The relationship between attachment, mentalization and epistemic trust: a systematic review

Introduction. Epistemic trust can be defined as the ability to rely on social and cultural information from others, enabling to integrate the new knowledge in the vision of self and world and thus promoting the learning from experience (Csibra & Gergely, 2006; Fonagy & Allison, 2014). Recently, the issue of epistemic trust is gaining growing interest in literature thanks to the recognition of the significant implications that it may have for treatment effectiveness but not only, as evidenced by the extension of its field of research and application to different contexts. However, this makes it increasingly difficult to identify a unique relational dynamic between epistemic trust, attachment and mentalization. In addition, this issue is still predominantly addressed on the theoretical level, while empirical studies are scarce, and this allows each researcher to make a different hypothesis. Therefore, the current systematic review aimed at exploring the role of epistemic trust in the relationship between attachment and mentalization, also looking at factors able to affect this link. Methods. This systematic review followed the PRISMA 2020 guidelines (Page et al., 2021). The keywords, searched on three databases, were the following: “mentalization”, “attachment” and “epistemic trust” and their dimensions and dysfunctions. Papers were included if they explicitly focused on the relationship between attachment, mentalization and epistemic trust, and if they were research articles. Studies were excluded if they addressed only one or two of the three constructs, and if they were theoretical articles, opinion articles, commentary, book chapters or interviews. Results. Results showed first of all that the main context of investigation of this relationship is the therapeutic one, with a focus on the treatment of two psychopathological conditions, namely borderline personality disorder and chronic depression, respectively handled with two therapeutic models, specifically Mentalization-Based Treatment (MBT) and Dynamic Interpersonal Therapy (DIT). Secondly, results predominantly revealed a relationship of interdependence between these variables (80%), that is the attachment experience influences the development of the mentalizing abilities, which in turn promote the emergence of epistemic trust, in line with what expressed by Milesi et al. (2023). However, from studies that empirically investigated this topic (20%) an interesting, contrasting datum emerged: there seems to be a relationship of interdependence only between mentalization and epistemic mistrust or credulity, but not between mentalization and epistemic trust (Campbell et al., 2021). Conclusion. These findings highlight the need to empirically deepen the link between these three variables and suggest therapists to pay attention not only to the creation of a secure therapeutic relationship and the improvement of mentalizing abilities, but also to clients’ epistemic trust, especially to its disrupted forms, which are able to hinder their ability to integrate the new information shared by therapist, thus compromising their ability to change and consequently treatment effectiveness.