A good therapeutic relationship in mental health services is a predictor of positive clinical outcomes for people who seek help for distressing experiences, such as voice hearing and paranoia. One factor that may affect the quality of the therapeutic relationship and raises further ethical issues is the impact of the clinical encounter on users’ sense of self, and in particular on their sense of agency. In the paper, we discuss some of the reasons why the sense of epistemic agency may be especially fragile in young people with unusual experiences and beliefs. We argue that it is important to identify and avoid behaviours that can undermine young people’s contributions as epistemic agents in the clinical encounter.

心理健康服务中良好的治疗关系是积极临床结果的预测因素，对于寻求帮助以解决令人痛苦的经历（例如声音听力和偏执狂）的人来说。可能影响治疗关系质量并引发进一步伦理问题的一个因素是临床遭遇对用户自我意识的影响，尤其是对他们的能动性意识的影响。在这篇论文中，我们讨论了一些原因，为什么具有不寻常经历和信仰的年轻人的认知能动性可能特别脆弱。我们认为，重要的是要识别和避免可能破坏年轻人在临床遭遇中作为认知代理人的贡献的行为。