Can Psychopathy Be Treated? What the Research Tells Us

Abstract

Psychopathy is a serious personality disorder marked by a constellation of stable and problematic interpersonal, affective, and behavioral characteristics. High scores on the tool most frequently used to assess psychopathy, the Hare Psychopathy Checklist-Revised (PCL-R; Hare, Manual for the revised psychopathy checklist. Multi-Health Systems, Toronto, ON, 1991; Hare, Manual for the revised psychopathy checklist, 2nd edn., Multi-Health Systems, Toronto, ON, 2003) or its derivatives, are associated with a host of antisocial behavioral outcomes, including treatment noncompletion and subsequent criminal recidivism. However, not all psychopathic offenders inexorably reoffend violently or otherwise, and many psychopathic offenders successfully complete treatment. This chapter provides an overview of the psychopathy treatment literature. It begins with a review of the challenges associated with working with psychopathic clientele, followed by a review of key findings from meta-analytic reviews in terms of what has been attempted, what has been shown not to work, and what approaches have promise. This follows with a review of the characteristics of ineffective approaches, and concordant research, which include programs that overtreat their clients, do not screen for risk, fail to target criminogenic need, prioritize inappropriate therapeutic foci, engage in unresponsive interventions, and/or lack staff direction or supervision. Second, this is countered by a proposed treatment framework for promising approaches with recent findings per the two-component model for the treatment of psychopathy grounded in the “what works” principles. Although psychopathic offenders present as a high-risk–high-need group often resistant to change, the central premise of this chapter is that there is little reason to believe that they are not also capable of making substantive treatment changes and reducing their risk for criminal recidivism.