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The most important recent contribution to mentalization theory is the construct of epistemic trust. It serves as a bridge from the theory's roots in attachment to its current affirmation of the primacy of social communication. Epistemic trust refers to the capacity to trust in the authenticity and relevance of interpersonally transmitted knowledge. Epistemic trust evolves alongside a stance of epistemic vigilance, which, in many ways, works to buttress and reestablish epistemic trust. Epistemic vigilance is stimulated by ambiguity about trust and thus requires effort to determine whether epistemic trust should be granted or withheld. To date, the emphasis of epistemic trust and epistemic vigilance is on cognition, while the present article proposes that both trust and vigilance integrate cognition with emotion. Both epistemic trust and epistemic vigilance are linked to the construct of mentalized affectivity, the capacity to modulate emotions through reflection on autobiographical memory. Last, epistemic injustice refers to an exclusion, silencing, or undermining of one's capacity to be a knower. Commonly found in testimonials and within systems that minoritize certain identities and backgrounds, epistemic injustice is also prevalent in the context of psychotherapy even with the best intentioned and ethically informed therapists. Ultimately, this article shows how the three constructs can be utilized clinically. A case example is used to illustrate our understanding of each construct and to provide clinical implications for the psychodynamic psychotherapist. A mentalizing stance by the therapist is ultimately proposed as a counterbalance to epistemic injustice.