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How the wind blows

You can't see, but the sky was alive with thistle-breeze.

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Section II

In this section, I will demonstrate that epistemic justice, specifically a particular form of testimonial justice, plays a critical role in enabling a therapeutic relationship. The therapeutic relationship is considered a key factor in the success of any psychotherapeutic treatment (Lambert and Barley 2001; Rogers 1965).

The possibility of identity prejudice related to the diagnosis must first be avoided. It is plausible that therapists may be insulated from this prejudice as, in my experience, they are often ambivalent about the value of diagnoses. Further, Carel and Kidd argue that clinicians need to recognize that patients are epistemically privileged in distinctive ways: they are the ones able to provide testimony concerning their own experience (Carel and Kidd 2014).

Although ‘epistemic justice’ may not be familiar terminology to therapists and counsellors, their training develops dispositional attitudes that seem analogous to the qualities of a particular form of testimonial justice that Fricker describes in discussing the role of a counsellor: the focus is on the demands of justice more than the quest for facts, in order to grant the patient space to ‘communicate something which can contribute to [her] meaning-making’ (Fricker 2007).

This distinctive form of testimonial justice is founded on ‘congruence or genuineness in the relationship; acceptance or prizing of the client; an accurate emphatic understanding of the client's phenomenal world’ (Rogers 1965). It may require, as it were, suspending disbelief. One therapist explained to me in conversation that although the stories some clients tell may be ‘made-up’, they are usually told with the aim, even if unconscious, of communicating an experiential truth that matters. Carel and Kidd speak to a similar concern when they write that they are ‘sufficiently aware of the existence of people’s unconscious desires and beliefs to know that they can be mistaken about their own desires and beliefs, but it is also the case that they have exclusive access to many of their desires and beliefs. In the interests of epistemic justice, physicians should accept what people with mental disorders say about these matters as true unless there is good reason not to’ (Carel and Kidd 2014). The underlying concern is the need to offer the client space to provide whatever testimony she can at that time, without silencing her by doubts or distrust.

In this vein, therapists adopt an attitude of empathic engagement (Angus and Kagan 2007). For example, therapists are directed to take the client’s story seriously, with an attitude of curiosity, the desire to learn and the quest to mutually explore the client’s understanding and experience (Anderson and Goolishian 1992). Likewise, psychiatrist R.D. Laing ‘spoke of the therapist’s willingness and ability to be truly present as one being relating to another, to be-with and be-for the client by entering into his or her worldview, or way of being’ (Wilson, McDonald, and Pietsch 2010) Fonagy et al. write: ‘Respect, validation, empathy… a rigorous and unstinting effort in trying to understand where a patient is coming from… [all serve to restore] communication by restoring epistemic trust’ (Fonagy, Luyten, and Allison 2015). ‘Epistemic trust’ can be understood as the sense that one’s testimony is valued and respected.

Therapists undergo an extensive period of training to develop a disposition that allows them to create an atmosphere of epistemic trust. Much of this is done in practice: in that they are supervised working with clients and their performance is analyzed. Even after accreditation, the learning process continues, with therapists discussing their cases with supervisors throughout their career. Another therapist told me in conversation that she feels it could take a decade of work to become consistently proficient at this skill.

However, many clinicians and certainly the majority of family members will not have any training in psychotherapeutic skills that could ameliorate interactions with those who have mental disorders. As clinicians may be making diagnostic or medication decisions, determining competency and responding to immediate crises, while family members may have day-to-day relationships with the patients, both groups would surely benefit were their interactions with patients better enabled, while the patients themselves would less often undergo the disabling effects of epistemic injustice or bad luck.

Fricker considers the virtues of the listener, but her focus is on developing the ability to judge the agent’s trustworthiness. She adapts an Aristotelian method of developing practical wisdom or phronesis, to this end (Fricker 2007). However, in the types of cases we are considering, judging trustworthiness is not the focus: we want to develop the means to restore epistemic trust, that is the priority, and Fricker does not offer a how-to manual here. But if there is a virtue that maps how to determine whether the other is trustworthy, it is puzzling not to consider the virtue of assuring that those who have been subjected to epistemic injustice are now, justly, being trusted. To adapt a passage from Julia Annas, ‘We cannot understand what [a] virtue is without coming to understand how we acquire it’ ANNAS.

I will seek to suggest in the remainder of this paper a means by which those lacking therapeutic years of training might yet achieve a greater proficiency in a critical skill, enabling epistemic trust, which would offer prudential and ethical advantages.

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