Not exactly the introspective search for personal insight and relief that a therapist hopes to find in a patient. Psychopaths typically want to sit out the psychotherapeutic dance, and many therapists are quite willing to let them do so.
• Most therapy programs do little more than provide psychopaths with new excuses and rationalizations for their behavior and new insights into human vulnerability. They may learn new and better ways of manipulating other people, but they make little effort to change their own views and attitudes or to understand that other people have needs, feelings, and rights. In particular, attempts to teach psychopaths how to “really feel” remorse or empathy are doomed to failure.
These sobering conclusions apply both to individual therapies, in which a therapist and a patient interact one-on-one, and to group therapy, in which people with different problems try to learn from one another and to develop new ways of thinking and feeling about themselves and others.
• As I noted earlier, psychopaths frequently dominate individual and group therapy sessions, imposing their own views and interpretations on the other members. For example, a group leader in a prison therapy program had this to say about an inmate who had scored very high on the Psychopathy Checklist: “He refuses to talk about things he doesn’t initiate. He doesn’t like to be confronted or questioned about his behavior.... He refuses to see how he blocks communication and dominates the therapy group by his long-winded monologues that attempt to circumvent discussions about his own behavior.” Yet, shortly after this was written, the psychiatrist wrote, “I am certain he has improved. He accepts responsibility for his actions.” And a psychologist wrote, “He has made good progress. He appears more concerned about others and to have lost much of his criminal thinking.” Two years after these optimistic statements about him, the inmate was interviewed by a female graduate student for one of my research projects. She said that he was the most terrifying offender she had ever met and that he had openly boasted of how he had conned the prison staff into thinking that he was well on the road to rehabilitation. “I can’t believe those guys,” he said. “Who gave them a license to practice? I wouldn’t let them psychoanalyze my dog! He’d shit all over them just like I did.”
A FORTY-YEAR-OLD MAN with fifty-five convictions for fraud, forgery, and theft in three countries attempted to avoid deportation from Canada on the grounds that he had been rehabilitated by his friendship with a seventy-six-year-old blind woman. A 1985 psychiatric report had described the man as “invariably pleasant, courteous, intelligent, and engaging,” but also as a pathological liar “with an entrenched personality disorder.” The immigration department lawyer referred to him as a “pathological liar who could charm the bark off a tree,” “a chronic liar ... who could not separate fact and fiction,” and a classic impostor. The lawyer pointed out that the man in question was paroled from prison in the United States in the late 1980s, had violated his parole and fled to Canada, and had made his way to Vancouver, “leaving a series of worthless checks across the country.” The twist here is that he now claims to have turned his life around because of self-awareness sessions at a Christian meditation center and church led by the woman mentioned above. His claims to have been rehabilitated have been countered by witnesses who testified that he continues to pass worthless checks and that he has not paid his bills. [From an article by Moira Farrow in The Vancouver Sun, March 2, 1991.]
THERAPY MAY MAKE
THEM WORSE
Some form of group therapy is an important part of most prison and court-mandated treatment programs. Group therapy is sometimes embedded in a “therapeutic community” program, in which the inmates or patients are given considerable responsibility for running their own lives. The ward staff forms an integral part of the community, and is specially trained to focus on the needs and capabilities of the patients and to treat them in a humanitarian and respectful way. Such programs are intensive and very expensive, in terms of both facilities and personnel, and they work reasonably well with most offenders. But they do not work for psychopaths.
Evidence for this stark conclusion is provided by several recent studies of forensic patients treated in a therapeutic community program. In each case, the patients were assessed with the Psychopathy Checklist.
• In one study, psychopaths were not motivated to do well, dropped out of treatment early, and derived relatively little benefit from the program. Following release from prison, their rate of return was much higher than that of the other patients.3
• In another study, psychopaths were almost four times more likely to commit a violent offense following release from a therapeutic community program than were other patients.4 But not only was the program not effective for psychopaths, it may actually have made them worse! Psychopaths who did not take part in the program were less violent following release from the unit than were the treated psychopaths.
At first glance this finding may seem bizarre. How could psychotherapy make a person worse? But the finding is not at all surprising to those who run these programs. They report that the psychopaths usually dominate the proceedings, frequently playing “head games” with the group leaders and other patients. “Your problem is that you rape women because you unconsciously want to punish them for what your mother did to you,” the psychopath pedantically tells another patient. At the same time, he offers few insights into his own behavior.
Unfortunately, programs of this sort merely provide the psychopath with better ways of manipulating, deceiving, and using people. As one psychopath put it, “These programs are like a finishing school. They teach you how to put the squeeze on people.”
They are also a rich source of facile excuses for the psychopath’s behavior: “I was an abused child,” or, “I never learned to get in touch with my feelings.” After-the-fact insights of this sort explain very little, but they sound good to those primed to hear them. I am constantly amazed at how willing some professionals are to take such statements at face value.
Group therapy and therapeutic community programs are not the only source of new tactics psychopaths use to convince others that they have changed. They frequently make use of prison programs designed to upgrade their education; courses in psychology, sociology, and criminology are very popular. These programs, like those devoted to therapy, may supply psychopaths with little more than superficial insight and knowledge of terms and concepts—buzzwords—having to do with interpersonal and emotional processes, but they allow psychopaths to convince the gullible that they have been rehabilitated or “born again.”
YOUNG PSYCHOPATHS
Logically, our best chance of reducing the impact of adult psychopathy on society is to attack the problem early. Thus far, however, such efforts have not been very successful. Following an extensive review of treatment programs, sociologist William McCord was led to conclude that “attempts to deflect the person from his or her psychopathic pattern early in life” generally have not been successful.5 Still, he felt that some hope was offered by programs in which the individual’s social and physical environment was completely changed and the entire resources of the institution were mobilized to promote fundamental changes in his or her attitudes and behaviors. But the results of one such program, described in detail by McCord, are sobering. Although the attitudes and behaviors of psychopathic adolescents seemed to improve during and after the program, the effect dissipated as they got older.
The situation may change as we learn more about the roots of psychopathy. Further, psychologists have developed intervention programs that are quite successful in changing the attitudes and behaviors of children and adolescents who have a variety of behavioral problems. Many of these programs deal not only with the child but also with the family and social context in which the problems occur.6
If used at a very early age, it is possible that some of these programs will be useful in modifying the behavioral patterns of “budding psychopaths,” perhaps by reducing aggression and impulsivity and by teaching them str
ategies for satisfying their needs in more prosocial ways.
ANOTHER SOBERING THOUGHT
Virtually all the evidence on the effectiveness of treatment for psychopaths is based on programs for people in prison or psychiatric facilities or in trouble with the law. Many of these programs are intensive, well thought out, and carried out under reasonably good conditions. And still they are ineffective.
Even if some program were effective in changing the attitudes and behaviors of psychopaths, there would be no way of using it to deal with the millions of psychopaths not in custody or court mandated to enter treatment. There is little or no chance that any on-the-street psychopaths would even contemplate entering such a program. And society has no means of forcing them to do so.
Occasional case reports or bits of anecdotal evidence claim that some particular procedure has had a beneficial effect on a psychopath. For example, in the past few years several people have told me that they have managed to bring about considerable improvement in the behavior of a psychopath they lived with. They can’t understand why I don’t get excited about their experiences.
Perhaps they did manage to make a therapeutic breakthrough, but there is no way of determining if this is the case. Was the treated individual actually a psychopath? Did he or she improve in middle age, a time when the behaviors of some psychopaths “spontaneously” improve? What was the individual’s behavior like before this change? And how do we know that it was the “psychopath” who changed? Many people confuse improvement in the behavior of the psychopath with changes in the way they themselves deal with the person.
For example, a woman with a psychopathic husband may say that he is not quite as bad as he once was. But what really may have happened is that she learned how to deal with the problem by keeping out of his way or by working extra hard to satisfy his needs and demands. She may have buried her personality and sacrificed her needs and aspirations in order to reduce conflict and tension in the relationship.
We cannot take seriously claims of effective treatments for psychopathy unless they are based on carefully controlled empirical studies.
SHOULD WE SIMPLY GIVE UP?
Depressing though the evidence is, there are several things that we should consider before writing psychopaths off as untreatable or unmanageable.
• First, despite the hundreds of attempts to treat these individuals and the great variety of techniques tried, there have been few programs that meet acceptable scientific and methodological standards. This is an important point, because it means that the evidence we base our conclusions on is not very sound. This applies both to the common reports that a particular program didn’t work and to the occasional report that something did work. Most of what we know is based primarily on clinical folklore, single-case studies, poor diagnostic and methodological procedures, and inadequate program evaluation. Indeed, the state of the treatment literature on psychopathy is appalling.
Perhaps the most frustrating thing about reading the treatment literature is that the diagnostic procedures often are hopelessly inadequate or so vaguely described that it is impossible to determine whether a given program had anything at all to do with psychopathy.
Another recurrent problem in trying to evaluate treatment or management programs is the failure to use carefully selected control or comparison groups. We know that the behavior of many psychopaths improves with age, and it is important to know the extent to which a given therapeutic program improves on the “natural” or “spontaneous” changes that occur with age.
• Second, few treatment programs are designed specifically for psychopaths, and those that are have to contend with so many administrative, government, and public policy issues that they soon become something other than what was originally intended. The fact is, a well conceived and methodologically sound program for the treatment of psychopaths has yet to be designed, carried out, and evaluated.
• The third point is that some of our efforts to treat psychopaths may be misplaced. The term treatment implies that there is something to treat: illness, subjective distress, maladaprive behaviors, and so forth. But, as far as we can determine, psychopaths are perfectly happy with themselves, and they see no need for treatment, at least in the traditional sense of the term. It is a lot easier to change people’s attitudes and behaviors when they are unhappy with them than when they consider them perfectly normal and logical.
But isn’t the behavior of psychopaths maladaprive? The answer is that it may be maladaprive for society but it is adaptive for the individuals themselves. When we ask psychopaths to modify their behavior so that it conforms to our expectations and norms, we may be asking them to do something that is against their “nature.” They may agree to our request, but only if it is in their own best interests to do so. Programs designed to get psychopaths to change their behavior will have to take this into account or be doomed to failure.
“EVERYBODY SWEARS PSYCHOPATHS can’t be treated. That’s a lot of hogwash,” said Joseph Fredricks, a homosexual pedophile whose long history of violence included the murder of an eleven-year-old boy. “Psychopaths are as human as anyone. They’re psychopaths because they are more sensitive than anyone.... They can’t stand pain of any sort, that’s why they let it roll off their backs,” he said. [Canadian Press, September 22, 1992]
ELEMENTS OF A NEW PROGRAM
Recognizing the urgent need for new ways to deal with criminal psychopaths, and aware of the prevailing pessimism about traditional treatment programs, the Canadian government recently challenged me to design an experimental treatment/management program for these offenders. I accepted the challenge for two reasons. First, as I indicated above, previous programs typically have been flawed in a number of ways, and none has been firmly grounded in the latest advances in theory, research, and clinical and correctional experience. Second, there obviously is an urgent need for programs that can reduce the likelihood that psychopathic and other offenders will commit violent acts both in prison and following their release into the community.
I put together an international panel of experts in psychopathy, psychiatry, criminology, correctional treatment, and program design and evaluation.7 At several meetings we decided that the focus of our efforts should be on psychopathic and other offenders prone to violence, and we hammered out the broad outline of a model program that we felt had a reasonable chance of success. The government recently has decided to go ahead with the program, and steps are being taken to set up an experimental unit at a federal institution.
Although it is not possible to provide a detailed description of the program in this book, some broad principles can be outlined. To a large extent, these principles are based on the view that the premise of most correctional programs—that most offenders have somehow gone off track and need only to be resocialized—is faulty when applied to psychopaths. From society’s perspective, psychopaths have never been on track; they dance to their own tune.
This means that the program for psychopaths will be less concerned with attempts to develop empathy or conscience than with intensive efforts to convince them that their current attitudes and behavior are not in their own self-interest, and that they alone must bear responsibility for their behavior. At the same time, we will attempt to show them how to use their strengths and abilities to satisfy their needs in ways that society can tolerate.
Of necessity, the program will involve very tight control and supervision, as well as clear and certain consequences for transgressions of program, institutional, and societal rules. It will also take advantage of, and seek ways to speed up, the tendency of some psychopaths to improve “spontaneously” as they reach middle age.
The institutional components of the program will be followed by strict control and intensive supervision following release into the community.
The design of the program will allow for the empirical evaluation of a variety of treatment components, or modules (what works and what doesn’t work for particular individuals). Some components
may be effective with psychopaths but not with other offenders, and vice versa. The participants in the program will be compared with carefully selected control (untreated) groups of offenders.
A program of this sort will be expensive and always in danger of erosion because of changing institutional needs, political pressures, and community concerns. And it is likely that the results will be modest at best. However, the alternatives—to bear the enormous expense of keeping offenders at high risk for violence in prison, or to run the risk of letting them out—are not very attractive.
IF NOTHING WORKS, WHAT THEN?
If you are dealing with a true psychopath it is important to recognize that the current prognosis for significant improvement in his or her attitudes and behavior is poor. Even if the experimental program described above bears fruit, it will not be of much use to psychopaths who are not in prison or subject to tight control.
If you are living with or married to a psychopath, you may already suspect that things are not going to get any better, and you may feel trapped by circumstances, unable to escape without putting yourself or others—especially your children—at risk. The problem is particularly difficult—and dangerous—for a woman living with a psychopathic man who has a strong need to possess and control people. Many women may think, “Maybe if I change it will be okay. I can try harder, keep out of his way, become more tolerant, give in a bit more.” However, as the growing literature on spouse abuse attests, such changes rarely do anything but reinforce and perpetuate the problem.
Of course, the best strategy is to avoid becoming entangled with a psychopath in the first place. Admittedly, this is a lot easier said than done. But there are some things you can do to protect yourself. If they don’t work, the only thing you can do is try to minimize the harm you experience. The next chapter offers some practical advice on both protection and damage control.
Without Conscience Page 22
