‘Trust me, we can sort this out’: a theory-testing case study of the role of epistemic trust in fostering relationships

ABSTRACT

Novel psychological theories are often conceived in a general or heuristic form that can benefit from development and granulation through context-specific theory testing. Here, a theory-testing single case study methodology, adapted from an approach developed in the field of psychoanalysis, is presented. The study exemplifies this methodology though an interrogation of the explanatory value of a relatively new child development theory, the theory of epistemic trust, in the context of the relationship between a foster carer (“John”) and a young person in their care (“Buster”). Using in-depth interview material, the ways and extent to which the theory of epistemic trust could aid understanding of this fostering relationship are examined. We discuss the implications for the development of the theory of epistemic trust and the applications of these findings to social work contexts. The strengths and limitations of this theory-testing case study approach are explored.

KEYWORDS:

• Foster care
• case studies
• theory development
• epistemic trust
• relationships

There are over 80,000 children in the care of UK governmental Local Authorities, with around three-quarters of these children living with foster carers (Department for Education, & National Department for Statistics 2020). Children coming into foster care have experience of early adversity, whether that be through experience of maltreatment while living with their birth family or through the loss of the opportunity to live consistently and safely with their biological parents. The relationships these children have with their foster carers can provide a nurturing context that promotes recovery from this early adversity, promoting positive psycho-social outcomes (Farineau, Stevenson Wojciak, and McWey 2013; Luke and Coyne 2008; Southerland et al. 2009; Sprecher et al. 2021). However, despite evidence demonstrating the vital role of fostering relationships, there are few theoretical models that attempt to characterise how these relationships develop, exist and are experienced.

Case study methodology has been widely used to help build theories, but the role of case study in helping to test and further develop existing theories is less well-established (McLeod 2010). However, small-scale, qualitative studies can be used to test the applicability of generalist theories of caregiving in the specific context of fostering relationships, allowing the development of more flexible, mature theoretical models (Flyvbjerg 2006). This study will present and apply a methodology, adapted from Edelson’s (1986) guidelines on case study research, originally developed in the field of psychotherapy research, to test the explanatory value of one theory of psychosocial development, the theory of epistemic trust, in the context of a fostering relationship. This approach may be appliable to other studies investigating the explanatory value of generalist theories in specific contexts as part of the process of theory refinement.

The theory of epistemic trust

The concept of epistemic trust was originally developed as a key component of the theory of natural pedagogy, a human-specific, cue-driven framework for understanding the how cultural knowledge is spread (Csibra and Gergely 2006, 2009, 2011). This theory outlines how opaque cultural knowledge and know-how, which naïve individuals are not able to work-out or acquire alone, is passed between humans. The transfer of opaque cultural knowledge is thought to be evolutionarily important given that much information needed to function adaptively in human society is too complex, nuanced, and specific to be coded for and passed on through generation-to-generation genetics.

The theory of natural pedagogy suggests that cultural knowledge is passed between humans when individuals lower their natural stance of epistemic vigilance and move into a state of epistemic trust. Epistemic vigilance is a protective state where individual’s learning of new cultural information is inhibited to prevent indiscriminate absorption of irrelevant, inaccurate, or damaging communications (Sperber et al. 2010; Wilson and Sperber 2012). Epistemic vigilance can be lowered by specific triggers, known as ostensive cues, that signal communicated information is personally relevant, safe and generalisable. In early development, ostensive cues from a caregiver to a child may include use of exaggerated prosody or ‘motherese’, eye-contact, and contingent physical and verbal responsiveness (Fonagy, Campbell, and Bateman 2017; Fonagy, Luyten, and Allison 2015). This ostensive cueing ought to lead to a state of epistemic trust where individuals can deferentially absorb new, personally relevant knowledge which helps them function in the social world. Recently, theorists have focused on how epistemic trust can help us understand how early parent-infant relationships may affect individual’s later ability to trust and learn from others (Campbell et al. 2021; Fonagy and Allison 2014; Fonagy and Campbell 2017).

In the theory of epistemic trust, during early development a caregiver’s responsive and contingent interactions with an infant serve as ostensive cues for the infant to lower their epistemic vigilance and enter a state of epistemic trust to receive communications from their caregiver (Fonagy et al. 2002; Gergely and Watson 1996). These contingent interactions may serve an additional function of encouraging the development of secure attachment relationships between caregiver and their children, which create an ideal, though not necessary, environment for the emergence of epistemic trust (Fonagy and Campbell 2017). In typical development, states of epistemic trust allow infants to eventually learn from their caregivers about the social world and how to function well in it (Fonagy, Luyten, and Allison 2015). However, when children experience unresponsive, unpredictable, or damaging interactions with caregivers they may lose the capacity to lower their epistemic vigilance (Fonagy and Allison 2014; Fonagy and Campbell 2017; Fonagy, Luyten, and Allison 2015). This may lead to a persistent state of epistemic freezing or hypervigilance associated with feelings of uncertainty and difficulties learning from, and functioning in, the social world (Fonagy and Allison 2014; Fonagy and Campbell 2017; Kruglanski 1989). Such adverse caregiving experiences may also lead to individuals being unsure of who or how to trust, manifesting as epistemic credulity where trust is extended unselectively in the absence of appropriate ostensive cues (Campbell et al. 2021). Over time, inappropriate early care may lead to infants developing trait-like dispositional differences in their capacity for adaptive social learning (Campbell et al. 2021). Those with experiences of early disrupted, inappropriate, or inconsistent early care, including children in foster care, may therefore be at greater likelihood of understandable disruptions in epistemic trust.

Individuals with experience of early adversity, including those who have spent time in foster care, are more likely to show disruptions in their trust of the world and others (Dozier 2005; Eldridge, John, and Gleeson 2020; Hyde et al. 2017; Nesmith and Christophersen 2014; Schofield and Beek 2005). These disruptions of trust may detrimentally affect quality of life and multiple areas of wellbeing (Campbell et al. 2021; Eldridge, John, and Gleeson 2020). Therefore, there is preliminary evidence that theory of epistemic trust be a useful model for understanding both the increased prevalence of disruptions of trust and the known higher risk of psychosocial difficulties amongst people with experience of foster care (Luke et al. 2014). Given what is known about the importance of fostering relationships as an opportunity to recover from early adversity, it may be that the experiences of these relationships can be explained utilising the theory of epistemic trust (Hill 2009).

Existing research into epistemic trust

An emerging body of empirical research contributes to our understanding of the applicability of the theory of epistemic trust to a range of contexts, though not yet that in the context of fostering relationships. One recent study found associations between global symptoms of psychopathology, a history of childhood adversity and levels of epistemic trust, credulity or mistrust (Campbell et al. 2021). This work has been critical in establishing the general applicability of the theory of epistemic trust and identifying associations with other developmental and therapeutically relevant constructs. However, it is difficult to ascertain from these correlational, context-independent findings how epistemic trust may manifest or be experienced in the context of individual therapeutic or developmental relationships.

Rigorous, context-specific, small scale studies of the theory of epistemic trust may be necessary to help develop the theory and create more flexible theoretical knowledge about how epistemic trust manifests in the real world (Flyvbjerg 2006). A number of qualitative studies have already contributed to developing this context-specific understanding of the theory of epistemic trust. For example, clinical case study work has helped demonstrate the clinical usefulness of the model of epistemic trust for understanding the presentation of borderline personality disorder in adolescent and parent samples (Bo et al. 2017; Byrne 2020). Jaffrani, Sunley, and Midgley (2020) also conducted a case study demonstrating the partial recovery of epistemic trust in the context of mentalization-based therapy for an adoptive family. These studies highlight how the theory of epistemic trust may be useful for understanding the psychosocial challenges faced by those with experience of early adversity and for developing appropriate therapeutic interventions for these individuals. However, it is unclear whether the apparent explanatory value of epistemic trust in these therapeutic contexts can be generalised to fostering relationships.

To summarise, there is strong evidence that young people in foster care are at elevated risk of demonstrating disruptions in their trusting orientation and that these disruptions have the potential to detrimentally impact upon their long-term psychosocial wellbeing. Fostering relationships may provide a potentially reparative developmental opportunity for recovery from early adversity. Emerging research has begun to demonstrate the explanatory value of the theory of epistemic trust for conceptualising the developmental impacts of early adversity and therapeutic recovery from this in various contexts. However, the theory of epistemic trust has yet to be examined in the context of fostering relationships. The research question of this study was ‘What is the explanatory value of epistemic trust theory in explaining the development, dynamics and experience of a fostering relationship?’.

Materials and methods

Design

This study used a qualitative dyadic case-study design adapted from Edelson’s (1986) guidelines for qualitative single-subject research. These guidelines provide a framework for using single case studies to test the explanatory value of theories in specific case contexts. This study examines the explanatory value of the theory of epistemic trust in understanding a fostering relationship between one foster carer (“John”) and one young person in their care (“Buster”). Here, explanatory value means ‘to what extent and in what ways is this theory able to help us to make sense of the development, dynamics and experiences of this fostering relationship?’.

Setting and recruitment

The present study was a follow-up to a larger, phenomenological study conducted with foster carers and young people with experience of foster carer that focused on experiences of fostering relationships (Sprecher et al. 2021). From this larger study, one dyad was identified where trust appeared to play an important role in the development of a fostering relationship. The members of this fostering dyad were purposively sampled and invited to take part in the present case study.

Participants

The participants in this study were a foster carer, (“John”), and an adolescent young person in foster care, (“Buster”). Names and some details have been changed, to preserve confidentiality.

The foster carer, (“John”) was a middle-aged, male foster carer who identified as White British and was living in England. John had fostered several children over nearly a decade, previously having worked professionally in another field for many years. One motivation for John to enter fostering were his own childhood experiences. John described coming from ‘not a nice background’ where he lived with a relative rather than his own parents. As John puts it, he ‘was in sort of foster care but not foster care officially’. John described being a foster carer as an opportunity to ‘give back’ and felt that his personal experiences in kinship care gave him an ‘advantage’ in working with children in foster care. As John explains, ‘I don’t know all of the issues, but I know some of the issues and I’ve done lots of things that they’ve done or doing or thinking about doing before they even think about doing it’.

The care-experienced participant, Buster, was a young man in his late teens who had been living with John for several years. Buster reported coming into foster care initially when he was four years old and then having several placements with different foster carers before coming to live with John’s family. During the time Buster has been living in foster care he had been in contact with his birth family, but the frequency of this varied over time. It was beyond the remit of this study to inquire about Buster’s experiences before coming into foster care and Buster did not choose to disclose this information during the interview process.

Ethics

Ethical approval was provided by the [anonymised]. Participants were consulted to ensure presented case material did not risk de-anonymising either individual. To achieve this, certain features of the case were altered in a manner that conserved the meaning conveyed through primary data presented but did not risk identification of participants. Participants selected their own pseudonyms to allow imparting sociocultural information through chosen names (Allen and Wiles 2016).

Data collection and processing

Data collection consisted of four telephone interviews, two with each participant. The interviews were semi-structured allowing for emergent areas of discussion based on what participants considered to be important in understanding the role of trust in their fostering relationship. Interviews were conducted with both John and Buster to triangulate findings and capture the interpersonal aspects of trust development. The interviews covered experiences of general and epistemic trust in their fostering relationship as well as in other key relationships in their lives such as those with teachers, friends and social workers. Interviews ranged from 50 to 100 minutes and were audio-recorded before being then transcribed using the software NVivo (QSR International Pty 2020) by the first author.

Data analysis: use of Edelson’s case study guidelines

The analytic guidelines developed by Edelson (1986) were originally developed to encourage the use of credible and robust analytic methodologies in single case study research, allowing case studies to be used to substantiate or test theories beyond simply generating hypotheses (Edelson 1986; Fridhandler, Eells, and Horowitz 1999). The following adapted version of Edelson’s six-step method was used for this study:

1. Documentation of observable phenomena – Edelson’s guidelines state case studies must document observable phenomena in a manner that can be independently agreed upon by multiple observers and that clearly separates facts from interpretations not strictly evidenced in the research data. Recording and transcription of case study material allowed for documentation of the content of this case. This process of documentation, including transcription by the first author, also allowed for familiarisation with the case material which was further aided by reading and re-reading transcripts alongside interview audio recordings. As with other qualitative analysis methods, this process of documentation and familiarisation allows the researcher to focus on the facts of the case and identify existing assumptions that they bring to the analytic process (Smith, Flower, and Larkin 2009).

2. Outline empirical generalisation and expected observations – For a case study to be used for hypothesis testing, the study must clearly outline the theory, formulation, or empirical generalisation to be tested. The theory must be described and then the observations that would be expected in a particular case, according to the theory, must be specified. In this study, the first author identified observations relating to the development, dynamics and experience of a fostering relationship that would be predicted by the theory of epistemic trust. These theoretically expected or predicted observations were specified then refined through consultation with a secondary researcher with expertise in the theory of epistemic trust (see Table 1) [Table 1 to appear here – presently at end of document].

3. Specification of observations that would contradict the empirical generalisation – Next, it is necessary to specify observations that would contradict the theory being examined. This prevents the researcher from cherry-picking only affirming data extracts and ensures that attention is given to areas where the theory does not fit the case material. In this study, the first author identified observations that would contradict the theory of epistemic trust and refined these by consulting the secondary researcher (see Table 1). To avoid rigidity in the analytic process, other apparently meaningful findings relating to trust in this fostering relationship but not pre-specified were also noted and synthesised in stages 4–5.

4. Assessment of how observations are accounted for by proposed empirical generalisation – At this point, Edelson explains, the observations documented in the specific case-study must be examined in relation to the theory proposed. Here, evidence should be used to make arguments for how observations or the facts of the case are explained by the proposed theory. The first author prepared a form of ‘prima facie’ or narrative accounting for the facts of the case study data using the theory of epistemic trust (see Findings Part 1). Here, the ways in which the predictions of the theory of epistemic trust were able to provide a convincing and comprehensive account of case content were assessed and evidenced by data extracts. The second author acted as an external validator assessing whether the extracts chosen evidenced the explanation provided by the theory of epistemic trust.

5. Assessment of alternative explanations of observations – Edelson specified that at least one alternative theoretical account must be provided of the observations of the case. The preparation of the ‘prima facie’ explanation of this fostering relationship highlighted areas where the explanatory value of the theory of epistemic trust required closer examination. In particular, the analytic framework (Table 1) allowed the first author to identify areas or patterns in the case data that contradicted or fell outside of the predictions of the theory of epistemic trust, confirmed through consultation with the second author. Significant questions regarding explanatory value of the theory of epistemic trust for this case were identified and responded to using case extracts as evidence (see Findings Part 2).

6. Outline generalisability of findings – Finally, in Edelson’s approach the extent to which the findings of this case study can be generalised to other cases must be outlined with justifications. This is addressed in the discussion section of this study.

Table 1. Framework for identifying expected and unexpected observations from case study material.

	Expected Observations	Unexpected Observations
Start of relationship	Young person shows initial disruptions to epistemic trust (epistemic mistrust or credibility) at the start of the fostering relationship linked to experiences of unpredictable, unreliable or inappropriate care.	Young person shows no initial disruptions to epistemic trust at the start of the fostering relationship despite experiences of unpredictable, unreliable or inappropriate care (e.g. hopeful about relationship, others and the world).
Impact of caregiving	Contingent, consistent and appropriate caring behaviour by the foster carer allows for young person to lower epistemic hypervigilance and demonstrate interpersonal trust in context of fostering relationship. Emergent epistemic trust is generalised, flexible and deferential.	Contingent, consistent and appropriate caring behaviour by the foster carer does not allow for young person to demonstrate generalisable, deferential epistemic trust in context of fostering relationship OR Non-contingent, inconsistent and inappropriate caring behaviour by the foster carer allows for young person to demonstrate epistemic trust in context of fostering relationship. Developing epistemic trust may not be generalised, flexible or deferential in nature.
Areas of psychosocial wellbeing and challenge	Young person’s relative areas of psychosocial wellbeing or challenge are well explained by associated areas of epistemic trust or disruptions to epistemic trust respectively.	Young person’s relative areas of psychosocial wellbeing or challenge are not associated with areas of epistemic trust or disruptions to epistemic trust respectively OR these areas are better explained by other changes (e.g. development of interpersonal but not epistemic trust).

Trustworthiness and credibility of findings

Several steps were taken to ensure the trustworthiness and credibility of findings. Firstly, the use of Edelson’s (1986) guidelines ensured transparency and rigour in the data collection and analysis, as well as consistent separation of the researcher’s interpretations and the facts of the case, allowing for others to independently assess the credibility of claims. This method avoids selective ‘cherry-picking’ of extracts that support researcher claims leaving little space for alternative interpretations. Secondly, a secondary researcher with expertise in epistemic trust was consulted as an external validator of interpretations made. Thirdly, study participants were consulted to assess whether data extracts used portrayed an accurate representation of the facts of the case. This study did not aim to reach absolute consensus between researchers and participants on all interpretations made, but it was important that data extracts were not presented in a misleading way and that there was some resonance of study findings with participant’s lived experience.

Results

The findings are presented in two parts. Firstly, a ‘prima facie’ of the story of Buster and John’s fostering relationship is presented through the lens of the theory of epistemic trust in three sections. Secondly, three questions are presented that emerged through the analytic process concerning the explanatory value of the theory of epistemic trust in this case. Data extracts are used throughout to evidence the findings discussed.

The prima facie: a fostering relationship through the lens of epistemic trust

‘Not knowing the trust is there’: is there evidence that Buster came into care with disruptions in his epistemic trust?

Buster described that before coming to live with John he had lived in ‘about 4 or 5 different homes’ and that they ‘all had different standards and expectations’. John’s understanding of Buster’s previous living environments was that these were characterised by caregivers ‘not doing what they say they’re going to do and him relying on himself’. This fits with Buster’s reflections that:

All the places that I’ve gone to, they keep saying that it’s going to be permanent […] and then one minute and I’m being moved again and it’s just like “well, hang on what’s going on here then?”.

These reflections provide clear evidence that Buster had experience of unpredictable care. Furthermore, Buster also reflected on the lack of responsiveness he received from previous caregivers around important life events, such as when he was excluded from school:

I ended up getting excluded and […] I got home and then I told them, and they didn’t really give a reaction […] And then that was when I was just like, well is this behaviour alright or is it not?.

There is evidence that Buster has experienced unresponsive care from caregivers who have not always behaved in trustworthy ways. These experiences of unpredictable care appeared to be associated with Buster demonstrating a marked mistrust of others before coming to live with John. Buster explained ‘not knowing the trust is there can knock someone off and like … Because obviously then they’re thinking “is there trust is there not? Should I build it up? Should I make the first move?”’. Buster spoke about feeling that he used to ‘hold it back’ in relationships and his outlook was ‘as long as I’d get through whatever I was going through without anyone else I would feel like it was a job well done’.

Fitting Buster’s description, John’s impression of Buster’s mindset at the start of their fostering relationship was ‘I’ve never trusted anybody, I have to look after me, I will control me, no-one’s going to control me’. John reflected on how ‘guarded’ Buster was when he first came to live with him:

When he first come to me, he wouldn’t, you know, he wouldn’t trust me with anything […] In foster care, you’re … not feeling great about yourself, you’re not feeling great about the world. Why should you trust anybody at all? […] He’s heard everything all before […] and it’s all fallen apart for him.

John and Buster’s descriptions paint a picture of the Buster who came to live with John as having a hypervigilant, guarded approach to relationships with others. As John explains in his validation of Buster’s initial mistrust, the experiences of many young people in foster care may lead to expected and understandable adaptations in their trust of others, fitting with the theory of epistemic trust. In Buster’s case, it appears that unpredictable and unresponsive care led to understandable disruptions in his epistemic trust, in particular epistemic hypervigilance.

‘The basics of actually learning to trust’: is there evidence that this fostering relationship helped Buster recover epistemic trust?

Both John and Buster frequently reported that a key characteristic of their fostering relationship was the consistency, reliability, and predictability of John’s caregiving style. Buster explained that ‘John, he is a person who if he says he is going to go out and run a mile tomorrow he will do it’ adding ‘that’s one of the main reasons why I can trust John’. These descriptions of John’s reliability fit with John’s own description of his caregiving approach, ‘I’m like a bad smell, I don’t go away, I’m still here. You’ve done this, I’m still here for you mate’. John explained he felt this reliability, particularly at challenging times, had allowed Buster to learn that ‘when things are going a little wrong, he can rely on me’.

There were strong indications that this consistent caregiving style facilitated Buster’s development of a specific trust of John. As John reflected:

There has been times when we’ve had a chat and he’s told me stuff […] and I’m thinking, “the old Buster would never have told me that”. […] I think that’s proof of it, that he’s trusting me with stuff.

Buster’s experiences mirrored this, as he explained, ‘I’m now at the stage where I know I can tell John anything and he’ll be able to help me get around it’, indicating a reliance in John’s ability to offer personally relevant help and support. Buster explained if he was unsure about ‘something to do with life skills or something, then I probably wouldn’t even try by myself, I’d probably just go straight to John about it and see what he thinks’. This seeking advice around ‘life skills’ illustrates Buster’s emergent ability to acquire complex cultural knowledge from John facilitated by developing trust in their relationship. As John explained, ‘he’s [Buster’s] got to trust me to know what I’m talking about’.

Another indication of Buster’s developing trust of John was his growing ability to learn about himself through John. For example, Buster described ‘a time when he [John] has sat me down and spoken to me and he’s said something that I’ve done or am capable of and it makes me think “is that really me?”’.

These instances of Buster confiding in John, seeking his advice, and acting on it, and learning about himself from John all indicate the lowering of previous epistemic hypervigilance and the development of Buster’s ability to learn epistemically from John specifically. Buster made clear the real-world personal impact of this ability to learn epistemically from John, for example, facilitating an improvement of his behavioural regulation at school. Buster explained, ‘He [John] said something and like it like changed the way I thought about myself, thinking like ‘I can turn it round’ and stuff’. This demonstrates that John’s consistent and contingent caregiving was felt to facilitate some recovery of Buster’s epistemic trust and that this change led to explicit psychosocial benefits for Buster. This finding aligns with the theoretical expectation and previous empirical findings that disruptions in epistemic trust are associated with lower psychosocial wellbeing (Campbell et al. 2021; Fonagy and Campbell 2017; Fonagy, Luyten, and Allison 2015).

While there is evidence that Buster began being epistemically trusting towards John, to what extent is this description of Buster’s specific trust towards John is representative of a true recovery of a generalised, deferential, and flexible epistemic trust? This question is addressed in Section 2 of the Findings. Buster and John particularly have identified John’s availability, consistency and predictability as key factors that have facilitated this shift in Buster’s trusting orientation.

‘That chink in his armour’: is there evidence that Buster shows persistent areas of psychosocial difficulty despite increases in epistemic trust?

Despite Buster’s emerging epistemic trust and areas of positive change, there remained other areas where Buster faced challenges for example challenges in social connection and ‘meltdowns’. These challenges could be understood as being related to Buster’s residual epistemic hypervigilance.

John reflected on how ‘the world of people around him [Buster] aren’t that many’. John understood the underlying reason for this social isolation as being related to Buster retaining areas of mistrust for others due to his early experiences. John explained, ‘if you’ve been in foster care […] it’s hard for you to trust anybody. […] Your underlying bit is everybody lets me down’. John experienced Buster as still having easily generalisable mistrust, for example, in relation to Buster’s social services:

He’s had the experience of being let down all these times. So, why would he? Why would he trust anything that they say at all? And that’s not just, that’s not just George the social worker but he will brand the whole of fostering in there.

This reflection both acknowledges the appropriateness of not trusting inconsistent professionals, like George, but also indicates that for Buster this mistrust is generalised easily to ‘the whole of fostering’ suggesting a persistence in epistemic hypervigilance. John’s explanations of Buster’s social isolation suggest this psychosocial challenge may be well explained by the persistence of Buster’s epistemic mistrust. This mistrust also seemed to manifest in Buster’s peer relationships. As Buster explained:

I was just playing a game like and he [a friend] would turn round and go ‘oh, right you’re getting really good at this game’. And I wouldn’t go ‘oh like cheers’, I wouldn’t go like ‘ah, thank you it means a lot’ and stuff. I’d be very blunt about it because I’m not really sure if he means it or he is being sarcastic.

Seen together, these extracts suggest that Buster’s experience of social isolation may be well accounted for by persistence in epistemic hypervigilance in certain contexts.

A second area of difficulty for Buster was the occurrence of ‘meltdowns’ characterised by high levels of emotional distress and dysregulation. John described these events as periods where Buster ‘thought he’d blown everything and that was the end of the world, that was it, that was done, he was done […] He was not going to be allowed to come back and I would get rid of him’. This description has parallels with Buster’s description of times when ‘if one thing went wrong then I’d make everything go wrong. […] I wouldn’t think that there was any point in trying to make it better.’ It appeared that, in these moments, Buster was not even able to trust John and reverted to high epistemic hypervigilance and low expectations of the world or what Fonagy and Allison (2014) call epistemic freezing. As John described:

He wouldn’t trust, when he’d gone into that mode, he wouldn’t trust anything I was saying. Nothing. I was going ‘mate’ I actually said ‘trust me, stop now, it’s all good, it’s not a problem, we all drop things, we all break things, trust me, we can sort this out’ […] He just wouldn’t. He was emotionally gone.

This extract illustrates the significant remaining impact of lingering epistemic hypervigilance and fragility of epistemic trust for Buster. There is evidence that, as would be expected by the theory of epistemic trust, that limitations in generalised, flexible epistemic trust for Buster continue to be associated with some areas of persistent psychosocial difficulty, particularly under heightened arousal. However, John was hopeful in explaining that these ‘end of the world episodes […] they’ve got fewer and fewer and fewer’. This positive change may have been facilitated by Buster learning to explore and address these difficulties through his epistemic trust of John. As John explained, ‘he knows he has that chink in his armour […] Through Louise [John’s wife] and I mainly, you know, talking about it, totally open and honestly’.

Emergent questions about the explanatory value of the theory of epistemic trust

Section 1 of this study’s findings have demonstrated the potential applicability of the theory of epistemic trust as an explanatory model for the dynamics, development, and experience of Buster and John’s fostering relationship. There is evidence that epistemic trust, on first examination, can be a useful explanatory framework for understanding this fostering relationship. However, through the data analysis process, three questions emerged requiring consideration in order to assess, in more detail, the ways and extent to which the theory of epistemic trust offers explanatory value in this case.

Was Buster’s mistrust and trust specifically epistemic in nature and concerning communications and knowledge from the social world?

The theory of epistemic trust specifically conceptualises trust as an epistemic mechanism that allows knowledge to be obtained from communications with the social world. This model of trust differs from other interpersonal models of trust that instead conceptualise trust as the basis for physical, emotional, and relational safety or security (Bowlby 1969a, 1969b; Erikson 1963). Therefore, to examine the unique explanatory value of epistemic trust in this case, it is important to assess whether Buster’s described trust and mistrust showed characteristics specifically of epistemic trust.

Buster’s ‘guarded’ presentation at the start of the relationship or as John described, Buster’s underlying belief that ‘everybody lets me down’, could be interpreted as relating to a relational mistrust of others, as opposed to an epistemic mistrust of information from the social world. However, reflections from John and Buster specifically highlight how this mistrust specifically manifested in being unable to take on social communications. For example, Buster explained how his lack of ability to trust the advice or help of others led to him trying to go his ‘own way to try and find the problem myself and then like sometimes there will be times where it bugs me to the point that it sends me up the walls and I get really annoyed and start breaking stuff’. This exemplified the specific impact of Buster’s disinclination to make use knowledge from the social world to solve problems and gain support, indicating a specific epistemic mistrust.

Evidence of the specific explanatory value of epistemic trust is also shown in the impact of Buster’s fostering relationship with John on his trusting behaviour. Some emergent trusting behaviours shown by Buster, such as confiding in John, do not require Buster to accept or trust social knowledge. However, some of Buster’s other new behaviour including advice seeking and learning about himself from John, which do require an acceptance of knowledge communicated socially. As John reflects:

I’m laying down the stepping-stones for him to step on and come with that knowledge […] and be able to trust me that […] when he steps on it they aren’t going to go into the water.

Therefore, Buster’s change in his trusting orientation towards John is evidenced as having components relating to knowledge acquisition which may not be accounted for by models of trust that are not specifically epistemic. This indicates that the theory of epistemic trust makes a unique contribution to understanding this case. However, there is also evidence that both John and Buster considered non-epistemically focused aspects of trust as also having an important role in their fostering relationship, perhaps one more important than the epistemic components of trust. As John explained, ‘it’s about the young person or whoever it is, knowing that you’re not gonna go away and you’re going to be there’ and the importance of Buster being able to ‘trust me that I can do the best for him and he’s not alone’. As Buster also explained, ‘to trust someone is like is to be able to rely on them and like know they’re there when you need them the most and like they’re there for support’. Therefore, while there might be a unique explanatory value in considering the epistemic or knowledge-based components of trust, in this fostering relationship there was also a significant, important role of Buster developing trust in the availability and reliability of support and emotional care from his foster carer, John. This might suggest that the prerequisite for epistemic trust is firstly the development of a secure attachment relationship, whereby the child is able to trust that the caregiver can provide consistent, sensitive and reliable protection and emotional regulation (Bowlby 1969b).

Did Buster demonstrate flexible generalisation of his recovered trust to the social world?

Epistemic trust is conceptualised as a trait-like trusting orientation that can be flexibly and appropriately generalised to the social world. A true recovery of epistemic trust for Buster would be reflected by a flexible, context-triggered, trait-like openness to communications from the social world rather than a specific openness to communications from John alone. Therefore, it is important to consider whether Buster’s apparent recovery of epistemic trust shows evidence of appropriate generalisation to others or whether his trust only extends to John as his caregiver.

John acknowledges that ‘the world of people around him [Buster] aren’t that many’ while Buster states that ‘it’s just mainly like I’d just go to John [for advice] really’. However, despite these indications of Buster’s relative social isolation, Buster demonstrates an intention to generalise his trust of John to other contexts. As Buster explains, ‘I know I need to like try and get out of it and get my friends to help me’, perhaps showing early indications of generalising his epistemically trusting outlook to those close in his social world. Furthermore, John described a recent example of Buster’s seeking advice from an appropriate source besides himself, a nurse, explaining, ‘he seems to have taken that onboard so that’s a good thing because normally he wouldn’t trust anybody as far as he can throw them’.

It appears that while Buster currently shows specific epistemically trusting behaviour towards John as a caregiver, there are only early indications that this change in trusting orientation has generalised to reflect a true recovery of epistemic trust. This interpretation is supported by evidence of the fragility of Buster’s epistemic trust that was discussed in relation to persistent areas of psychosocial difficulty for Buster, such as his experience of ‘meltdowns’. However, Buster’s incremental generalisation of epistemic trust is likely adaptive and appropriate, particularly in light of his past experiences, as an overly generalised, indiscriminate trusting of others would be evidence of epistemic credulity. It may be appropriate to consider generalisation of epistemic trust as the latest step in Buster’s gradual lowering of epistemic hypervigilance. This finding makes the case that theoretical refinement of more fine-grained stages of recovery and flexible, appropriate generalisation of epistemic trust may be a fruitful area for further work.

Was Buster able to demonstrate deferential trust of knowledge of others?

True epistemic trust is conceptualised as allowing for individuals to acquire cultural knowledge deferentially, that is by accepting the information shared by trusted others as correct without independent investigation (Csibra and Gergely 2006, 2009, 2011). This deferential learning through epistemic trust is particularly important for acquiring ‘opaque’ cultural knowledge which cannot be gained through reasoning or external evidence. Therefore, to understand if Buster gained true epistemic trust, we must interrogate whether he was able to take a deferential trusting stance.

There are several indicators that Buster was able to show a deferential trust of information from John, particularly regarding areas he felt less knowledgeable about. As Buster explained, ‘something to do with life skills or something, then I probably wouldn’t even try myself I’d probably just go straight to John about it and see what he thinks […] because obviously he was more experienced than I am’.

This extract demonstrated Buster showing sophisticated and flexible epistemic trust where he considered the characteristics of the information source, in this case John, to decide whether to deferentially accept his advice or rely on his own knowledge. However, there are several instances where Buster was apparently reluctant to rely deferentially on knowledge from even trusted sources, like John, without the use of external evidence as an ‘epistemic support’ to trusting this information. One of several examples of Buster relying on epistemic supports was Buster’s explanation of why he was able to trust John’s advice over that of others:

[John] has an app so every time I spend something on my card, he can see what I’ve spent […] So, if John said, “you need to cut down on spending money” […] I’d say, “you know what John you’re right”.

Therefore, there is evidence that while Buster has at times been able to rely deferentially on the knowledge of John and others, that he still shows some reliance on ‘epistemic supports’ in learning from the social world. This is another indicator that the changes in Buster’s trusting orientation may not reflect a true or complete recovery of epistemic trust as it is currently theorised. It is, however, important to note that Buster’s resistance to taking a deferential stance may have a protective and adaptive role. Given Buster’s experiences of early adversity, this may demonstrate an adaptive lack of epistemic credulity towards an often-untrustworthy world. Again, this finding suggests the importance of further delineation and description of the stages in recovery of epistemic trust for those with experience of early adversity. Furthermore, this finding raises questions as to how helpful current theoretical descriptions of epistemic trust are in describing adaptive states of social learning – that may be a balance of deferential epistemic trust of trusted sources and the use of external information. This may be especially important to consider in the context of adolescence where it may be developmentally important for young people to empirically test information rather than relying exclusively on the knowledge of caregivers or trusted adults.

Discussion

This study aimed to examine the explanatory value of the theory of epistemic trust in explaining the development, dynamics, and experience of one fostering relationship between a foster carer, John, and a young person, Buster. A single case study, adapted from Edelson’s (1986) guidelines for case study research, revealed the value of specifically epistemic models of trust for explaining many aspects of this fostering relationship. The findings of this study first presented a narrative of Buster and John’s fostering relationship as viewed through the lens of epistemic trust. Epistemic trust was demonstrated as a useful model for explaining Buster’s initial mistrust at the start of this fostering relationship, his recovery of trust through his developing relationship with John, and the links between Buster’s trusting orientation and his psychosocial wellbeing. Questions emerged regarding the explanatory value of the theory of epistemic trust in this fostering relationship. Consideration was given to what extent and in what ways presentations of trust described in this fostering relationship aligned with theoretical constructions of trait-like epistemic trust or mistrust.

This case study demonstrates a relatively novel approach, adapted from Edelson’s (1986) guidelines, developed primarily in the context of psychotherapy research, for testing the explanatory value of theories when applied to different contexts that may be valuable for qualitative researchers across a range of disciplines. This method may be used as a starting point for complexifying, refining and granulating existing theories by examining them in new contexts. In this study, the theory of epistemic trust was applied to the novel context of fostering relationships. Most previous theoretical work looking at epistemic trust in development has focused on relationships between birth parents and infants (Fonagy, Luyten, and Allison 2015; Fonagy et al. 2017a). Therefore, some of the predictions of these developmental theories may be less relevant in the context of fostering relationships, particularly when young people have had multiple previous caregivers or are building relationships with new caregivers in adolescence. Is consistent, contingent care, that promotes epistemic trust in an early developmental context, sufficient for the recovery of epistemic trust in foster care for older children with histories of relational adversity? Does appropriate care look the same for these children? The findings of this study suggest that it may be particularly important for the theory of epistemic trust to be refined to account for how epistemic trust can be recovered in middle childhood, adolescence, or adulthood, outside formal therapeutic interventions. Longitudinal studies which track the development of epistemic trust in young people entering foster care alongside observations of their interactions with caregivers may help to inform such theoretical developments.

The methodological approach to this case study highlighted specific areas of development for the theory of epistemic trust. For example, one area of refinement of the theory of epistemic trust suggested by this study is a granulation of the stages of recovery of epistemic trust in individuals with histories of relational adversity. In this study, there was evidence that Buster began to recover epistemic trust as a result of his relationship with his foster carer, John, but this recovery appeared to be partial. Buster’s epistemic trust appeared to be fragile: his trust of others shut down in moments of high emotional arousal. Buster also demonstrated limited generalisation of his epistemic trust and a reliance on ‘epistemic supports’ rather than deferentially learning from the social world. These findings align with those of another single case study of epistemic trust in the context of therapy for an adoptive family (Jaffrani, Sunley, and Midgley 2020). In this case study, it was found that members of the adoptive family were able to partially transfer their epistemic trust of their therapist to other professionals affiliated with this therapist, though such trust was not complete and did not generalise to non-affiliated professionals or organisations. Based on these findings, and further longitudinal work, delineation of the stages and processes of recovery of epistemic trust may be a logical next step in developing the theory of epistemic trust. It may be especially significant to investigate whether recovery of epistemic trust occurs through similar mechanisms inside and outside of formal therapeutic interventions (Fonagy and Campbell 2017). A granulation will form a foundation for investigations into what forms of intervention, support or interaction work best in supporting individuals to recover epistemic trust depending on their position along this developmental line.

The present study indicates that provision of consistent, open, and predictable relationships may be critical for the recovery of epistemic trust. Therefore, it is essential that social care services invest in well-evidenced support for carers that reduces placement instability and increases carer’s capacity to provide consistent care. It has been suggested that increasing the capacity of foster carers to reflect on their own mental states and those of the children in their care, known as mentalizing, may be a powerful tool in achieving this (Midgley et al. 2019, 2021; Redfern et al. 2018). When foster carers can adequately mentalize about their own thoughts and feelings, those of the children in their care and how they interact they may be better able to provide consistent, available, and sensitive care. Caregiver mentalizing may also be an important step in encouraging young people to mentalize about others and learn from their social world (Camoirano 2017; Fonagy and Campbell 2017; Fonagy et al. 2017b). Therefore, foster carer mentalizing may play an essential role in encouraging a recovery of epistemic trust for young people living in foster care. Preliminary evidence suggests that supporting foster carer mentalizing does improve the psychosocial wellbeing of children in foster care (Midgley et al. 2019, 2021). Future research could investigate how this improvement in wellbeing may be linked to a recovery of epistemic trust for these young people in foster care. Social work services may benefit from training in the identification of fostering relationships where there are challenges in the development of epistemic trust and referral of foster carers and social workers to mentalization-informed interventions which have potential to lead to improvements in this area (Fonagy and Campbell 2017; Jaffrani, Sunley, and Midgley 2020).

This study demonstrated how a consistent and sensitive relationship with his foster carer, John, allowed Buster to begin to show epistemic trust and the positive impact of this on his wellbeing. This psychosocial improvement indicates that developing epistemic trust may be a mechanism for recovery from psychological distress even without formal psychological intervention. This finding may help explain the phenomena of ‘spontaneous remission’ whereby many individuals with psychiatric diagnoses are shown to recover from their symptoms even without intervention (e.g. Whiteford et al. 2013). Positive, trust-affirming relational experiences in the general social world may provide an opportunity for recovery for many who do not access psychological support through formal channels. This case indicates that fostering relationships, like therapeutic relationships, may provide an opportunity for recovery of epistemic trust and a reduction in psychosocial distress (Hill 2009). However, historically there has been a lack of conceptualisation and in-depth study of how fostering relationships may work therapeutically. Greater understanding of how fostering relationships can function therapeutically, perhaps through pathways of epistemic trust, is beneficial in guiding the training, support, and identification of best practice for foster carers. This study suggests that it is important for social work staff to identify cases where changes in epistemic trust, and associated improvements to wellbeing, are seen to occur naturally and those where further psychological support for both foster carers and young people may be helpful in addressing residual challenges in this area. Supervising social workers as well as children’s social workers may engage in this process collaboratively through reflections on trust in relationships with young people and their foster carers, potentially making use of psychoeducational techniques in sharing ideas about the importance of epistemic trust. It is notable that, for John and Buster, ideas of trust were extremely relevant, and both reported the value of reflecting on and discussing the role of trust in their relationship openly.

However, it is critically important to note that any attempt to facilitate a recovery of epistemic trust in young people in foster care acknowledges that trust is not simply a characteristic of an individual but a function of systemic and interpersonal influences (Benkert et al. 2006). Therefore, young people in care must be provided with safe, trustworthy relational environments before the process of lowering epistemic hypervigilance can be appropriately commenced to avoid nurture of epistemic credulity and the removal of appropriate, adapted defences for these young people.

One finding of this study was that areas of recovery of epistemic trust were associated with positive psychosocial developments for Buster while areas of persistent hypervigilance appeared linked to remaining areas of psychosocial difficulty. These findings align with Campbell et al. (2021) finding that higher levels of epistemic mistrust were associated with higher levels of global psychopathology, suggesting a profound role of epistemic trust in determining developmental risk of mental health problems. This association between psychosocial wellbeing and epistemic trust may be important in foster care contexts where elevated psychosocial distress for young people may be associated with behaviour and presentations that may be challenging for foster carers to manage, ultimately impacting on placement stability (Munro and Hardy 2006). There is evidence that placement instability and psychosocial difficulties for young people in foster care may coincide to create a vicious cycle (Newton, Litrownik, and Landsverk 2000). It has been noted by Nesmith and Christophersen (2014) that placement instability is linked to higher levels of mistrust in young people in care. Therefore, escalating levels of mistrust and vigilance are a candidate mechanism for explaining the entangled relationship between instability and poor psychological wellbeing for young people in care. It is, therefore, crucial that where possible social work services continue to promote placement stability through early intervention where fostering relationships may be under pressure or where relational difficulties are evident. An understanding of indicators of epistemic mistrust and credulity may assist social workers in identifying placements where further support may be beneficial. However, it is important to acknowledge that placement stability is not always the preferred option when a placement is inappropriate (Munro and Hardy 2006).

This case study considers the role of epistemic trust in one fostering relationship, that between John and Buster, where the development of trust was felt to be an important mechanism in facilitating change in a young person’s psychosocial wellbeing. However, epistemic trust, alongside other forms of trust, may not play an equally important role in all fostering relationships. For example, Schofield and Beek (2005) emphasise the importance of different factors alongside trust including promotion of self-esteem, a sense of family membership and autonomy as all crucial factors in the development of supporting relationships in foster care. There be a proportion of children who, dependent on differing early experiences, enter foster care with appropriate and adaptive epistemic trust where this is not an important area for development through a fostering relationship, but instead an existing area of resilience. While epistemic trust is proposed as a potential universal p-factor for psychopathology further research is required to explore the role it plays in a greater diversity of fostering relationships (Fonagy and Campbell 2017).

Strengths and limitations of methodological approach

Given this study’s use of a novel adaptation of Edelson’s (1986) approach for conducting case study research, it is important to consider the strengths and weaknesses of this methodology for researchers considering its application. The methodology presented has the advantage of lending transparency and trustworthiness, as well as a degree of structure, to the process of conducting case study research. Case study methodologies are often idiosyncratic and there can be scope for ‘cherry picking’ of data that support a particular theoretical approach. However, this methodology ensures adequate consideration is given to evidence identified in data that contradicts theoretical predictions. Furthermore, the credibility of this methodological approach was enhanced in this new adaptation of Edelson’s (1986) guidelines through the engagement of multiple researchers in the data analysis process which promoted interrogation of the resonance and validity of interpretations. This single case methodology allowed for the interrogation of generalist heuristic knowledge, regarding the theory of epistemic trust, and the examination of this in the specific real-world context, here a fostering relationship.

While this methodology provides a level of rigour and credibility to the use of a single case study, it still holds some of the limitations of such small sample research. Case study research is idiographic, it is not clear to what extent the findings of this study can be generalised, for example to other developmental settings or fostering relationships. This study served as a context-specific application of the theory of epistemic trust and, while findings may be resonant with other long-term fostering relationships, it was not the intention to attempt to characterise all relationships of this type. The fostering dyad were identified as one where trust played an important role in the development, dynamics, and experience of this relationship, but this component may not be a critical one for all such relationships. As this study was cross-sectional, another limitation may be that it was not possible to track the development of epistemic trust in this fostering dyad over time and the interpretations may be influenced by biases in the recollections of participants. Finally, this study is based entirely on interview data, but other forms of data collection may have provided better insight in some areas. For example, observational methods may have been useful in examining how John created predictable interactions with Buster rather than relying on after-the-fact reporting. However, this methodology could be applied to longitudinal data in future applications and to studies drawing from multiple data types.

Conclusions

This case demonstrates the use of an adaptation of Edelson’s (1986) case study guidelines to examine the explanatory value of a theory, that of epistemic trust, applied to a novel context, fostering relationships. This study showed the explanatory value of this theory in explaining several aspects of the development, dynamics, and experience of a fostering relationship. Disruptions in epistemic trust served as a valuable lens for understanding the psychosocial challenges faced by a young person in foster care. Furthermore, a fragile recovery of epistemic trust well characterised the psychosocial changes in this young person demonstrated as arising from his experience of care from his foster carer. However, this approach also raised questions as to how well the theory of epistemic trust, in its present form, accounts for the mechanisms by which a fostering relationship, rather than a formal therapeutic intervention, may facilitate a recovery of epistemic trust. Use of this methodology lays the groundwork for future research examining what support may encourage a more complete recovery of epistemic trust for those with a history of early adversity which may have implications for the support provided by social care services. Additionally, this methodology may provide useful for researchers across various disciplines hoping to investigate the applicability of existing theories in new contexts.

Acknowledgements

The authors would like to deeply thank the participants in this study, Buster and John, for their generosity in their involvement in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Eva A. Sprecher

Eva A Sprecher is a PhD student at University College London (UCL) in the Psychoanalysis Unit where her research focuses on the relationships between foster carers and the children they care for. She also works as a Research Officer on the Reflective Fostering Study at the Anna Freud National Centre for Children and Families.

Elizabeth Li

Elizabeth Li is a PhD student at University College London (UCL) in the Department of Clinical, Educational and Health Psychology. Her research explores the role of epistemic trust in the therapeutic process for depressed adolescents. Elizabeth is also a Post-Graduate Teaching Assistant and Module Tutor at UCL.

Michelle Sleed

Dr Michelle Sleed is a Senior Research Fellow and research tutor at the Anna Freud Centre. She is also the research tutor for two University College London postgraduate programmes: the MSc in Developmental Psychology and Clinical Practice and the PsychD in Child and Adolescent Psychotherapy. She runs several training courses relating to early years research and parenting assessments, including the training in Reflective Functioning on the Parent Development Interview. Her research is mainly in the area of early parent-infant attachment and infant development, with a specific focus on parental representations and mentalization.

Nick Midgley

Nick Midgley is Professor of Psychological Therapies for Children and Young People in the Research Department of Clinical, Educational, and Health Psychology at University College London, London (UK). He is co-director of the Child Attachment and Psychological Therapies Research Unit (ChAPTRe) at the Anna Freud National Centre for Children and Families / UCL. Nick’s research focuses on the field of child and adolescent psychotherapy, with a particular interest in promoting the use of qualitative and mixed methods. He has played a key role in the development of mentalization-based treatments for children and families. As well as continuing studies into the treatment of adolescent depression, his current research focuses primarily on interventions for children in foster care, including the development and evaluation of the Reflective Fostering Programme.