‘The one place where I can come and not get in trouble’: emotional safety and epistemic trust in brief psychosocial Intervention for adolescent depression

Epistemic trust – trust in interpersonally communicated knowledge – has recently gained attention in psychotherapy research, yet its operation within therapeutic relationships remains insufficiently understood. This study examined how relational and epistemic processes developed within a single case of Brief Psychosocial Intervention (BPI) and the extent to which they were accounted for by the three-communication-systems model of epistemic trust. A theory-building single-case study design was employed using complete transcripts from 11 therapy sessions with a 14-year-old female with depression. Iterative deductive, inductive, and abductive analysis indicated that the case broadly followed the processes described by the existing three-communication-systems model. However, the analysis also distinguished emotional safety in communicating vulnerable experiences from epistemic openness to communicated knowledge, with indicators of emotional safety evident before more explicit epistemic openness towards the therapist. The case further supported understanding therapeutic learning as a collaborative process in which patients actively contribute to the construction of therapeutic understanding. These findings do not establish emotional safety as a necessary precursor to epistemic trust, but suggest potential refinements to existing accounts of epistemic trust and generate propositions for further psychotherapy process research.