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Personality / Capacities

Capacity for Trust, Empathy, and Intimacy

This capacity is about how we relate to the people who matter to us. It has three strands. Trust is the ability to rely on others without being either constantly on guard or naively credulous. Empathy is the ability to grasp what someone else is feeling and to respond to it with care. Intimacy is the ability to move closer to and further from people as each relationship and moment calls for, without losing yourself or losing them.

The Psychodynamic Diagnostic Manual (PDM-3) treats this as the seventh of its 13 “M-Axis” mental capacities, in the domain it calls Identity and Relationships. The previous edition called it the capacity for relationship and intimacy; PDM-3 renamed it to bring trust and empathy into the name (Lingiardi, Muzi, & Bornstein, 2026, p. 710). The manual’s description reaches below the surface of a person’s social life to the “internalized object relations” underneath it: the mental pictures we carry of ourselves, of other people, and of what happens between us (p. 723).

Nobody is equally good at all three strands, and most people trust, empathize, and draw close more easily with some people than with others. The manual itself notes that a person may function somewhat differently in the three areas, and asks clinicians to focus on whichever is most telling (p. 723). A rating here describes a pattern, not a verdict on whether someone is lovable or kind.

Across the Range

Like every M-Axis capacity, this one is rated from 5 (healthy) down to 1 (severely impaired), with written descriptions for levels 5, 3, and 1. The anchors below are paraphrased from PDM-3 (Lingiardi et al., 2026, p. 724).

5: Rich and flexible
People at this level have deep, emotionally rich relationships, and their care and empathy hold up even when feelings run high or life is stressful. They can give support and take it. Their trust is selective: they can extend it and also withhold it when that makes sense. Relationships are a source of pleasure, comfort, and security for both sides.
3: Present but disrupted
The capacity is real but gets knocked off course by anger, shame, or fear of separation. Under stress the person may pull away, act out, or cling. Some find it easier to give support than to accept it, or the reverse. Empathy may be too thin, or so porous that other people’s feelings flood in. Trust may tilt toward moderate suspicion or toward taking in whatever others say without discrimination. In hard times, relationships become confusing, painful, too distant, or too sticky.
1: Severely limited
Relationships are shallow and organized around the person’s own needs, with little mutuality. The person may seem aloof and isolated. Empathy may be absent, purely self-serving, or used to manipulate. Trust tends to fail in one of two directions: either nothing anyone says can be relied on, or nearly anything is believed, leaving the person open to exploitation.

One idea in the manual deserves special mention: epistemic trust, a concept that Peter Fonagy and colleagues brought into psychotherapy (Fonagy & Allison, 2014). It means trusting that what other people tell you is genuine and relevant to you, so that you can learn from them. PDM-3 asks clinicians to consider it as part of this capacity, and notes that it rests on early expectations about whether others are competent and well-meaning (p. 723). The manual also folds sexuality into intimacy: awareness of one’s own desires, freedom to enjoy them, and the ability to join sexuality with emotional closeness (p. 723). It distinguishes cognitive empathy (taking another person’s perspective) from affective empathy (feeling with them and responding sensitively), and it notes that healthy adult relating includes connections of different depths, from acquaintances and colleagues to close friends and partners, along with the ability to set limits (p. 723).

How It Develops

PDM-3 describes the capacity as resting on early experience. In the adolescent chapter, it is said to depend ultimately on the attachment patterns formed in childhood and on how coherent the resulting “internal working models” are (Tanzilli & Malberg, 2026, p. 433). Internal working models are attachment research’s term for the inner maps of self and others that let us anticipate how relationships will go (Lingiardi et al., 2026, p. 734). Caregivers who are reliable and attentive, and who mirror a child’s feelings back in a recognizable way, teach that other people are worth learning from, which lowers the child’s guard and opens the channel of trust (Tanzilli & Malberg, 2026, p. 433).

Adolescence reorganizes all of this. The people who activate attachment needs gradually shift from parents to peers, and teenagers have to work out whom it is safe to learn from while also wanting to belong (p. 434). PDM-3 sketches a progression from early teen friendships based on concrete similarities, to more mutual and self-disclosing relationships in the mid-teens, to a late-adolescent focus on stable, chosen partnerships and better judgment about whose information is reliable (pp. 435–436). The manual stresses that individuation and intimacy are complementary rather than opposed at this age (p. 434). For young adults, PDM-3 recalls Erik Erikson’s stage of “intimacy versus isolation” (Tanzilli, 2026, p. 645).

In later life, sensory loss, illness, and growing dependence on caregivers can strain relationships, yet the capacity for relatedness may be preserved or even deepen (Del Corno & Plotkin, 2026, p. 912). There is evidence, the manual reports, that older adults may lose some cognitive empathy while keeping or gaining emotional empathy (p. 912).

How It Shows Up in Personality

Because relationships are where personality is most visible, nearly every style touches this capacity. A few patterns stand out in the literature.

Level of organization matters as much as style. McWilliams (2011, p. 55) suggests that people vulnerable to psychosis are unconsciously preoccupied with the issues of the earliest, “symbiotic” phase of development, especially trust, while, in Erikson’s terms, those at the neurotic level have largely traversed the stages of basic trust and autonomy (p. 58). People at the borderline level have more capacity to trust than those at the psychotic level but may take years to form a solid working alliance (p. 84). The capacity is closely tied to mentalization, since empathy depends on imagining another person’s mind, and to differentiation and integration, since intimacy requires telling self and other apart.

How Different Thinkers See It

Erik Erikson

Erikson recast Freud’s oral stage as a period of total dependency in which basic trust, or its absence, is at stake (McWilliams, 2011, p. 24). His life-span scheme later placed “intimacy versus isolation” in young adulthood, after the adolescent work of identity (Tanzilli, 2026, p. 645). In this view, trust is the floor on which later intimacy is built.

Attachment theory

McWilliams (2004, p. 303) credits John Bowlby with calling attention to the centrality of dependency needs in human motivation. PDM-3 draws heavily on attachment research for this capacity, recommending the Adult Attachment Interview as a way to assess it and describing internal working models as implicit rules for how one “lives in relationships” (Lingiardi et al., 2026, p. 734).

Heinz Kohut

In his first major article (1959), Kohut argued that we can only bring another person’s unknown inner experience to life by imagining ourselves in their place, a process he called “vicarious introspection” (as summarized by Peri Herzovich & Govrin, 2021). Empathy, in this view, is a way of knowing, not just a way of being kind. His later idea of selfobjects, people whose affirmation helps hold our self-esteem together, describes why losing them can leave us feeling diminished (McWilliams, 2011, p. 182).

Melanie Klein

Klein described a developmental move from the paranoid–schizoid position to the depressive position, in which the child comes to grasp that the caregiver is a separate person with a separate mind (McWilliams, 2011, p. 25). McWilliams (p. 172) describes the aim of work with patients with psychopathic dynamics as helping them toward that depressive position, where others become separate subjects worthy of concern. For Klein, then, concern for others is an achievement of development rather than a given.

D. W. Winnicott

Winnicott wrote about the universal need to keep a sense of a true self despite the compromises the environment demands (McWilliams, 2004, p. 303). When a child is valued only for a role, a “false self” develops, presenting what has been learned is acceptable (McWilliams, 2011, p. 183). Intimacy in this frame means being known as one actually is, which a false-self adaptation quietly prevents.

Mentalization research

Fonagy and colleagues, whose work on mentalization underlies this idea, treat trust as partly a matter of knowledge: whether you can take in what others communicate and revise your picture of the world (Fonagy & Allison, 2014, as summarized in Tanzilli & Malberg, 2026, p. 433). PDM-3’s inclusion of epistemic trust, and its warning that both excessive mistrust and excessive credulity are impairments (Lingiardi et al., 2026, p. 724), comes from this tradition.

Examples

Kai: learning to trust

One case in the PDM-3 online supplement describes Kai, a nonbinary young adult who grew up in a family and community that rejected their gender expression. From adolescence on, Kai had little trust that intimate relationships were possible and tended to withdraw socially. For Kai, a therapist who shared their racial background provided a cultural resonance that helped build trust. Later they found a partner through a supportive group and began to build a circle of reliable friends. Their PDC-3 rated this capacity at 2.

Lingiardi & McWilliams (Eds.), PDM-3 Online Supplement (2026), pp. 55–62

Emilia and her daughter

Emilia, an 84-year-old widow in the supplement’s older-adult case, believed her daughter was still angry at her and preferred someone else. In treatment, she gradually acknowledged her own jealousy and recognized that her daughter’s wish to have her nearby was a sign of affection, not anger. After the psychologist met the daughter, who described Emilia as a tender mother, Emilia was visibly relieved and arranged to see her daughter almost daily. She also evoked warm closeness in her psychologist. Her chart rated this capacity at 3.

Lingiardi & McWilliams (Eds.), PDM-3 Online Supplement (2026), pp. 38–43

History

Psychoanalysis started with drives and conflicts, and only gradually put relationships at the center. Erikson’s mid-century reformulation of Freud’s stages in terms of interpersonal tasks, such as trust versus mistrust, had a large clinical impact (McWilliams, 2011, p. 53). Object relations theorists such as Klein and Winnicott, attachment researchers following Bowlby, and Kohut’s self psychology each added a different angle: inner images of others, the bond itself, and the empathic responsiveness that sustains the self.

The PDM tradition operationalized these ideas as a rateable capacity. PDM-2 called it the capacity for relationship and intimacy; PDM-3 renamed it the capacity for trust, empathy, and intimacy and gives explicit attention to epistemic trust, reflecting the influence of mentalization research (Lingiardi et al., 2026, pp. 710, 723). The manual now suggests several instruments that bear on it, including Shedler–Westen Assessment Procedure items such as being able to sustain a love relationship marked by genuine intimacy and caring, and the Adult Attachment Interview (p. 734). It also extends the capacity to parenting, where trust shows up as the ability to rely on good sources of advice without being swamped or swayed by bad ones (Lingiardi et al., 2026, p. 750).

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