CRJS 450 THE PSYCHOPATH

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CRJS 450THE PSYCHOPATH

• Treatment and Management
• of the Psychopath

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Key Questions

• Where should psychopaths be dealt with mental
  health or criminal justice system?
• What sorts of security, custody, and management
  strategies are necessary in dealing with
  psychopaths in correctional populations?
• Can Psychopaths be treated?
• If so, what treatment approaches are the most
  promising?
• If not, then what?

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Preliminary Theories
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The Psychopath The forgotten man of psychiatry
and penology

• Cleckley noted long ago that theres no known
  treatment or place to deal with psychopaths in
  correctional or psychiatric settings.
• According to Cleckley, the psychopath should be
  deemed incompetent, but responsible and dealt
  with in a special setting with strict control,
  constraint, and structure.

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Features of approach recommended by Cleckley

• Complete control over financial resources
• Increased control and limits over own behavior
• No protection from social or legal consequences
  of behavior (from relatives, therapist, or
  others)
• Therapist must make clear that he/she understands
  thoroughly and only convinced through action not
  words
• Psychopath must be shown that behavior is
  self-defeating
• Therapist must search for a leverage point to
  stimulate socially acceptable behavior

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The Yochelson Samenow Criminal Personality
Approach

• Focus on conscious choice, responsibility, and
  teaching new ways of thinking.
• Change agent must show that is knowledgeable
  and not naïve/easy to manipulate the you know,
  I know approach.
• Psychopath given 3 choices Stay the same, die,
  change.
• Techniques phenomenological reporting, total
  implementation, strict cognitive-behavioral
  approach.

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Tactics used by Psychopaths During
Examination/Assessment Identified by YS

• Building self up by putting examiner down
• Feeding examiner what psychopath thinks he/she
  ought to know
• Assent (agrees for deceptive purposes)
• Attempting to confuse

• Vagueness
• Minimization
• Diversion
• Lying
• Silence/Secrecy

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Tactics During Treatment Identified by YS

• Selective attention
• Total inattention
• Tardiness/missed appointments
• Feeding treatment provider what he/she wants to
  hear
• Confession
• Showing insight
• Socializing and leadership

• Tailoring the approach
• Misunderstanding
• Generalizing a point to absurdity
• Deliberate postponement
• Claiming that has changed enough to leave program
• Putting treatment provider on the defensive

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Empirical Findings
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Is Treatment of Psychopathy Possible?

• There are important ethical, humanistic, and
  public safety reasons for not giving up hope.
• What do we know-need to know in developing
  successful treatment for psychopaths?

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Why should we continue to search for a way to
treat psychopaths?

• Lack of empirically sound studies
• Public safety
• Correctional management
• Classification problems whos treatable?
• Just because biologically determined doesnt mean
  untreatable

• Psychopathy has only moderate predictive validity
• Lack of research progress normal delay between
  research and application
• Progress in offender treatment research
• Realistic expectations of efficacy
• Avoidance of negative effects (making psychopaths
  worse)

Losel, F. (1998) Treatment and management of
psychopaths. In D. Cooke, A. Forth and R. Hare
(Eds.) Psychopathy Theory, Research and
Implications for Society. Kluwer Amsterdam.
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Research on Treatment of Psychopaths

• Much of the research is drawn from the general
  correctional treatment literature.
• Research suggests that
• traditional psychotherapy doesnt work
• cognitive-behavioral interventions are most
  promising
• Treatment should have high integrity with
  adherence to the risk-need-responsivity principle
  (Andrews Bonta, 2003)
• treatment doesnt work for primary psychopaths
  and/or makes them worse.

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So, what do we know?

• Cognitive-behavioral approaches show some success
  with violent offenders populations (that may
  contain some psychopaths)
• Therapeutic Communities dont work with
  psychopaths
• Punitive/deterrence tactics show weak and
  sometimes negative effects on recidivism (unless
  willing to imprison for long periods)
• Pharmacological treatment shows some promise

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Promising Principles (Losel 182-187)

• Theoretically sound conceptualization
• Thorough dynamic assessment
• Adherence to Risk-Need-Responsivity principle
• Intensive level of service and dosage
• Clearly structured and controlled setting
• Positive institutional climate/regime
• High program integrity

• Thorough selection, training, supervision of
  staff
• Neutralizing unfavorable networks and group
  processes
• Strengthening natural protective factors
• Controlled aftercare and relapse prevention
• Systematic program evaluation
• Early prevention and intervention

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Targeting Risk, Need, and Responsivity Principle
Characteristics Associated with Psychopathy

• Risk Principle Treatment is most effective when
  it is used with those who have appropriate risk
  of offending. Static Factors such as high PCL-R
  score criminal history antisocial behavior
  reflect high risk.
• Need Principle Treatment is most effective when
  criminogenic needs are identified and targeted.
  Criminogenic needs include dynamic factors such
  as attitudes, values, beliefs, behaviors that
  minimize value of prosocial activities.
• Responsivity Principle Idiosyncratic
  characteristics that are not directly or
  indirectly cause criminal behavior, but that
  influence response to treatment such as working
  alliance between therapist and offender,
  treatment readiness, intelligence, information
  processing deficits, learning style, and
  personality characteristics.

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From Wong, S. Hare, R.D. (2005). Guidelines for
a Psychopathy Treatment Program. Multi-Health
Systems
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A Slightly More Pessimistic View See Harris,
G.T. Rice, M.E. (2006). Treatment of
Psychopathy A Review of Empirical Findings in
Patrick, C.J. (Ed.) Handbook of Psychopathy.
Guilford Press.

• There is no evidence that treatment applied to
  psychopaths is effective in reducing crime or
  violence and some programs make psychopaths worse
  (increase recidivism).
• The reason for this is that psychopaths are
  fundamentally different than nonpsychopaths
  Psychopathy is an evolutionarily viable life
  strategy that involves lying, cheating, and
  manipulating.
• Effective intervention and/or minimization of
  harm caused by psychopaths involves
• application of social learning principles in form
  of behavioral contingency programs from a
  Multi-systemic Therapy (MST) Approach.
• Incapacitation where practical
• Societal changes that reduce the behavioral niche
  for psychopathy (opportunity reducing strategies
  that make it harder for psychopaths to get away
  with their behaviors)

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Special Issues in Treating Psychopaths
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To Treat or not to Treat

• Suggestions from Meloy (1988)
• Role clarification of clinician treatment or
  evaluation?
• Recognition that psychopathy is a process a
  hypothetical continuum
• Assessment and acknowledgement of severity of
  disturbance
• Decision not to treat

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Countertransference Issues in Working with
Psychopaths (Meloy, 1988)

• Therapeutic Nihilism
• Illusory Treatment alliance
• Fear of assault or harm
• Denial and Deception

• Helplessness and guilt
• Devaluation and loss of professional identity
• Hatred/wish to destroy
• Assumption of psychological complexity

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Therapeutic Resistance Meloy (1988)

• Manipulative cycling
• Deceptive practices
• Malignant pseudoidentification
• Sadistic control

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Interpersonal Measure of Psychopathy
(IM-P)(Adapted from Kosson, Gacono, Bodholdt,
2000, p.221)

• 1. Interrupts Doesnt allow interviewer to
  finish sentences and behaves as if entitled to
  speak at any time.
• 2. Refuses to tolerate interruption Expresses
  anger or dissatisfaction when interrupted.
• 3. Ignores professional boundaries Ignores
  established rules of conduct. Attempts to cross
  the line by making inappropriate
  requests/comments.
• 4. Ignores personal boundaries Ignores customary
  social boundaries. Attempts to engage clinician
  in personal conversation
• 5. Tests Interviewer Asks targeted
  questions/makes requests with purpose of
  determining who interviewer is and how far he/she
  is willing to go (e.g., whether or not will
  overlook certain rules/regulations).

• 6. Makes personal comments Makes reference to
  interviewers appearance, personal life, etc.
• 7. Makes requests of interviewer Asks
  interviewer for favors, special consideration,
  items, etc.
• 8. Tends to be tangential Avoids direct
  response. Discusses peripherally related subjects
  while refusing to focus on topic at hand.
• 9. Fills in dead space Talks during moments of
  silence. Appears unable to tolerate quiet-empty
  space.
• 10. Unusual calmness or ease Low anxiety and
  calmness in interactions with interviewer.
• 11. Frustration with argument avoidance
  Expresses frustration when conversation is
  redirected away from argument/conflict. Appears
  to want to engage in argumentative discourse.

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Interpersonal Measure of Psychopathy
(IM-P)(Adapted from Kosson, Gacono, Bodholdt,
2000, p.221)

• 12. Perseveration Persistence with line of
  conversation, behavior, etc despite clinician
  discouragement/contradiction/rebuke.
• 13. Ethical superiority Makes comments to
  suggest he/she is superior to clinician.
• 14. Expressed narcissism Builds self up by
  embellishing achievements, status, and
  uniqueness.
• 15. Incorporation of interviewer into personal
  stories Interviewer is given a hypothetical role
  (usually an antisocial role or lower position
  than interviewee) in personal stories.
• 16. Seeking of alliance Attempts to identify
  commonalities with interviewer/to establish a
  partnership/camaraderie.

• 17. Showmanship Embellishes accomplishments/attem
  pts to one-up interviewer and others.
• 18. Angry Expressions of anger at inappropriate
  times and in response to generally benign
  conversation.
• 19. Impulsive answers Responds to interviewer
  questions quickly, without thought.
• 20. Expressed toughness Makes comments/engages
  in body language to convey power, toughness,
  strength.
• 21. Intense eye contact Makes a point to
  maintain direct eye contact with interviewer.

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Correctional Management
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Managing Psychopaths in Correctional Facilities

• Psychopaths present a special challenges in
  correctional settings
• Psychopathy is associated with
• Increased disciplinary infractions
• Physical aggression and institutional violence
• Coerced homosexuality/prison rape
• Sexual involvement with staff
• Escapes
• Assault of correctional officers

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If not treatment, then what?

• Research on psychopathy can guide correctional
  classification and management
• Classify offenders for treatment and management
• Screening and treatment planning
• Determine how to treat certain types of offenders
  (with co-occurring conditions)
• Better manage correctional facilities
• Train correctional staff

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Societal Responses to Severe Criminal Psychopaths

• Intensive Management?
• Supermax Prisons?
• Civil Commitment?
• Capital Punishment?

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Can/Could These Offenders be Treated? If Not,
then what?