Episode 75 Transcript: Trust and Building Real Bonds in Therapy

 Guest: Jon Allen, PhD

Distribution Date: Monday, Feb. 16, 2026

 

Today we're delighted to have Dr. Jon Allen. Dr. Jon Allen, he's an accomplished author. He holds a position of clinical professor as a member of the voluntary faculty in the Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine. He's also a member of the honorary faculty at the Houston Psychoanalytics Society and the adjunctive faculty at the Institute for Spirituality and Health at the Texas Medical Center. He retired from clinical practice as a senior staff psychologist after 40 years at the Menninger Clinic, where he taught and supervised fellows and residents, conducted psychotherapy, diagnostic consultations and psychoeducational programs, and led research. And he does continue to mentor here, by the way, and is  still a very valued member of our team. Dr. Allen, so  we we really want to talk today about the issues of  trust and psychotherapy, which I know you you've written about quite a bit, including an excellent book. So can you tell us just a little bit how you got interested in the subject and maybe address why you think it's like crucial to psychotherapy?

 

Good. Well, thank you for that introduction and for this opportunity,

 

because I really  have thought deeply about trust for quite a while now. And it's great to have a chance to share this knowledge. I actually would say that I got prepared to think about trust   30 years ago   at Menninger when we started a   trauma program for mostly patients who had been traumatized in early family relationships. I came up with a very simple   understanding of the essence of trauma, relational trauma in particular, is feeling alone and invisible in pain and suffering. And the alone and invisible part is what I want to emphasize. So I discovered this was in the mid-80s that a bunch of us started   to realize with the psychiatry as a whole, started to realize the significance of trauma. And   so we developed this program, and I developed an educational group for patients, in addition to doing therapy. But I discovered attachment theory, which I'd never been taught about. And secure attachment, you can imagine in this context, you know, alone in pain, secure attachment. Wow, that is that's where the action is. The benefit of attachment is also there's a wonderful research literature.

 

Right.

 

So this is very solidly empirical work. So I was that got me into the territory of trust, even though I wasn't thinking specifically about trust. But then recently, as I homed in on trust, there's a fascinating thing about it. So I have talked with patients, groups, students, therapists. If I ask, you know, how many of you think trust is really important in psychotherapy? Everybody agrees. Yeah, really important. But trust is neglected in the psychotherapy literature. You'll see the word used in passing all over the place.

 

Yes.

 

But rarely does anybody think about, okay, well, how do we understand trust? What do we mean by that? We take our understanding for granted. Now there are two exceptions that I know of. There may be more, but Jon Gottman, who does family work, marital work, he belatedly in his career said, Hey, it's all about trust. The other one is Peter Fonagy, my colleague and friend, who I've worked with for 25 years, and he he's been   contributed to Menninger's work a lot. Peter Fonagy, Ditto, late in his career, said, trust, really important. Now there are two things that Peter focused on. One is especially important to me is we think of trust as part of the process of therapy. We need to create trust to do the work of therapy. But he that's all true. But he says, well, wait a minute. Trust is an outcome of therapy, an outcome of therapy. It's great to trust your therapist, helps you do the work, but what's crucial is trust in your relationships apart from therapy. The benefit of creating trust in therapy, then, is to generalize it beyond the therapy. And Peter also talked about one dimension of trust, which is he calls epistemic trust, that is, trust in the knowledge that's being communicated to you. But I think there are many other aspects of trust.

 

I know we're gonna talk about that more, but maybe just

 

 as before we get to too deep into this, can you maybe just   a basic definition of what you mean by trust? Okay. Yeah.

 

This comes from early developmental research. Okay. This is my take on it. We develop the capacity to trust   by three years of age. The core of it, as I see it, is that trust is basically cooperative, it's a joint cooperative endeavor. And by three years of age, you know, the child has learned to form joint commitments to a goal. Okay, let's build this together. And if the parent quits on, you know, without reason or explanation, the child protests. You know, there was at least an implicit and sometimes explicit. So that it's a capacity for cooperation. And the cooperation, the goal is the well-being of the trusting person. It's all about well-being. You know, you somebody you ask somebody for a ride to work, and they show up because they're concerned that you need a ride to work. Yeah. So that that may sound really simplistic, but I'm answering your question. Yeah, absolutely.

 

One thing I have appreciated so much in in the work that you've done even before this book, Dr. Allen, is you name something called plain old therapy. Um, and this idea that the common factors that underlie almost all the different quote-unquote flavors of therapy, if you will, tend to be what drives the change process. And in this book, and I don't know that we actually said the name of your book, it's trusting in psychotherapy. You've talked a little bit about the common factors and explain it, I think incredibly well what they are and why they're so critical in doing psychotherapy. And I wonder if you can share with us a little bit about how you see trust fitting into that, into this common factors approach.

 

Yes, well, that's a that's a great question, I think, because it really cuts to the chase. I think there's an irony in the field of therapy, and that is that therapists have developed literally hundreds, hundreds, several hundred brands of therapy. Okay, so you got all these methods, all these techniques. It is, in my view, the field is a mess.

 

And sometimes people seem to adhere religiously to one, and while all the other ones aren't, you know, yeah.

 

Exactly. Right. But the challenge is to integrate. Each one of us therapists has a challenge to integrate from all this knowledge which we couldn't begin to master. Okay.

 

That's right.

 

Now, here's the irony that for decades the that it's been known that actually what's common to the therapies is more important for the outcome than the differences among them. The first publication, the American Journal of Orthopsychiatry, 1936. So it's been nearly a century.

 

Orthopsychology --phone psychology? No, no, I meant integrative psychology. Oh, okay. Gotcha, gotcha.

 

Don't mind me.

 

So that was proposed. There's a psychologist by the name of Saul Rosenzweig, but now we have tons of evidence that the common factors have more of an impact than the differences in brands, in methods, in techniques, and so forth. Now, so what are the common factors? Well, I'm going to give you two examples. One is Carl Rogers, a psychologist writing in mid-century,  and he said   the therapist, three things. The therapist needs to be empathic, to show positive regard, acceptance, and to be genuine, authentic. He said, and he said, if you do that, you've you those are the necessary and sufficient conditions for effective therapy. I don't, I think they're necessary, I don't think they're sufficient. Because the irony is we need some methods and techniques. You have to figure them out what you're going to use. So we don't dispense with methods. But the key is the and the other big one is the therapeutic alliance.

 

Right.

 

In over 300 studies, 30,000 patients in research on the alliance, and it is the biggest contributor to the outcome. So think about the quality of the relationship as the fundamental impactful aspect of psychotherapy. I'm not dispensing with methods and techniques or theories. We each need to figure them out, but it's going to be the quality of the relationship. So trust, trust is not a common factor. It's not among the ones that have been studied. I found it in a list of 31 common factors. But it didn't, it's not. So I think of trust as the superordinate   common factor. It's kind of a way of thinking about, you know, Rogerian factors, alliance. The alliance is collaboration on goals. See, that goes, that's what I was talking about.

 

Dr. Bob Boland: 10:53

Well, I imagine you can't have a alliance without trust.

 

Right. Not really. It's kind of a broad way of thinking about all the common factors.

 

And and you can't my  sense too is you can't do the methods and the other important things without the alliance. So you're right, in so many ways it can boil down to trust. Without that trust, this is very, very difficult work. I was going to say impossible, but I think very, very difficult.

 

Dr. Jon Allen: 11:18

Very difficult, I would say. Yeah. The like the alliance, that we don't like trust, we can't take the alliance only as a process. See, we like you need alliance to get the therapy going with very distrusting patients. The alliance would be   be the optimal outcome of the therapy.

 

Dr. Kerry Horrell: 11:38

Yes, right.

 

That's what I was thinking when I said the alliance goes, you know, up and down, and repairs of rupture are crucial.

 

As the word impossible was like coming out of my mouth, I stopped myself because I thought, well, that's not true, because I have worked with so many mistrusting patients. So it's not that without that, you can't do the therapy. That is the therapy, but it is quite difficult.

 

We can imagine many of the patients we treat have a lot of trouble problems with trusting developing minds, maybe especially at Menninger. Yeah, sure. Right. But you know, you already made reference, by the way, to um one type of trust. Uh, that what was that again that Peter Fonagy called it?

 

Epistemic trust, trust in knowledge.

 

Yep.  But you said that there's other ones. So I'm curious, like what how do you divide it up or how do you think about it?

 

Here again, I as Kerry said, I like plain old therapy and plain old simple. I like simple ideas. The trouble is I like so many of them. Simple is good though. Take a so the basic division I make is between care and competence. Think about going to a physician, right? Well, of course, you want them to be competent, but you also want care. It's a two by two. You can imagine, you know, competence without care, care without competence, both of them is what we want. But neither of them would be really, really poor. So that and that's a kind of dyadic way of thinking, which is, you know, I'm doing mainly did individual therapy. So , but then we have, in addition to the dyadic trust, we have social trust, which is the trust in groups, a family group, , you know, a group of friends, a group of peers, and all the way into the community. So that's that competence, by the way, for for those that kind of trusting in peers, the way we should do things,  is   that develops by age six, according to the research that I've used. So we've got care and competence, we've got social trust, then self-trust is very important and hugely problematic for many of our patients who don't trust themselves to take care of themselves,

 

 to they don't trust their judgment. And distrust, we need to think about distrust, shades of distrust. Such as well, shades of distrust. We need to be distrusting. It's crucial. We need to be trusting, we need to be distrusting, and we need to get both of them right.

 

I have to say, so I have had the opportunity to teach Dr. Allen's curriculum in the trauma group on Hope for a year, alongside a wonderful social worker named Lynn Quackenbush. And I learned so much that year following that curriculum. I was the one teaching it, but boy, and I was also learning it as we went through. And one of the things we talked about was for people with trauma, they have a hard time discerning between trust and mistrust and who to who to trust and who to be more mistrustful of them. They tend to trust the people they shouldn't, and they don't trust the people they shouldn't. And we kind of called it their internal compass for trust is just can be wonky. Um, and so I wonder if that's what you're thinking about with distrust. There are people you shouldn't trust and being able to discern that is difficult.

 

It's a survival skill.

 

Right.

 

Right. In fact, right, there's a genetic disorder of people who are trust who trust everyone, and that's not a good survival skill.

 

It's a genetic disorder.

 

Um was it Wilson's disease, I think? No, no, not that. Um Williams, maybe I forget. I'm sorry.

 

That's fascinating.

 

Oh, yeah, Williams. I think right. I think it's Williams, right? Yeah, Wilson's is a   kidney.

 

So one of the things that never mind.

 

It doesn't really matter.

 

One of the things that you talk about in your book and in your work is then the idea of working towards, as the therapist, becoming trustworthy, and then also using the therapy to restore trustworthiness. And I think this is probably, as you're saying, an area of limited   training. Like most people are just, well, be trustworthy. Well, what the heck does that mean? And how can actor how can traitors be actively working on developing trust as a trait, as a skill? I actually don't know how you would define that, but how is that something people can be working on?

 

Yeah, so boy, this is this is a big broad question. And again, it's really crucial. So it if we neglect try, we don't think about trust enough, you know, wow, trustworthiness hardly ever enters our mind. But the crucial point is that it owns this this flows from what we were just talking about. Trust is reasonable in proportion to trustworthiness. Distrust is reasonable in proportion to lack of trustworthiness. So you use the word discernment. That's  the one I use. What we want to do is create discerning trust and discerning distrust. See, we focus

 

 too much on the patient's distrust. I think patients distrust, traumatized patients, is reasonable. If it's discerning and the and being too trusting gets them into trouble. So you see them going flipping from you know, one trusting sort of naively   to being very distrusting. So we got to get   in the middle. I think the problem is not the patient's distrust, the problem is they're missing opportunities to trust people who are trustworthy, and that's then our responsibility as therapists is to become trustworthy. Out of the gate, as you were implying, Kerry, out of the gate, be reasonable for patients to distrust us. If that's been their experience. So we have to demonstrate our trustworthiness and should not take it for granted. Becoming trustworthy in a relationship with a person who has difficulty in trust is not easy. We're going to make mistakes, we're going to fail them. We're going to  need to learn how to be trustworthy with them.

 

I was just saying, maybe the pull or the draw is   overly pathologize the patient as if they should just, I'm a therapist, they should just trust me. And in the ways they don't trust me, it's like that's their problem. Where I again, it's sort of like it's hard to think about it dyadically for me sometimes.

 

Yeah, I mean, a way when you think of it, it's amazing patients trust us at all at the start. I mean, they haven't they've barely met us, and we're asking them to tell them intimate details about their lives that they've maybe not told anyone else.

 

Yes, exactly. So I want to address the issue about how we become   trustworthy. Yes, yes, please. Yeah, you when I think about therapy is a personal, a personal endeavor. That is, it's our person that is that is really the main determinant of the effectiveness of our work. Now we begin developing our capacity for trust. As I said, in the first years of life, we beginning begin developing our trustworthiness in the first years of life. I believe that the knowledge we bring to the conduct of psychotherapy, I'm setting aside the manualized, you know, behavioral kinds of approaches. Uh the knowledge we bring to therapy is mainly from our history of close relationships. Mainly. That's the source of our expertise as therapists. So we're already pretty grown up by the time that we start acquiring professional   knowledge, which is superimposed. But here's the real rub of trustworthiness as a therapist. Mainly it's going to be on the nonverbal level, as it was early in life. Your manner, how you respond, you know, your tone of voice, you know, it's  at the kind of gut intuitive level, the capacity to interact with another person. And mind you, in the most challenging of circumstances where they're in excruciating pain that is hard for us to bear, how we bear it, the shame they feel when they confide in us, how we respond to what feels shameful to them. All of this is going on that we start learning early in life, for better or for worse, and continue, and we don't have all that much control over. If we try to control our nonverbal way of being, it is just we look, you know, wooden crazy odd, it's just weird. So, you know, it's it's it's a paradox that the most important thing that we need to do is be trustworthy at this kind of implicit nonverbal level. And it's the thing that we have the least control over.

 

I feel that resonates so much because in my very first class, it was a pre-practicum class, we were given tips on things like how what to do with our hands and how to like they gave us all this instruction about our body language, and

 

 I just felt paralyzed. I was like, I don't know what to do with my hands, and am I nodding too much? And oh my gosh, I agree. It's that that is really hard to um make up or to you can't be someone else, yeah.

 

Exactly. It's being natural in the most difficult interpersonal situations, and what's natural, you know. So that's and now I don't want to downplay understanding in being trustworthy, our knowledge and our professional skill, or just short of any professional skill, our capacity to understand what's going on inside ourselves and other people, what Peter Fonagy calls mentalizing, is this is this is crucial because they need to feel understood. But it's this bedrock, you know, that I think without the bedrock of a feel for the other person as trustworthy, basic trust, as Erickson called it, the care, the feel you have for it. Without that, I don't think the understanding is going to do the job.

 

Yeah.

 

I wonder if this question is too big of a question for this moment. That's okay. But how would something like countertransference play into this? I'm thinking about a patient I worked with a few years ago who, upon first meeting with me within five minutes, said, I can already tell you are too much like my mother. I will not be able to work with you. And then, you know, there was such, and this patient was actually older than me at the time. There were so many reasons why I thought this doesn't have much to do with me. Um, how does countertransference and the reactions patients have to us then impact our ability to do some of this working on trust?

 

Yeah, I'm not keen on transference and counter-transference as concepts, which is horrendous. Can you say more about that? Well, I think about learning. We all learn how to relate in in our prior relationships. That's what I'm talking about. We all transfer and counter-transference. Well,  it's a response to the way you're seen by a person. But I think the issue is the source of our feelings as therapists, there are many sources, and being seen in a way that feels us to us very distorted, you know, has  a kind of impact. But I think we are operating in the realm of feelings. And those feelings come from all over the place, they come from the way the patients treat us, they come, you know, from what's going on inside us. I think and the feelings are natural. I like the idea of natural reactive feelings. And the idea that we're supposed to be machine-like makes no sense because if we're talking about our emotional responsiveness, is where the therapeutic action is, and how we respond to being seen in ways that just don't seem to fit. You know, we have to deal with that, not just patients, but in life. I mean, everything we say about therapy relationships pertains to close relationships. Rogers, you know, it's good to be empathic, have positive regard, genuine. That's good relationship. Yes, therapeutic alliance. You know, we agree to do something, you know, we have a goal, you know, we stick with it. We're just talking about good relationships. And so I think these labels can be a little thrilling, especially if we think we're not supposed to have strong negative feelings, which are utterly natural and unavoidable.

 

Well, I always worry when we talk about   counter-transference and transference that we're just kind of over kind of like over-clinicalizing something that's just normal behavior and normal reaction. I mean, presumably we react to the people based on how other relationships have been in our past.

 

And I just seems, you know, the thing the thing I'm thinking about though is it maybe earlier you were discussing this, Dr. Allen, is what can we do with patients who are mistrusting us in that way where it's totally understandable, it's coming from their past. Maybe I'm thinking about how helpless I feel sometimes working with patients who immediately mistrust me. And I'm like, how am I supposed to demonstrate my trustworthiness when you've when it feels like you've kind of already marked me as you know, because of other relationships you've had. How do we do that?

 

I imagine it's a lot of what we do, right?

 

It is indeed. I I like what you said, Bob, about this. These are, you know, these are natural ways we respond in all relationships. I I think Kerry, one thing you learn immediately from that patient is how other people are liable to feel in relation to that patient. And then thinking about, okay, well, what needs to change so that the again, the action is outside the therapy. What you know, we want to help people, you know, relate in ways. And this goes to another crucial point I really want to make. We need to think about reciprocity. So we think the patient needs to be trusting the patient, the therapist needs to be trustworthy. Now, let's think the therapist needs to be trusting of the patient. If I don't feel safe with the patient, I can't think straight, I can't do good work, I'm gonna be unnatural because I'm gonna be inhibited and constricted. So I need to trust the patient, and therefore the patient needs to be trustworthy. And if the patient is going to have good relationships outside the therapy, trustworthiness is gonna be crucial. So that's where it's really helpful. Now, how do you get there? A terrible and a good answer. Skill in being human. That's what I think. Skill in being human. Now, the vagueness of that is ridiculous, okay? But it shows you that you know, somebody who teaches you how to hold your hands and blah blah blah. This is it's not gonna help. You can't so if we we could say, boy, I'm a therapist, I want the algorithm therapy, the manualized therapy for skill in being human, because that's what I really need. See, this whole thing is ludicrous. So we can't control you know some of so much of how we come across nonverbally. So   I do have one thought about okay. One more thought. Yeah. So transparency. Transparency, this is the opposite of the old classical psychoanalytic stereotype. It is on the other extreme. Transparency. Let that person know what you're thinking, how you're feeling. This is not easy. Tact, we need tact and restraint, but openness is the so, you know, what you'd want to get to with that patient, Kerry, is this making this discussible. You know, it's interesting to me that you see me like your mom. And I need to know more about what she was like, and then I want to let you know how I see myself. Now one thing that's really important is patients, like therapists, will see things in you that you don't see in yourself. And you can learn from them because they are analyzing you all the time. Yes. And they're sensitive and responsive. And so they're sort of therapizing you. You they have to educate you about what they need. And so we need to be open to their views and compare our views. Wow, that's interesting. You see me as being impatient. Well, what well, as a matter of fact, I am feeling kind of frustrated.

 

This kind of gets into the notion of like self-disclosure and stuff. And to what point do you tell people about yourself? I mean, of course, I can just look you up on the internet, I can learn things about you.

 

You're well known. Yeah, it's this is really it's great because it's it's so important vis-a-vis the trustworthiness of the therapist. One very useful distinction is between self-revelation and self-disclosure. Self-revelation is what with you know, our sex, our age, our race, our manners, our where our office is, what it's like, and then now what's on the internet. This is all out of our control. They learn a ton about us. Sure. I think our patients know us very well, even if we disclose no personal information. What I like to do is with the idea of transparency, is to say as much as I can about what I'm thinking and feeling about the patient, about the relationship, and about myself in the relationship. Now, personal information, I think this is very controversial. It's complicated. There are advantages, there are disadvantages, but I think to focus too much on that is beside the point, because they know you as a person in that relationship. And I like to be as open as possible about what's going on in me vis-a-vis that relationship. I actually made a policy of writing personal, I call them personal formulations where I would summarize my understanding in writing and give it to the patient. Here's what I'm thinking. This is my sense of you, your development, the therapy, where it is, where it needs to go, put it all on paper and let them, you know, see it and critique it.

 

It's so powerful.

 

What do patients make of that? Uh, the most common reaction is that they're amazed by how much time and thought you've put into their treatment and appreciative of it.

 

I've  also found because I from learning with Dr. Allen through my training, I have also taken to doing this. And I think one of the things that I've noticed the most is that patients feel both amazed by the fact that so much of their life can be   summarized in a few pages, but also in some ways somewhat horrified. They're like, here it is, my whole life in two pages. Like there's something also quite destabilizing it for many of my patients.

 

Maybe you have to write a little more.

 

Yeah.

 

Well, I  think, you know, if you don't want to reduce the patient to what you've put on paper, it's your thinking that you've put on paper, what you're thinking about them. I think the hardest thing for patients is when you summary  a history of trauma, for them to say told you. See, what I put in those is 99% what the patient has told me. But seeing this, oh my God, you know, this, this, this, this happens. That can be daunting for patients.

 

Dr. Allen, I've I have been appreciating this conversation so much. I think you're getting at, like we said, the very core of what is needed to be working on, working with people in psychotherapy. We're  so grateful that you came and shared with us.

 

Yeah, I appreciate just the kind of the real world and kind of natural way that you talk about things too. It's in a way, it's very reassuring.

 

Yes. Yeah. And so as a reminder to our listeners, we've been talking with Dr. Jon Allen about the concept of trust, but also about his recent book, Trusting in Psychotherapy. Dr. Allen, would you like to have the last word, anything that you would want people to walk away with?

 

I do want to have the final word, and I was prepared for this question. Okay, shoot. My final word is we're talking about ideals. We have a political assault on trust in our society. Epistemic trust, trust in knowledge, fake news, alternative. Facts don't matter anymore, right? Yeah, really good plan. We had social trust and trust, you know, vaccines and masks and so forth. This this is a profoundly problematic social situation we're in. And     distrust that is actively abetted, I think is is creating havoc. I'm not sure what its impact is on therapy, but   it's well, I think it undermines all authority in a way, don't you think? Yes, the good point that that is a but you have the last word, not me. I'm sorry.

 

 No, I no, I think that's a good clarification. So I just want to say, you know, for people who listen and think, God, does this guy live in a cave when he's talking about trust? I  don't. I would I'd like to.

 

Gosh, well, thank you so much, Dr. Allen.  And as a reminder, we've been your hosts. I'm Dr. Kerry Horrell.

 

Dr. Bob Boland.

 

This has been the Mind Dive Podcast. Thanks for diving in. The Mind Dive Podcast is presented by The Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

 

For more episodes like this, visit www.menningerclinic.org.