When psychologists talk to someone about what is and what is not psychopathy, many questions arise. There is one that always ends up coming out, because it is perhaps the most interesting of all. Is it possible to treat these people psychologically effectively? Some are talking about treatment and others about healing, which are very different things.
For this article we are going to talk what we know today about the prognosis of psychopathy from a clinical point of view. Remember that science is constantly changing knowledge and what we know today may not be as true tomorrow. Given the caveats, let’s see what the meta-analyzes say.
Ways to understand psychopathy
Unfortunately, diagnostic manuals do not recognize psychopathy as a clinical entity. While these labels have many detractors – and rightly so – there is something they are used for. By presenting the criteria for a disorder in a clear, complete, and orderly manner, it allows for investigation. And any research group that takes these criteria as a benchmark will almost certainly study the same phenomenon.
Psychopathy does not have this benchmark, so each research group can study different definitions of psychopathy. There have been successful attempts to unite definitions and understand psychopathy as a set of traits that often present themselves at the same time. Perhaps the most common is that of Hervey Cleckley, who describes at length the clinical features of the psychopath.
Robert Hare later identifies two factors in these descriptions main: using others in a selfish, emotionally cold, harsh and remorseful way and on the other hand a chronically unstable, norm-breaking and socially deviant type of life.
Naturally, research into the effectiveness of treatment for psychopathy largely depends on how we understand it. Although most of the research uses the best known criteria, we should keep in mind that there are a number of trials that may have measured psychopathy in different terms.
Is psychopathy incurable?
Any psychology student who has tackled personality disorders has some sort of automatic springboard that prompts them to answer this question with a resounding “yes”. There is a widely held belief that psychopathy is impossible to eradicateThis also happens with antisocial personality disorder.
This is because personality disorders are incurable, they do not remit in their entirety as they are exaggerated manifestations of normal personality traits. And in the same way as personality is changeable to some extentRigid personality models are also only permeable to a certain extent.
It is at this point that a leap of faith is often made that is not fully justified. Just because a mental disorder never goes away doesn’t mean you can’t respond to treatment. This is why we are talking about treating and not healing. The truth is, the evidence for the treatment of psychopathy is not that convincing.
The notion that this disorder is intractable it can come from the psychoanalytic current, Which suggests that personality forms during the first 5-6 years of development and remains largely unchanged. But even within psychoanalysis it has changed and the possibility of modification is being conceived.
Hare himself proposed a theory of psychopathy which justified its status as “insoluble”. In this first theory, he says that psychopaths suffer from an injury to the limbic system (located in the brain) that prevents them from inhibiting or interrupting their behavior. It further predicts that psychopaths will be unresponsive to punishment, that they will never be able to learn that an action can have bad consequences. In a later examination of this theory, Hare described psychopaths as emotionally insensitive, With more difficulty in dealing with the emotions of others.
What do the studies say?
Any theory is left in speculation when it comes to therapeutic efficacy. When we want to know if a disorder or phenomenon responds to different forms of treatment, the best way to find out is to test that hypothesis.
Many research groups have shed the burden of clinical pessimism about psychopathy and have conducted clinical trials to assess the viability of treatments.
Surprisingly, most of the articles address the problem of psychoanalytic psychopathy. Almost everyone understands the phenomenon as described by Cleckley, with the exception of a few tries. The cases treated with psychoanalytic therapy show some therapeutic success compared to the control groups. This finding supports the view that insight and disease awareness they could be beneficial to psychopaths.
Cognitive behavioral therapies appear to be slightly more effective than psychoanalytic therapies. These therapies addressed issues such as thoughts about oneself, others, and the world. In this way, some of the most dysfunctional characteristic traits are addressed. When the therapist combines the cognitive-behavioral approach and the insight-based approach even higher treatment success rates are achieved.
The use of therapeutic communities was also tested, but their results were only slightly better than those of the control group. This is not surprising, as therapeutic communities have little direct contact between therapist and client, which the psychopath really needs.
The use of medication Treating the symptoms and behaviors unique to psychopathy, in the absence of more clinical trials, shows promise. Unfortunately, the methodological precariousness of the studies in this regard and the small number of articles do not allow us to draw definitive conclusions on this question.
Dismantle the myth
You don’t have to believe fervently in the results of studies to realize that psychopathy is far from insoluble. Although we do not have specific programs that address all of the dysfunctional aspects of the psychopath, if we do have therapeutic tools to stop the most maladaptive behaviors. The question of whether these therapeutic benefits are sustained over time is something that remains in the air.
One of the basic problems that arises in the treatment of psychopathy, as in other personality disorders, is that the client rarely wants to go to therapy. And even in the odd case that they come on their own, they often resist change. Ultimately, we will ask the patient to introduce a series of changes in their personality which are not at all easy to implement and which threaten their own identity.
With these patients it is necessary do intense disease awareness and motivation work for change before the therapy itself. This extra effort exhausts both the patient and the therapist, who often ends up dropping out or unfairly labeling the patient as intractable. The truth is, if we can’t become a psychopath, it’s just because we haven’t figured out how to get it yet.