The development of the Epistemic Trust Rating System (ETRS)

Shimrit Fisher, Timur Guralnik, Peter Fonagy, Sigal Zilcha-Mano

Research output: Contribution to journalArticlepeer-review


Objective: The present study introduces and validates the Epistemic Trust Rating System (ETRS), an observer-based measure designed to assess epistemic trust (ET) within psychotherapy. ET in psychotherapy has gained much theoretical attention as a critical component in the therapeutic context, given its inherent link to social communication. However, its empirical validation remains pending, largely due to the absence of a refined instrument to gauge ET levels within the therapy environment. Therefore, this study aimed to translate ET’s theoretical construct into tangible markers within the therapeutic context. Method: One hundred eighteen patients enrolled in a randomized controlled trial received psychodynamic psychotherapy for depression. Incorporating top-down theoretical considerations with bottom-up empirical observations yielded an overall ETRS score accompanied by three distinct sub-scales, each assessing a singular ET element: one gauges the patient’s propensity to share; another measures the degree to which “we-mode” moments are achieved within the session; and the third evaluates the patient’s receptiveness to learning. Results: The findings demonstrate the psychometric robustness of the ETRS, with good internal consistency, interrater reliability (ICC(1,8) =.86-.90), and convergent (r =.23-.29) and discriminant validity (r = -.10). Conclusion: The current study highlights the ETRS as a promising tool bridging theory and empirical exploration, enhancing our understanding of epistemic trust in psychotherapy.

Original languageEnglish
JournalPsychotherapy Research
Early online date7 Jan 2024
StateE-pub ahead of print - 7 Jan 2024

Bibliographical note

Publisher Copyright:
© 2024 Society for Psychotherapy Research.


  • attachment
  • epistemic trust
  • measurement
  • psychometrics
  • psychotherapy
  • therapeutic relationship

ASJC Scopus subject areas

  • Clinical Psychology


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