Introductory Chapter: Psychology and Trust – Who, When, Why, and How We Trust

1. Introduction

We all want to believe that we are trustworthy. Yet no one can be trustworthy all of the time. In some situations, we may not even be able to trust ourselves. When I worked in an eating disorders clinic, one of the challenges for the teens, when they were returning to school, was eating lunch. When they found themselves back in an environment of competition, where discussions between young women took place as to who could eat the least, our patients often could not trust themselves to follow their meal plan. As a team, we discussed with them if there were other options. Could they eat with one supportive friend or in the guidance counselor’s office? Could they find a way to trust the meal plan and do what they needed to do? They needed to eat even while a false voice, their eating disorder, was telling them lies. It would tell them how they were too fat or did not need to eat that much. It was an untrustworthy voice that tried to steer them away from health.

Now, I work with students who often struggle with impostor syndrome. This concept was first described in 1978 when Clance and Imes studied high-achieving women [1]. They described that family dynamics and societal sex-role stereotypes fueled a feeling of phoniness. This phenomenon has been studied in many different groups of high achievers, especially in healthcare. My students often have difficulty internalizing their many successes, with a self-critical voice telling them that they do not know enough. It makes them question whether they should be in medical school. Did they trick the admissions committee into thinking that they were smarter than they were? As a psychiatrist, I encourage them to practice self-compassion even as they struggle to know which of their thoughts they should trust. Should they trust the voice that says they can make it through school or the one that tells them that they are not as smart as the people around them? This internal battle is one that we all face. We work to be honest with ourselves, but sometimes very negative thoughts can pop into our minds. If we fail an exam, we tell ourselves that we are idiots. Sometimes we get those negative messages from people around us. Another view of the impostor syndrome is that it is not the high achiever who feels like an impostor but others in society who label them as that. The individuals in control question whether someone is smart enough, “do they belong in this institution of learning or in a high-level position?” This often happens to individuals of color who face bias and systemic inequality [2]. In my counseling role, students of color describe feeling that their intelligence is being questioned by their instructors. Impostor feelings can not only come from inside but also be perpetuated by those in power.

As we try to trust ourselves, we are faced with the added difficulty of how to trust each other. Ernest Hemingway said, “The best way to find out if you can trust somebody is to trust them.” That is a scary thought. Are there any signs that let us know who we should or should not trust? With so many interactions online, I am often reminded by our IT Department about phishing emails and scams. We have to be skeptical about out-of-the-blue requests or offers that sound too good to be true. We have to develop certain spheres of trust. If you do not know someone at all, they have to earn your trust. The more time you spend with them, the more you will trust them. But what happens when that trust is broken? Is there a way to rebuild trust? With online dating, conversations can abruptly end, phone calls are no longer returned, or someone just does not show up where they said they would be. When that happens, then how do we start to trust strangers again? As we get to know friends, we start to trust them more and more. Until we find that something that we thought was secret got shared with someone else. We may not lose our trust completely, but we might weigh each interaction a little bit more. If I tell them this, can I trust that it will stay between us? Family is typically our closest circle of trust. This is one reason it is so difficult when family members violate it. Emotional or physical abuse happens in close relationships. Child sexual abuse is typically perpetrated by someone the child knows. Abuse can not only affect an individual’s trust in others but also their trust in themselves. If our parents scream, insult or even hit us when they are angry, how do we trust ourselves to be able to handle negative emotions without striking out at someone else?

As a community, how do we trust others to help take care of us? In the United States, there are ongoing incidents of unfair treatment based on an individual’s race or culture. If someone in power has violated your trust, how does that affect your view of everyone in that particular profession? It is often difficult for African Americans to trust the healthcare system because of past practices—with unequal care since slavery and practices that undermined individuals’ health by denying available care, like the Tuskegee Syphilis study. Continued health disparities, like these events, impact how much African Americans trust the medical establishment [3]. As Murray [3] discusses, trust requires a willingness to enter into a dependent relationship in order to have one’s needs addressed. If your trust has been betrayed, by individuals or an organization at large, then it is difficult to rely on that establishment again. You need to be seen as an individual and have your needs understood and met. You need to be heard and your fears and questions addressed. In this way, perhaps, trust can be kindled. It is the ability to trust in the healthcare establishment as a whole and a healthcare provider individually that can begin to reduce healthcare disparities. When individuals trust their physicians, they become more compliant with care and improve their overall health. If, though, one feels that healthcare professionals do not listen to concerns or complaints, it can have an effect on future compliance. I have met individuals who felt that previous physicians did not listen when they expressed concerns or described side effects from medications. This experience of not being heard made them wary to try treatment again even as they were struggling with mental health concerns. Our conversations then focused on what they should expect from the medication and what they should expect from me. If they have a concern, they need to be able to express it and trust that I will take it seriously.

The ability to trust those in a position of power is one chapter in this volume; it focuses on trust in high-risk professions. How do trainees trust their mentors to keep them safe if, for example, they are out in the field dealing with venomous snakes? The authors also address the high stakes of medicine, in which trainees need to trust that they will learn the skills they need to become competent professionals. Yet during the residents’ training, patients also need to trust that if they come to an academic medical center they will receive the competent care that they expect. The chapter looks at the important characteristics of mentors in these relationships. For example, trainees feel that they can trust their mentor more if their mentor is personally invested in their success. That is, perhaps, one of the most important characteristics of trust—that you know the person is not just in the relationship for themselves but in it as a partnership. In interpersonal relationships, there is evidence that trust is built right from the beginning. If a breach happens early on, it is difficult for trust to be developed as opposed to if a relationship has already been established [4]. In those situations, breaches can be handled through apologies or reestablishing one’s trustworthiness. Yet similar to trust, forgiveness requires a leap of faith. As [5] discusses, in close relationships this leap is smaller if past history and present behavior indicate that the partner is not going to take advantage of the forgiveness. If one makes him or herself vulnerable, they want to know that they will not be continually injured in the process.

Trust in teaching is not limited to knowledge. The next chapter looks at teacher personality and inclusiveness. Certainly, mentors and managers have their own traits and quirks. Yet we may need to temper them in certain environments, such as the classroom or workplace. My family is used to my sarcastic sense of humor but that type of humor does not have a role in other facets of my life. I have worked with a therapist in the past who often used humor in sessions, sometimes to a detrimental effect on the therapeutic relationship. When he joked and minimized a patient’s concerns, they no longer felt that they could trust him to understand. He may have been trying to use humor to get them to take a step back or to lighten their struggles. But humor usually needs to come from the individual who is struggling. Some people when they have suffered losses turn to dark humor. That is their coping strategy. Yet they may not be receptive if someone else uses it, and it can feel dismissive of their ongoing pain. How can teachers remain true to themselves but create an inclusive classroom? The chapter looks at characteristics that people bring to an interpersonal setting. They consider that individuals will not only need to be authentic but also respect social structures and values. Managers, teachers, therapists, and everyone needs to recognize that we have experienced the world from our point of view. Our experiences may be very different than what someone else has gone through. For us to trust each other, it is important to not make assumptions that we know how someone feels or sees a situation. We often need to be vulnerable and share how we are experiencing something, but also be open to another’s point of view. When those involved feel like they are being heard, they can more reliably trust the decision. When I worked in the eating disorder clinic, we would sometimes have individuals being considered for admission who some staff felt were not appropriate for the program. It was always important to have a discussion and understand their concerns. Sometimes even if we did need to admit the individual, we could try and adopt a framework that would handle the staff’s concerns. For example, if the patient had violated the staff’s trust in the past, we would work to ensure that situation could not happen again. Even if not everyone agrees on a decision, trust can be strengthened when people feel that they have been heard.

Another chapter examines trust within the workplace and how new managers need to be willing to make themselves vulnerable to benefit from the current team’s knowledge. I have certainly seen this play out in clinic settings. A new administrator wants to appear in charge and implement programs without asking or relying on the experience of the individuals who have worked there for an extended period of time. If asked, employees could have pointed out, we already tried that and it did not work for these reasons. Those conversations do not always happen. Leaders do not want to demonstrate a lack of knowledge. If employees are not asked, they may not offer insights for fear that they will be seen as being negative or undermining the planned project. In 2006, Hurley [6] found in a survey that about half of business managers did not trust their leaders. He describes the impact that a lack of trust can have on a workplace; employees who feel they cannot trust their workplace, describe it as “stressful”, “unproductive”, and “tense”. Those in work environments where trust is present use words like “supportive,” “motivating,” “productive,” and “comfortable.” We can see the huge impact trust can have in many different environments. We all bring our expectations and personalities into work. Some people may be more willing to trust, and others need more proof. It is often important to remember, “The higher the stakes, the less likely people are to trust” ([6], p. 57). If the outcome can significantly impact the individual being asked to trust, they will need evidence that proves the trust will be warranted.

When we think about trust between individuals, we need to consider past trauma. This can impact trust in all aspects of an individual’s life. It can be especially hard for someone who has been abused in the past to be able to develop secure attachments in the present. It can be hard to let people get close. One of the chapters examines relationships with dogs and how this connection can help someone deal with past trauma. Dogs offer unconditional love and trust us completely. Within that relationship, their owners know that they are accepted by their dogs no matter if the owner is flawed (and who is not). Our dogs love us—warts and all. There is a quote, attributed to Bill Murray, “I am suspicious of people who do not like dogs, but I trust a dog when it does not like a person.” We all want individuals in our lives that we can rely on. Yet sometimes learning how to accept trust is by making other connections, such as with dogs. My two dogs are sleeping next to me as I write this chapter. Their trust, comfort, and willingness to be vulnerable are evident when they roll onto their backs and expose their soft stomachs to me. I have earned their trust, and I trust them. If in no other way, then I can trust that they will let me know when it is five o’clock and suppertime.

Comfort and familiarity can help or hinder trust in certain types of relationships. The final chapter of the volume looks at psychological interventions in forensic settings. The author considers the transference and countertransference that can occur in those relationships. Transference is the experience of a patient attaching emotions to their therapist that typically are related to past interpersonal connections, such as from childhood. Countertransference is the feeling that the therapist might experience, which is from their past and not directly related to the patient. This occurs in many relationships; we attach feelings left over from past relationships to someone new in our lives. For example, if a family member is often critical, then even simple feedback can trigger an emotional response. It can push buttons left over from those important and emotionally charged relationships. In psychotherapy, it is important to recognize how transference and countertransference can impact the therapeutic relationship. Sometimes it can be positive. Individuals can view the therapist as a healing variation of a past important person and work to understand how to trust again. Sometimes the transference can lead to negative situations when an individual feels acutely betrayed by a therapist that he has developed feelings for. I witnessed this when I worked in a forensic unit. All close relationships, especially those in therapy, can trigger intense feelings. It is the role of the therapist to help the therapeutic partnership navigate those emotions. This chapter offers a fascinating view of the emotions that can impact an individual in life and in the therapy and the engagement of trust.

Trust is important in every aspect of our lives. We need to be able to trust ourselves and know that we are making our own authentic decisions. At times, our minds will present thoughts that are not healthy for us. These thoughts hold us back and can keep us from taking risks. If we do not trust our skills and talents, we may not reach for new and exciting opportunities. We need to find mentors who we can trust and whom we know are working with us from an authentic place. They want to support us and help us to succeed. This is important in the manager, teacher, and therapist role. When we have more power in the relationship, we need to demonstrate that the other person can trust us. We will not betray and belittle them. If they make a mistake, we will provide support and guidance to help them learn. Yet while providing that guidance, mentors also need to make certain they keep themselves safe. Someone with a lot of experience can forget how much they know and how little their trainee does. We need to remember this as teachers, physicians, and scientists working in high-risk professions. Do not stick your hand in a bag unless you are sure that there is not a venomous snake inside. A deadly lesson. But one that can be shifted to many situations. When teaching a trainee, they need to gradually earn your trust by demonstrating that they have learned the lessons that you taught them. In our various roles, we may have to admit to deficits in knowledge so that we can learn from others around us. We have to trust that they will not use this admission against us. That they will not use any struggles or requests for help as evidence that we do not belong here. At times, we may remain on the defensive as we work to learn whether we can trust another person. They can gain our trust by showing understanding and compassion. That is important for mentors, physicians, teachers, managers, anyone in power, and really for everyone. We can begin to trust through our initial interactions, but it will be actions that truly demonstrate whether someone can trust us and if we can trust them. Hopefully, this volume can help provide some insights as you develop your ability to trust and be trusted.