Mental health articles

Treatment of psychopathy
Psychopathic individuals do not seek treatment, and most interventions occur within prison or other custodial settings. As a result of their lack of motivation to change, psychopathy has often been considered an untreatable condition, although there have been some voices of dissent from this somewhat negative viewpoint. Of interest are three review papers of the treatment of psychopathy published within two years of each other and reviewing essentially the same literature. Salekin conducted a meta-analysis on data from 42 treatment studies, and concluded that while ECT and therapeutic communities were relatively ineffective interventions, good results could be achieved following psychoanalytic and cognitive therapy. Evaluating much the same literature, Reid and Gaconowere more pessimistic in their conclusions and could f i nd no evidence of consistent therapeutic gain following any form of treatment. Similarly, Wong and Hare concluded that, of the 74 empirical studies they could identify, only two were adequately conducted, and that the evidence was so weak that it remained unclear whether any intervention could be effective. Measuring the effectiveness of programmes to treat psychopathy is problematic. A defi ning characteristic of psychopathic individuals is that they tell lies and are manipulative. Self-report measures should therefore be treated with considerable caution. Even behavioural measures cannot be relied on. The results of a study by Seto and Barbaree illustrate the problem. Their study examined the impact of a relapse prevention programme for sexual offenders similar to those described in Chapter 11. Participants included a range of people, not just psychopathic individuals. Their report focused on the relationship between apparent progress made within therapy as a function of in-session behaviour, homework quality, and therapist ratings of motivation and ‘progress’, and the frequency of reoffending following treatment. Among non-psychopathic individuals, greater within-therapy improvements were predictive of lower levels of offences following discharge from prison. By contrast, there was a positive association between apparent progress in therapy and the frequency of offences committed by the psychopathic individuals who took part in the programme. It seems that these people were able to learn the responses that the therapists considered indicative of progress and were able to simulate them. Those that were best at this simulation were also the most likely to re-offend. Therapy did nothing to change the underlying motivation of their behaviour.