6/18/2015 Rehabforpsychopaths|ScienceNews

Feature: MentalHealth

Rehabforpsychopaths
Contrarytopopularbelief,therapycanhelpsomepsychopathsstayoutofprison
By BruceBower 7:30am,June17,2015

Mountingevidenceindicatesthatbetterdesignedprisonprogramscanhelpcriminalswithpsychopathicpersonalitieslivelessviolentlyoncereleased.

Magazineissue:Vol.187,No.13,June27,2015

Nudity,mindalteringdrugsandencountergroupsbringouttheworstinpsychopathsbehindbars.Thatsnota
pitchforanewrealitytelevisionshownotyet,atleast.Itsanevidencebasedconclusion.Aninfamous
experimentaltreatmentprogramforviolentcriminals,conductedmainlyfrom1968to1978inaCanadianmaximum
securitypsychiatricfacility90milesnorthofToronto,triedthosetacticstopreparemenforlifeontheoutside.
Offenderswithpsychopathicpersonalitiesgraduatedfromtheprogrammoreviolentthanever.

Theresultsofthatstudyplayedabigpartinstokingfears,stillcommontoday,thatpsychopathsexploit
psychologicaltreatmentstobecomebettercriminals.Mountingevidenceindicates,however,thatbetterdesigned
prisonprogramscanhelpcriminalswithpsychopathicpersonalitieslivelessviolentlyoncereleased,says
psychologistDevonPolaschekofVictoriaUniversityofWellingtoninNewZealand.

IntheCanadianstudy,prisonersparticipatedinatherapeuticcommunity.Mendevelopedtheirownrulesand
sanctionsformisbehaviorwithlittlesupervision.Rulebreakerswereconfrontedandchallengedbytheirpeersin
prisonerledtherapysessions.Thosewhoadaptedwelltothesystemsatoncommitteesthatmetedoutpenalties
toothersforbadbehavior.Staffsometimesforcedprisonerstospenddaystogethernakedinaroomwithwall
mountedfeedingtubes.Menreceivedalcohol,LSDandotherdrugstohelpbreakdowntheirpsychological
defensesduringgroupencountersessions.Atthetime,thestudywasconsideredaboldattempttorehabilitate
previouslyuntreatablecriminals.

CrimeBuster

Misconceptionsaboundaboutwhatmakespsychopathstickandwhethertheircriminalbehaviorcanbe
treated.UniversityofSaskatchewanpsychologistMarkOlverrunspsychologicalprogramsforviolent,
psychopathicoffenders.Olverdescribeswhatpsychopathyisandhowtreatmentworks.
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psychopathicoffenders.Olverdescribeswhatpsychopathyisandhowtreatmentworks.

Itfailed.Tenyearsormoreafterreleasefromthefacility,78percentofpsychopathswhoweretrackedafter
graduatingfromtheprogramhadbeenarrestedforfurtherviolentoffenses,versus55percentoftheiruntreated
counterparts.Nonpsychopathiccriminalsdidnotbecomemoreviolentaftercompletingtheunorthodoxprison
program.

Treatmentbackfiredamongpsychopathicprisonersforgoodreason.Psychopathsinprisontendtogetfarmore
belligerentandaggressivewhencriticizedorpunishedthannonpsychopathiccriminalsdo,Polascheksays.Often
glibandcharmingonthesurfacebutcallousanduncaringunderneath,criminalpsychopathsdigintheirheels
whenharshlydisciplined.

Unsurprisingly,psychopathsplacedintheCanadianprogrambrokefarmorethantheirshareofcommunityrules.
Themenalmostallguiltyofviolentcrimesgotincreasinglyhostileaspunishmentspiledup.Aregulardietof
harshpenaltiesmadealreadyviolentpsychopathsevenmoredangerous.

CurrenttreatmentprogramsforprisonersarenothingliketheCanadianexperiment.Andthereasonsgobeyonda
tighteningofethicalstandards.Treatmentsbeingtestedtodayattempttohelpprisonersreadjustpersonalgoals
andcontrolanger.Thisapproachworksbestwithnonpsychopathiccriminals,butpsychopathsappeartobenefitas
well.Simplecomputerprogramsshowearlypromiseinhelpingpsychopathicprisoners,specifically,toseebeyond
theirimmediateneedsandbecomemoreawareofthosearoundthem.

Althoughcriminalswithpsychopathyareamongthehardesttoworkwith,psychologicaltreatmentcausesthem,
likeotherhighriskcriminals,toreoffendless,Polascheksays.

Personalitycheck

ModernnotionsofpsychopathyhavebeenheavilyinfluencedbypsychiatristHerveyCleckley.In1976,he
characterizedpsychopathsasmaskingashallowandirresponsiblenaturewithaconfidentdemeanor.Theycould
sometimesbecomeviolentorpredatory.

Cleckleysawnohopeforthepsychotherapyofhistimechangingpsychopathsattitudesorbehaviors.That
convictionremainspopulartoday,alongwithmisconceptionsofpsychopathsasevil,homicidalvillainsakinto
CharlesMansonorfictionscunningHannibalLecter(SNOnline:1/14/14).

Psychopathyisnotanofficialpsychiatricdiagnosis,largelyduetoalackofconsensusonhowtodefinethis
personalitypatterninthegeneralpopulation.Clinicianstodayemphasizethatpeoplewithpsychopathic
personalitiescanbefearless,impulsive,emotionallyshallow,charminglymanipulative,hotheadedandcold
hearted.PsychologistMarkOlveroftheUniversityofSaskatchewaninSaskatoonandhiscolleaguesusea20
itemchecklisttodeterminewhichoffendershavepsycho pathicpersonalitiesthatcreatespecialproblemsforprison
staffandtreatmentproviders.Thechecklist,developedbypsychologistRobertHareoftheUniversityofBritish
ColumbiainVancouver,coversfourgeneralareas(seetablebelow).

Harehasestimatedthatpsychopathicpersonalitiescharacterizeabout1percentofthegeneralpopulation,with
roughlyequalprevalenceinmenandwomen.Researchonpsychopathsinandoutofprisonhasfocusedalmost
exclusivelyonmen.

Psychopathsarenotonetypeofperson,Olversays.Someareschemingandnonviolent,forinstance,and
othershaveemotionaldeficitsandcanbeviolent.

Olversplitsviolentpsychopathiccriminalsintotwobroadgroups:Onegroupiscallous,deceitfulandemotionally
shallowtheotherishighlyanxiousandimpulsive,histeamreportedinMayintheJournalofAbnormal
Psychology.Withtherapythattargetscertaingroupspecificcharacteristics,bothdisplaycomparablereductionsin

30
percent

Dropinnewviolentcrimesamongpsychopathicoffenderswhocompleteintensive,therapistledtherapyversusthose
whodont

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reoffendingaftertreatment,hesays.Olversteamfoundthatratesofnewviolentcrimesfollowingreleasedropby
30percentormoreamongpsychopathicoffenderswhocompleteintensive,therapistledgroupprograms.

Psychopathiccriminalsreceivethesametreatmentasotherviolentprisonersdo,withadjustmentsbasedon
individualneeds.Inwhatisknownascognitivebehavioraltreatment,therapistledgroupsworkonwaystocontrol
angerandmeetneeds,suchasfeelingincontrol,withoutbreakingthelaw.

Ifaparticularlybelligerentprisonerdecidesingrouptherapy,forexample,totrycalmingdownwithafewdeep
breathswhenfrustrationsariseduringtheday,prisonstaffmaysupporthisefforts.Physicians,cafeteriaworkers
andotherswhocrosspathswiththemanwillgivehimtimetocollecthimselfduringinteractions.Staffmembers
thenreportbacktothetherapistonwhathappened.Gradualbehaviorimprovementmayleadtoaparttimejobin
theprison,providingmorepracticeatdealingwithothersandhandlingfrustrations.

Treatmentisalsoprovided,asneeded,foralcoholism,drugaddiction,depressionandothermentalailmentsthat
canaccompanypsychopathy.

Therapistsneedpatience,skillandathickskintoworkwithpsychopathicprisoners,Olversays.Havingtypically
grownupasvictimsofvarioustypesofabuse,manypsycho pathiccriminalsarrogantlyanddeftlymanipulate
otherswithoutremorse,inhisexperience.Thesearenotmenwhoviewpsychologicaltreatmentfavorablyorform
warmrelationshipswithatherapist,Olversays.Thegoalisforeachmantolivepeaceablyamongothersandstay
outofprison.Thatssuccess,evenifmanypsychopathicoffendersremainabrasiveandemotionallydistantafter
completingtreatment.

Itsnotillegaltobeanasshole,Olversays.Itsillegaltobeatpeopleupandstealfromthem.

Olversteamtrackeddataonnewoffensescommittedfiveto10yearsafterreleasefromprisonbyviolentand
sexualoffendersinthreepreviouslypublishedCanadianstudiesofcognitivebehavioraltreatments.

Grouptreatmentslastedanaverageofeighttoninemonths.Inthelargeststudy,29percentof321sexoffenders
hadpsycho pathicpersonalities.Nearlythreequartersofthosemencompletedtreatment.Anaverageof10years
afterbeingreleasedfromprison,roughly60percentoftreatmentcompletershadbeenarrestedforviolentcrimes,
versus92percentofmenwhodidntfinishtreatment.Thedisparityinrearrestratesspecificallyforsexcrimeswas
smaller:42percentfortreatmentcompletersversus50percentfortheothers.

Storycontinuesaftertable

Badmix

Cliniciansandresearchersofteninterviewindividualsforsignsofpsychopathyusinga20itemchecklistoftraits
consideredcentraltothispersonalitytype.Peoplewhoscorehighinpsychopathycanexhibitdifferentmixesof
thesecharacteristics.Twolifestyleitemsarenotshownbelow:sexualpromiscuityandfrequent,briefmarriages.

Psychopathychecklist:

Interpersonal Emotional Lifestyle Antisocial

Needforstimulation/prone Poorbehavioral
Glibness/superficiality/charm Lackofremorseorguilt
toboredom control
Grandiosesenseofself Earlybehavioral
Shallowaffect Parasiticlifestyle
worth problems
Lackofrealisticlongterm
Pathologicallying Callousness/lackofempathy Juveniledelinquency
goals
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goals
Failuretoacceptresponsibility Revocationof
Conning/manipulative Impulsivity
forownactions conditionalrelease
Irresponsibility Criminalversatility

Source:R.Hare,J.Skeemetal/PSPI2011

Inallthreestudies,ratesofreoffendingprogressivelydroppedamongpsychopathicmenwhoshowedthemost
improvementduringtreatment,OlverandhiscolleaguesreportedintheDecember2012InternationalJournalof
ForensicMentalHealth.Inoneinvestigation,only23percentofmenwhorespondedwelltotreatmentgotarrested
forfurtherviolentoffenses,versus57percentofthosewhotookpoorlytotreatmentbutcompletedit.Improvement
duringtreatmentwasmeasuredviaobservedbehaviorchanges,suchasadropinexplosivereactionswhen
dealingwithprisonstaff.

Inamorethansevenyearfollowupof32treatedand32untreatedviolent,psychopathicoffenders,treatedmen
spentanaverageof2.4feweryearsinprisonfornewoffensesthanuntreatedmen.ByOlverscalculations,that
reductioninprisontimewouldsavemorethan$233,000foreachoffender.

Readingcontext

Achievingthegoldstandardoftreatmentresearchassigningpsychopathicoffendersatrandomtodifferent
programsortonotreatmentisnearlyimpossible.YaleUniversitypsychologistArielleBaskinSommersandher
colleagueshavecomeclose,though.Theyassignedpsychopathiccriminalstooneoftwocomputertraining
coursestorefocusthemensattention.Onecoursemayhelpdeterfuturelawbreaking,BaskinSommersteam
reportedintheJanuaryClinicalPsychologicalScience.

TheirapproachisbuiltonresearchledbypsychologistandstudycoauthorJosephNewmanoftheUniversityof
WisconsinMadison,whofoundthatprisonerswithpsychopathyfocusonlyontheirowngoalsandignore
situationalcontexts.Whileworkingonsimplememoryorjudgmenttasks,forexample,psychopathiccriminalsare
notstartledbysuddennoisesandtheydontnoticewhenimagesonthecomputerscreenaremislabeled.That
formofmyopic,goalorientedattentiontranslatesinto,say,ignoringonesownnervousnesswhileconningpeople
outoftheirlifessavings.

BaskinSommersgrouprandomlyassigned56psychopathicinmatesinWisconsintooneoftwocomputertraining
programs.Inone,participantslearnedtonoticethecontextofexperimentalsituations.Forinstance,themen
viewedaseriesofmugshotsandhadtopressakeyontherightwhenthepicturedpersonseyeslookedrightand
akeyontheleftwhenhiseyeslookedleft.Butwhenfacesshowedpredesignatedemotions,suchasfear,themen
hadtoswitchtheirresponses:Ifeyeslookedright,pushtheleftkeyeyesleft,pushtherightkey.Intheother
trainingregimen,inmatespracticedselfcontrol,suchasholdingtheirbreathdespitediscomfortandrefrainingfrom
pressingcomputerkeysinagameuntilafterhearingasoundplayedthroughloudspeakers.
Inmatescompletedweeklyonehourtrainingsessionsoversixconsecutiveweeks.Bytheprogramsend,themen
doingcontexttraininggotsubstantiallybetteratthosetasks.Andtheyscoredhigherthanbeforetrainingon
attentionandemotionalcontroltasks.

Nosuchimprovementoccurredamongpsychopathicoffenderswhocompletedtheselfcontrolprogram.The
researcherssuspectthatpsychopathsrootproblemismoreaboutoverfocusingontheirimmediateaimsand
ignoringconsequencesthanoverreactingtofrustrations.

BaskinSommersgroupplanstotrackstudyparticipantsfortheremainderoftheirsentencesandafterrelease
fromprisontoseeifcontexttrainingleadstodeclinesincriminalbehavior.

Isuspectcontexttrainingmakespsychopathicoffendersmorereceptivetootherinterventions,BaskinSommers
says.Grouptreatments,suchasthosestudiedbyOlver,mightworkevenbetterwithmentrainedtobecluedinto
theirsurroundings.Itsworthinvestigating,shesuggests,andmightreduceinitialresistancetotreatmentprograms.

Evenifcontexttraininghelpspsychopathicoffendersbecomelesscrimeprone,thatdoesntconfirmBaskin
Sommersclaimthatmyopicattentionisacorepartoftheirpersonalitiesandcriminalbehavior,remarks
psychologistScottLilienfeldofEmoryUniversityinAtlanta.

Psychopathsdisplayweakornostressresponseswhileawaitingfearfulnoisesordisturbingimagesthattheyknow
arecoming,Lilienfeldsays.Thattypeofanticipationtypicallysetsoffanxietyalarmsinnonpsychopathic
volunteers.

Thereasonpsychopathsdontattendtofearprovokingstimulimaysimplybethattheyarenotespeciallyafraidof
theminthefirstplace,hesuggests.
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Evenso,hesays,ifBaskinSommersprogramlessensviolenceamongpsychopathicmenreleasedfromprison,it
wontmatterwhethercontextblindnessisacauseorasymptomoftheirproblem.

Avoidingtrouble

Itsanopenquestionwhethercontexttrainingonitsownwillmakeprisonersmorelawabidingafterreleaseor
moreresponsivetocognitivebehavioraltreatmentsinprison.Furtherstudiesmaysupportothertypesofcomputer
trainingforpsychopathicoffenders,suchasprogramsdesignedtoimproverecognitionofemotionalexpressionson
otherpeoplesfaces.

Researchersalsoknowvirtuallynothingabouthowsomepsychopathicexconsstayoutofprison,evenwithout
psychologicaltreatment.Asmallstudyofsuchmenconductedmorethanadecadeagobegsforalargerfollowup.

Aspartofhis2003doctoralthesis,NewZealandpsychologistNickWilsoninterviewed14psychopathicmenwho
hadavoidedprisontimeforfiveyearsafterservingsentencesformurder,sexoffensesandotherseriouscrimes.
Manyofthemenhadmovedtoruralspots,farfromillegaltemptationsandhardscrabblebuddies.Mostwere
unemployedbuthadwivesorgirlfriendswhoworkedanddiscouragedalcoholanddrugbinges.Exconscontinued
tothinkaboutcommittingseriousinfractionsandtwoadmittedhavingmanipulatedyoungermenintocarryingout
crimes.

Butadesiretoescapetheindignitiesofprisonkeptpsychopathicoffendersfromdirectlyactingontheirworst
thoughts,concludedWilson,nowattheDepartmentofCorrectionsinHamilton,NewZealand.

Olverrecallstreatingapsychopathicoffenderwhofitthatbill.Abig,burlyman,hefrequentlythreatenedtohurt
othersandgaveintourgestopeepintostrangerswindowsandseeksexwithunderagegirls.Themandeveloped
somestrategiesforcontrollinghisimpulsesintreatmentandgotajobafterleavingprison.Despitethose
achievements,heconfidedtoOlverthathestillcouldntbringhimselftocareaboutwhathappenedtootherpeople.

Butknowingwhatitwouldbeliketogrowoldaloneandbehindbarsprovidedarealitycheck,Olversays.Hejust
wantedtoavoidcomingbacktoprison.

Callouskids

Nooneisbornapsychopath.Thelastdecade,though,haswitnessedaburstofstudiesexaminingtreatmentsfor
delinquentandviolentyouthswhoexhibitastrikinglypsychopathicfeaturelittleornoconscience.

Theseyoungstersscorehighonascaleofcallousunemotionaltraits,includingalackofguiltandremorse,lackof
concernforothersfeelings,shallowexpressionsofemotionandnotcaringaboutmuchofanything.

Elevatedcallousunemotionaltraitsarefoundin10to32percentofchildrenincommunitysamples.Thoserates
remainfairlystableduringchildhoodandearlyadolescence,sayspsychologistPaulFrickoftheUniversityofNew
Orleans.

Butkidsandteensarecapableofchangingastheygetolder.A2007investigationfoundthatonlyaboutoneinfive
13yearoldboyswhoscoredinthetop10percentofcallousunemotionaltraitsrelativetotheirpeersscoredonthe
highendofpsychopathyatage24.

Amajorityofcallousunemotionalkidswontgrowuptobepsychopathic,buttheyhaveseriousbehaviorand
familyproblemsandareatincreasedriskofenteringthejuvenilejusticesystem,Fricksays.

Sixstudiesconductedfrom2006to2013demonstratethatchildrenandteenshighincallousunemotionaltraits
showarangeofimprovementsafterparticipatinginintensivefamilyandjusticesysteminterventions,conclude
psychologistsDevonPolaschekandJenniferSkeemoftheUniversityofCalifornia,Berkeleyinthe2015Handbook
ofPsychopathy.

Onestudytrackedhighlycallousunemotionalteenageboyswhoweretreatedinjuvenilefacilitieswhileserving
sentencesforviolentcrimes.Fiftysixboysreceivednearlyayearoftraininginsocialskills,waystoformbetter
friendshipsafterrelease,strategiesfordealingwithauthorityfiguresandbecominglessviolent.Eightyfiveboys
receivedstandardtreatment,withmedicationassessmentsandpsychotherapyorcrisisintervention,ifneeded.

Ofthosewhocompletedtheintensivetraining,only12gotarrestedforviolentactsoveratwoyearperiodafter
beingreleased.Inthestandardtreatmentgroup,42boyswererearrestedforviolentbehaviorafterrelease.

Storycontinuesaftergraph

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For
younger
kidswho
arehighly
callous

EYESPYCallousunemotionalkidswithconductproblemslookedtheirmothersintheeyeslessthanwellbehavedkidsandlessthan
kidswithconductproblemswhohadfewcallousunemotionaltraits(left).Mothersofcallousunemotionalchildrentriedtomakeeye
contactasmuchasothermothersdid(right).
Source:M.R.Daddsetal/J.ChildPsychol.Psychiatry2014
unemotional,helpmaycomeintheformofaskillthatseemsnaturaltomostchildrenlookingtheirmothersin
theeyes,suggestspsychologistMarkDaddsoftheUniversityofNewSouthWalesinSydney.

Thechildrenslackofconcernforothersappearstobeintimatelytiedtoanearlyderailmentofeyecontact,Dadds
proposes.IntheJuly2014JournalofChildPsychologyandPsychiatry,aDaddsledteamreportedthat16highly
callousunemotional4to8yearoldswithseverebehaviorproblemsspentlittletimegazingintotheirmothers
eyesduringmutualplay.Inthesamestudy,44kidswhooftenmisbehavedbutalsoshowedconcernforothersand
genuineemotionsmaintainedgoodeyecontactwiththeirmothers.

Avertedgazesmayemergesurprisinglyearlyinkids.Fiveweekoldswhopaylittleornoattentiontoan
experimentersfacemovinginfrontofthemareparticularlylikelytoscorehighoncallousunemotionaltraitsatage
2.5years,reportedpsychologistRachaelBedfordofKingsCollegeLondonandhercolleaguesin2014
inBiologicalPsychiatry.

Muchresearchindicatesthateyecontactbetweenadultsandchildrensupportsthedevelopmentofconscience
andempathy,Daddssays.Heisstudyingwhethercallousunemotionalkidsgetalongbetterathomeandatschool
afterfourmonthsoftraininginmakingeyecontactwiththeirmothers.Resultsareduelaterthisyear.Bruce
Bower

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