Epistemic trust among youth and young adults with severe mental health illnesses during their transition to adulthood: A qualitative study

Abstract

Epistemic trust (ET), the capacity to accept information from others as relevant, reliable, and personally meaningful, is key to therapeutic change. While ET's role in clinical populations has been investigated, little is known about how it develops or recovers in therapy, especially during adolescence, a period marked by major psychological and relational transitions. This qualitative study explored how ET is built, challenged, and restored within therapeutic relationships in an outreach team for youth with severe mental health illnesses. Twelve semi-structured interviews were conducted with participants aged 18–24 (50% female, Mage=20.92), all experiencing multiple complex psychiatric illnesses. Thematic analysis revealed five key themes: (1) therapist’s basic attitude, (2) therapist’s voice as a guide, (3) therapy as a safe space, (4) recognition as a unique person, and (5) rupture and repair. These findings highlight the role of therapeutic behaviors in fostering ET. Further longitudinal research is needed to understand how ET evolves and how it can be restored in patients who disengage from therapy.