Therapeutic communities of psychopathy

Therapeutic communities were first developed under the leadership of Maxwell Jones in the UK in the late 1940s. These provided an intensive 24-hour-a-day intervention to change psychopathic behaviour. Those within them were made responsible for the physical and emotional care of others within the community. The group itself established acceptable and unacceptable behaviours. Members were required to accept the authority of the group, and to submit to its sanctions if they disobeyed the rules.

Communities were loosely based on Rogerian principles, and tried to inculcate high levels of honesty, sincerity and empathy. One of the best evaluations of the effectiveness of this approach was reported by Rice et al. – although the community it assessed was signifi cantly more authoritarian than the UK model. They focused on a therapeutic community situated within a maximum security prison in the USA. The programme was led by those within it, and comprised 80 hours of intensive group therapy each week, intended to help participants develop empathy and responsibility for their peers. Those who responded well led therapeutic groups and became involved in administering the programme. All participants were involved in decisions about who was released or transferred from the programme. Participants had little contact with professional staff. Nor did they have much opportunity for diversion: access to television or even informal social encounters were severely limited. Participation in the programme was compulsory: disruptive behaviour, for example, resulted in entry into a sub-programme in which the individual discussed their reasons for not wanting to be in the programme, but they were ultimately expected to resume participation. The authors noted that some of these programme characteristics would now not be ethically acceptable, but that the programme was well regarded at the time it took place in the 1960s and 1970s. The programme accepted both psychopaths and non-psychopaths, who were followed up for an average of ten years after discharge. Analyses compared the outcomes on psychopathic individuals, non-psychopathic participants and a matched control group who did not enter the community. Their results were similar to those reported by Seto and Barbaree.

Nonpsychopathic individuals were less likely to offend following discharge than those in the control group. By contrast, psychopathic individuals who participated in the programme were more likely to engage in violent crime following discharge than those in the control group, with known recidivism rates of 78 versus 55 per cent respectively. The therapeutic community approach may actually have taught psychopathic individuals how to manipulate others more effectively – an unexpected and unwanted result.