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Therapeutic Considerations and Interventions for Psychopathy

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The Complexity of Psychopathy

Part of the book series: Dangerous Behavior in Clinical and Forensic Psychology ((DBCFP))

Abstract

Psychopathic offenders present a challenge to treatment providers. By definition, they experience limited distress that might motivate them for treatment. Because of their attitudes and behaviors, psychopathic offenders have been predominantly seen as unresponsive to treatment. In this chapter, we provide a review of existing empirical research on the treatment of psychopathy. We take a historical approach, starting with early treatment approaches and empirical studies into their effects, up until more recently developed interventions. Our review suggests that there is no empirical evidence to support the thesis that psychopathic offenders are generally unresponsive to treatment. In fact, several common “myths” that psychopathic patients are unable to form a working alliance with a therapist or that they cannot develop empathy, are refuted by recent evidence. We end our chapter with a set of “lessons learned” and “pointers to the future” concerning the treatment of psychopathy.

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Notes

  1. 1.

    Extensive descriptions of the program can be found elsewhere (e.g., Barker & Mason, 1968; Barker, 1980; Barker & McLaughlin, 1977; Harris et al., 1994; Nielsen, 2000; Quinsey, 1981; Weisman, 1995). In fact, in the 1970s, the Oak Ridge regimen was described extremely positively by both a panel of experts and a Canadian government report, claiming “here psychopaths are treated with success” (Quinsey et al., 1998). In 2000, however, a class lawsuit was raised against the institution and its practitioners because the treatment program was so degrading and inhumane. In May 2017, a Canadian judge ruled in favor of the plaintiffs, stating that Oak Ridge ran therapeutic programs for years that amounted to torture for the patients involved (Fine, 2017).

  2. 2.

    There were some attempts at reviewing the treatment literature on psychopathy before the Salekin (2002) meta-analysis. For instance, a study by Garrido et al. (1995) reported on two separate meta-analyses, though without providing the needed detail on references and methods. Also, Wong (2000) found that very few studies satisfied the criteria of a well-designed study. That is, few studies used validated assessments of psychopathy, adequately described the treatment approaches used, or employed control groups and appropriate outcome measures. A few years later, a subsequent systematic review of the treatment literature, conducted by D’Silva et al. (2004), came to a similar conclusion.

  3. 3.

    Twenty-seven (63%) patients in the high-psychopathic traits group (N = 43) were diagnosed with PCL-R ≥ 26.

  4. 4.

    In the PCL: SV manual, Hart et al. (1995) state that a score of 18 or above on the Screening Version strongly suggests psychopathy.

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  1. Maastricht University, Maastricht, the Netherlands

    Corine de Ruiter

  2. Private Practice, De Bilt, the Netherlands

    Martin Hildebrand

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    Jennifer E. Vitale

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de Ruiter, C., Hildebrand, M. (2022). Therapeutic Considerations and Interventions for Psychopathy. In: Vitale, J.E. (eds) The Complexity of Psychopathy. Dangerous Behavior in Clinical and Forensic Psychology. Springer, Cham. https://doi.org/10.1007/978-3-030-83156-1_14

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