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Psychoanalytic and attachment theories offer important insights into the internal experiences of caregivers who struggle to understand and meet their children’s needs. Increasingly, efforts are being made to operationalize these theories to identify mechanisms that contribute to effective intervention outcomes. Epistemic trust (ET) has been proposed as a central mechanism of change in successful therapies, but more empirical evidence is needed. This study uses Edleson’s theory-testing case study methodology to examine ET within a mentalization-based treatment (MBT) program for a caregiver involved with child protection services. Four hypotheses were tested for a parent presenting with high epistemic mistrust (EM): (1) a history of adverse childhood experiences, (2) presence of mental health difficulties/diagnosis, (3) impaired mentalizing abilities, and (4) measurable benefit from the MBT intervention. One parent met the inclusion criteria. Although not generalizable, this case study supported the first three hypotheses relating to ET theory, yet draws attention to the need for further theory development relating to co-occurring high EM and high credulity. The fourth hypothesis showed mixed results: while reflective functioning did not improve, EM and credulity both improved post-treatment. These findings highlight how ET theory offers a clinically meaningful framework for understanding change processes in MBT interventions.