We hope our findings can guide therapists in recognising both visible and subtle signs of epistemic mistrust - and in finding ways to reconnect before young people quietly disengage from care. This study helps us listen more closely to what trust really looks like in the therapy room, and how we might build it when it’s absent or repair it when it’s at risk.
The Repairing Epistemic Mistrust and Securing Engagement in Therapy (RESET) Study
A secondary data analysis on dropout and epistemic mistrust among adolescents diagnosed with major depressive disorder.
The Repairing Epistemic Mistrust and Securing Engagement in Therapy (RESET) Study
Many adolescents leave mental health treatment early, often because they feel therapy is not helping. This project focuses on a subgroup of adolescents who end therapy feeling dissatisfied, aiming to understand the relational and psychological processes that may contribute to these experiences.
The secondary data analysis study explores why some young people disengage from therapy and how difficulties in trust and communication in adolescents—particularly in therapeutic moments of tension or disconnect—might influence a young person's decision to stop therapy.
By analysing recorded therapy sessions, the research will examine how these challenges unfold and whether specific therapeutic responses may help repair moments of strain and improve engagement.
The findings aim to support therapists working with adolescents who are at risk of disengaging from care.
Co-Principal Investigators: Dr Elizabeth Li (University College London and Anna Freud Centre) & Dr Sally O’Keeffe (Newcastle University)
Funder: British Association for Counselling and Psychotherapy (BACP)
Study benefits
Identifies signs of epistemic mistrust and trust in therapy sessions
Develops a coding tool to identify signs of epistemic mistrust and trust in therapy sessions, with direct insights from our young people advisory panel.
Explores how epistemic mistrust influences adolescent therapy dropout
Improves understanding of why adolescents disengage from therapy, particularly how epistemic mistrust—difficulty trusting and learning from others—may shape their experience of therapy and influence their decision to leave.
Supports development of trust-focused, dropout-prevention therapies
Contributes to more responsive and adaptive therapeutic approaches that build or repair trust and prevent dropout.
Enhances therapist training to better support at-risk adolescents
Informs training and supervision of therapists, helping professionals better support adolescents at risk of disengaging from mental health care.
Relevant publications:
Li, E., Midgley, N., Campbell, C., & Luyten, P. (2025). A theory-building case study of resolving epistemic mistrust and developing epistemic trust in psychotherapy with depressed adolescents. Psychotherapy research, 1–19. Advance online publication.
Li, E., Midgley, N., Luyten, P., Sprecher, E., & Campbell, C. (2022). Mapping the journey from epistemic mistrust in depressed adolescents receiving psychotherapy. Journal of Counseling Psychology, 69(5), 678–690.
O’Keeffe, S., Martin, P., & Midgley, N. (2020). When adolescents stop psychological therapy: Rupture-repair in the therapeutic alliance and association with therapy ending. Psychotherapy, 57(4), 471–490.
O’Keeffe, S., Martin, P., Target, M., & Midgley, N. (2019). ‘I just stopped going’: A mixed methods investigation into types of therapy dropout in adolescents with depression. Frontiers in Psychology, 10, 75.
O’Keeffe, S., Martin, P., Goodyer, I., Kelvin, R., Dubicka, B., IMPACT Consortium, & Midgley, N. (2019). Prognostic implications for depressed adolescents who drop out of psychological treatment during a randomised controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 58(10), 983-992.
O’Keeffe, S., Martin, P., Goodyer, I., Wilkinson, P., IMPACT Consortium, & Midgley, N. (2018). Predicting dropout in adolescents receiving therapy for depression. Psychotherapy Research, 28(5), 708-721.
For more information, please contact elizabeth.li@ucl.ac.uk and sally.o'keeffe@newcastle.ac.uk.
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