From a mentalizing perspective, symptoms of depression arise from reactions to threats to attachment relationships—and thus threats to the self—and associated impairments in mentalizing problems. Mentalization-based treatment (MBT) for depression targets mentalizing impairments, dominant attachment styles, and problems with epistemic trust. Depression is not a homogeneous disorder, and mentalizing problems vary depending on whether the depressed mood is mild, moderate, or severe. Mentalizing interventions for the different severities of depression are summarized. A specific adaptation of MBT, namely dynamic interpersonal therapy (DIT), is also discussed.

The development of mentalizing and non-mentalizing is discussed along with the importance of mentalizing as a psychotherapy process in the treatment of mental health problems. A defining feature of mental disorder is the experience of “wild imagination,” and we consider that mentalizing difficulties—that is, the tendency to get caught up in unhelpful ways of imagining what is going on both for ourselves and for other people—are the price we as a species pay for the immense benefits of the human imagination. Mental health problems arise when mentalizing is lost and we use mentalizing processes that are from earlier stages of development. The relationships between mentalizing, use of low mentalizing modes, epistemic trust and distrust, and social processes are summarized.

Interactive mentalizing is a problem for couples who are struggling to relate to each other constructively. Mentalization-based treatment for couples (MBT-CO) is a structured intervention that targets the ability to see things from the other person’s perspective, and the recovery of epistemic trust. Initially couples are asked to identify their own problems in the relationship and then to try to consider their partner’s perspective. The clinician supports discussion between them from the different perspectives, and strengthens their capacity to see things from alternative viewpoints. The aim is to enhance interactive mentalizing in the relationship so that the partners are able to maintain a balance between closeness and the erotically charged “otherness” that generates sexual intimacy and pleasure.

The COVID-19 pandemic has led to far-reaching challenges in the field of (democratic) education. This chapter focuses on two aspects. First, as a measure to contain the spread of the coronavirus, schools in many countries were closed for extended periods of time. In this chapter, school closures are discussed as an issue of educational justice, with particular attention to the problem of an education for democratic participation. Second, the pandemic has raised questions of democratic legitimacy: The political measures taken to combat the virus were seen as illegitimate by parts of the population. In this context, there is disagreement about the basic facts regarding the virus and the response to it. The chapter discusses how teachers should deal with this kind of disagreement, in the classroom.

Psychopathological descriptions, diagnostic criteria, and experimental studies suggest issues with trust across the range of different personality disorders. While the majority of findings refers to Borderline Personality Disorder, the studies investigating trust issues in other personality disorders suggest differential patterns of trust impairments, but also common determinants. For example, traumatization during childhood and adolescence seems to be important for alterations in trust across the spectrum of personality disorders. In this chapter, we describe the definition and classification of different personality disorders, report findings elucidating the specific importance of issues with trust in this group of mental disorders and present therapeutic approaches aiming to restore trust. Most of the empirical studies focus on self-reports and behavioral indices of trust. In contrast neurobiological studies investigating the neuronal correlates of trust impairments are extremely sparse. One exception are studies on the effects of the prosocial neuropeptide oxytocin which emphasize that the mechanism underlying alterations of trust in personality disorders are complex. At the end of the chapter, we discuss implications for future research on trust that may contribute to our understanding of impairments in trust in personality disorders and thereby help to improve the treatment options for this domain of interpersonal dysfunction.

This commentary extends on Dixon-Gordon, Conkey, and Woods’ (this volume) review of studies on brief personality disorder treatments by exploring two ways in which this evidence base advances the state of personality disorder treatment, and, relatedly, ways in which findings from short-term and long-term treatment studies might be productively integrated toward the development and testing of better treatments. First, these studies improve the accessibility of personality disorder treatment by testing specific interventions of limited intensity and duration that may be implemented with greater ease by generalist clinicians with less specialized training, time, and program resources. Good Psychiatric Management for borderline personality disorder is offered as an example of a “stepped-care model” in which the delivery of specific short-term interventions could be stratified according to an evidence-based algorithm yielding maximal benefit for the largest number of patients within the shortest amount of time. Second, brief personality disorder treatment studies suggest ways to conceptualize change processes at the level of structural features of treatments and at the level of what is happening in patients’ minds. Change models derived from studies on longer-term personality disorder treatments, such as the generation of “epistemic trust” as posited by the developers of Mentalization-Based Treatment, might be productively applied and empirically evaluated in the setting of short-term treatments.

This rejoinder begins with an expression of gratitude and broad agreement with the two commentaries by Kenneth Levy and Nicholas Salsman. The rejoinder considers three main issues: (1) the fact of the range of psychodynamic treatments that have been found to be effective in the treatment of personality disorder (PD); (2) the value of considering a dimensional approach to psychopathology in general and PD more specifically, particularly in the context of recent work on the general psychopathology factor; and (3), the issue of transference and different ways of approaching it across different psychodynamic treatments.

This chapter gives an account of the different psychoanalytic traditions and their approaches to PD: the Kleinian/Bionian model, the British object relations perspective, Kohut’s self psychology, the structural object relations model, the interpersonal-relational approach, and mentalizing theory. The chapter goes on to describe two contemporary psychodynamic treatments, along with their evidence base: transference-focused therapy and mentalization-based treatment. Recent developments in the authors’ thinking in relation to PD are then described, partly in the context of recent work in the area of a general psychopathology or “p” factor. In particular, the authors discuss personality disorder in relation to epistemic trust, and suggest that psychopathology might be understood as a form of disordered social cognition, perpetuated by the obstacles to communication that these social cognitive difficulties create. It is postulated that effective therapeutic interventions for PD possess the shared characteristic of stimulating epistemic trust and creating a virtuous circle of improved social communication.

Collaborative/therapeutic assessment (C/TA) adds value to psychological assessment by enhancing the therapeutic effects assessment can have. This chapter tracks the influences and research that have guided the evolution of assessment into C/TA and therapeutic assessment (TA), which is a semi-structured C/TA designed to maximize therapeutic effects. It describes the steps and techniques of TA, including developing the client’s questions for an assessment to address, extended inquiry, assessment intervention sessions, and summary discussion sessions. It then explores the empirical foundation that supports the efficacy of C/TA and TA. The added value that TA offers is outlined, including its contribution to working with clients struggling with personality disorders and issues involving epistemic hypervigilance. Finally, discussion of future research that could further TA as an effective consultation technique and as a stand-alone therapeutic intervention itself is considered.

Since to trust implies to run a risk, you may want to make sure your trust is justified before you decide to trust someone. In this chapter, the authors examine the justification of trust in the information we receive from others (epistemic trust). They stipulate that only information which is relevant to the receiver counts as testimony. Contrary to this, irrelevant information, arguments, and the provision of pieces of evidence do not count as testimony. By resorting to the concept of street-level epistemology, that is, by shifting from the truth content of a statement to the content relevance (i.e. relevance to the receiver of the information), it is possible to justify epistemic trust. Between the extreme positions of complete rejection and almost a priori acceptance of epistemic trust, the authors argue that it is responsible to grant derivative authority, i.e. to accept testimony to p if and only if we have sufficient reason to believe that p. To determine what counts as ‘sufficient reason’ they present two strategies: ‘epistemic vigilance’ and assessing the ‘epistemic trustworthiness’ of the trustee.

Epistemic trust is an axiom of dialogical epistemology. It refers to the ethical relation between the Ego-Alter and has deep roots in daily life. Epistemic trust makes sense only in relation to its opposite, whether distrust, mistrust, doubt, risk or danger. I have explored two basic and mutually overlapping forms of epistemic trust/distrust. One form concerns the participants’ presupposition, or the lack of it that they live in a temporarily shared social world comprising a common ground for understanding and interpretation of their social reality. The other form refers to the capacity and readiness of participants (or the lack of it) to learn and accept knowledge and experience from one another. When established, epistemic trust is implicitly taken for granted, and it forms the common ground for understanding of the social reality, of common values and intentions to aim at ‘good life’. Epistemic trust is historically and culturally embedded and it ranges from micro-social to macro-social forms. The chapter discusses epistemic trust focusing on authority and positions of trust, on communicative contracts of secrets and non-disclosure, the hermeneutics of trust and the hermeneutics of suspicion. It shows some examples of complex relations of trust/distrust, such as the dialogicality of confession.

This Chapter is concerned with axioms and concepts of dialogical epistemology derived from the Ego-Alter interdependence. This interdependence is always about something, i.e. about objects or events, or about reflections on the Self’s and the Other(s)’ thoughts, imaginations and actions. I have referred to triangular relations between the Ego-Alter-Object in two ways. First, following Serge Moscovici’s ideas, there is a triangular relation between the Ego-Alter-Object of knowledge. Second, following the ideas of the anthropologist Louis Dumont, I have introduced the consumerist triadic relation the Ego-Alter-Thing of desire. Ethics in these two kinds of triangle follows different routes. In the former case, ethical relations between the Ego-Alter stem directly from intersubjectivity and the search for social recognition as the primary ontological relations. In the latter case, the ethical relations between the Ego-Alter are masked by the apparent priority given to the relation between the Self and the Thing of desire. In this case, the Ego’s search for social recognition, which superficially appears as craving for the Thing of desire, is in fact the desire for the desire of the Other’s desire. In other words, obtaining Objects of Others provides the Self with a social status and thus, with illusory social recognition.