Psychotherapy for People with Antisocial Personality Disorder

Psychotherapy for People with Antisocial Personality Disorder


An interesting article


Can individuals with psychopathy be treated?

From its first conceptualization in modern psychiatry, psychopathy has been surrounded with therapeutic pessimism (Cleckley, 1941; D’Silva, Duggan, & McCarthy, 2004; Salekin, Worley, & Grimes, 2010).

Psychopathy is a severe form of antisocial personality disorder characterized by a lack of empathy and remorse, self-aggrandizement, a manipulative interpersonal style and poor behavioral controls and can best be determined on the basis of a structured clinical rating scale such as the Psychopathy Checklist-Revised (PCL-R; Hare, 2003).

Many experts believe that these characteristics are difficult, if not impossible, to ameliorate (Harris & Rice, 2006), and the findings of some studies suggested that treatment makes psychopaths more dangerous (e.g., Rice, Harris, & Cormier, 1992; Seto & Barbaree, 1999). Possibly as a result of the entrenched therapeutic pessimism about psychopathy, very few empirical studies have examined psychopathy’s responsiveness to psychological interventions. To date, no randomized controlled trials of psychological interventions for psychopathy have been published in the clinical literature. Recent reviews, however, conclude there is little compelling empirical evidence that psychopathy is either immutable or amenable to psychological treatment, mainly because of a lack of treatments based on sound theoretical models of psychopathy (e.g., Salekin et al., 2010).

Forensic hospitals in the Netherlands have a long history of treating severe personality disordered offenders, where more than two-thirds of the patients have a personality disorder without a concomitant major mental disorder, in contrast to forensic hospitals in the United States (de Ruiter & Trestman, 2007). Under Dutch legislation, offenders who have committed a severe crime and who suffer from a mental or developmental disorder, including personality disorders, can be sentenced to involuntary treatment in a forensic hospital. They remain within the forensic hospital as long as the offender is deemed a danger to society, subject to review by the court every 1 or 2 years. In Dutch forensic hospitals, prevalence rates up to 35% have been reported for offenders with PCL-R psychopathy (Hildebrand & de Ruiter, 2004).

Forensic hospitals in the Netherlands mostly offer a cognitive behavioral treatment program with a focus on relapse prevention (e.g., Laws, Hudson, & Ward, 2000), although no controlled studies of treatment outcome have been published. Earlier studies on the efficacy of treatment in Dutch forensic hospitals showed that the outcome in naturalistic terms is positive.


Source: Psychotherapy for People with Antisocial Personality Disorder

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