Assessing and Treating Psychopaths

Abstract

The psychopathic individual is characterized by limited affective experiences, is known to act impulsively and often antisocially, but also seems calm and at ease in the presence of others (Cleckley, The mask of sanity, Mosby, St. Louis, MO, 1941/1996; Hare, Manual for the Hare Psychopathy Checklist—Revised, Multi-Health Systems, Toronto, ON, 2003). Psychopathic individuals are present in significant numbers within the criminal justice system, where their persistent antisocial behavior strains both human and financial resources. Upon release they are more likely to reoffend than nonpsychopathic offenders, resulting in greater cost to their communities and—typically—return to the system (Hemphill et al., Legal Criminol Psychol 3: 139–170, 1998). Despite the seriousness of this syndrome, little systematic research has been conducted examining treatment within this population. Based on early negative conceptualizations, strengthened by a small number of documented treatment failures, psychopathic individuals have been described as “untreatable”. More recently, some evidence suggests that, although they are less likely to retain in treatment than non-psychopathic individuals, adult offenders with psychopathy who complete intensive CBT and risk-reduction oriented treatment programs respond similarly to these interventions as nonpsychopathic offenders. In this chapter, research in this area is reviewed, with an emphasis on placing early research in context and identifying the gaps in the existing literature. Specifically, the chapter includes: (1) review of the assessment and prevalence of psychopathy across diverse groups; (2) review and discussion of early research on the treatment of psychopathy; and (3) review and discussion of more recent intervention research, including studies with adults and adolescents. Overall, although it appears that there may be some treatments that impact positively the functioning of psychopathic individuals, it is not clear yet the extent or duration of these benefits. Moving forward, information regarding the responses of psychopathic individuals to existing treatments must be collected, and interventions targeted to this resistant group must be developed and systematically tested. Despite some advances, the field as a whole is still in the early stages of development and growth is urgently needed.