http://psychiatry.medscape.com/IMNG/ClinPsychNews/2000/v28.n05/cpn2805.38.02
.html
Treatment for Psychopaths Is Likely to Make Them Worse
Carl Sherman, Contributing Writer
[Clinical Psychiatry News 28(5):38, 2000. © 2000 International Medical News
Group.]
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FORT MYERS, FLA. -- When it comes to treating psychopaths, Robert Hare, PhD,
offers you but one succinct bit of advice: "Don't waste your time. Nothing
you do can make any difference at all."
If anything, data presented by Dr. Hare at the annual meeting of the
American Neuropsychiatric Association made that assessment sound overly
optimistic.
Treatment, in fact, appears to increase the rate of recidivism among
criminal psychopaths, he said.
Dr. Hare, professor of psychology at the University of British Columbia in
Vancouver, defined psychopathy on the basis of scores on a widely used
instrument that he developed -- the Psychopathy Checklist. It measures
"arrogant and deceitful personal style," "deficient affective experience,"
and "impulsive and irresponsible behavioral style."
Psychopathy thus defined overlaps with, but is a more selective category
than, antisocial personality disorder. Most psychopaths have the disorder,
but most with the disorder are not psychopaths. Psychopathy "may be the most
important factor in predatory violence," he said.
Dr. Hare suggested that psychotherapy for this population is something of an
oxymoron. "What do you treat? They have no subjective distress; they don't
have low self-esteem; they are not dissatisified with their behavior. Do you
treat personality traits that they don't want to change?"
Not only are there little if any data substantiating successful treatment
for psychopaths, but also several studies suggest that interventions can
have a negative outcome. In one study, 176 persons released from a program
for "personality-disordered offenders" -- some of whom were psychopaths --
were treated in a program of intensive group and individual therapy (80
hr/wk); 146 personality-disordered offenders who were not treated served as
controls.
The rate of violent offenses declined in the treated group of nonpsychopaths
but actually rose among treated, compared with untreated, psychopaths, Dr.
Hare said.
In another study of more than 300 offenders in short programs for social
skills training and anger management, 12-month reconviction rates were
significantly higher in psychopaths who were treated than in nontreated
psychopaths, he said.
Particularly unsettling were findings from a study of 216 sex offenders.
Those with the highest rates of reoffense were the individuals with high
psychopathy scores who were rated "good" by psychologists for treatment
change, as defined by victim empathy and their understanding of their
"offense cycle" and relapse prevention plan.
Recidivism, in other words, was most likely in those "who had the ability to
convince the therapists they had made good progress in treatment," Dr. Hare
said.
Why psychotherapy should facilitate, rather than discourage, criminal
behavior is unclear, but one quite likely possibly is that therapy --
particularly in the group setting -- provides the psychopath with an
opportunity "to learn more about other people. . . . It improves his ability
to con," Dr. Hare suggested.
================================
Robert F. Tatman
[EMAIL PROTECTED]
Jenkintown, PA, USA
"Y Gwir Yn Erbyn y Byd"--Y Bardd Cymraeg
"The Truth Against the World"--motto of the Welsh bards
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