirical validity to the model.
Keywords: Psychotherapy process; Personality disorder; Epistemic trust; Control-Mastery Theory; Patients’ tests of the therapist