Attachment and psychopathy in forensic patients
| DOI | https://doi.org/10.1108/13619322200900020 |
| Date | 03 November 2009 |
| Published date | 03 November 2009 |
| Pages | 40-51 |
| Author | Anne Van den Berg,Karel Oei |
| Subject Matter | Health & social care |
Mental Health Review Journal Volume 14 Issue 3 September 2009 © Pier Professional Ltd
40
RESEARCH
Anne Van den Berg
De Rooyse Wissel, Forensic Psychiatric Hospital, Venray, The Netherlands
Karel TI Oei
Institute of Criminal Law and Victimology, Department of Forensic Psychiatry, Tilburg University, The Netherlands
Attachment and psychopathy
in forensic patients
Abstract
Effective treatment of patients with severe psychopathy is very difficult to achieve. This conclusion may
be drawn from an extensive examination into the usage of the term ‘psychopathy’ in scientific research
literature, in theoretical development from various psychological schools of thought, in the practice of
therapy and in assessment. The central issue for the authors of this article is the inability of severely
psychopathic patients to commit to the patient–therapist relationship. Attachment theory and mentalisation-
based treatment are used here to define the cause and nature of this inability, which is incurred in very
early childhood. These two models can aid in the development of more dynamic definitions of psychopathy,
better suited to dynamic therapy formats.
The ways in which psychopathy is defined partly account for a number of problems encountered in the
practice of therapy. The authors assume that the treatment of psychopathy should be interactional and
should match patients’ individual levels of psychological development and mentalisation; highly psychopathic
patients often perceive others as objects, ie. as part of the context, not as subjects, ie. autonomous
personalities.
The authors propose to conduct further research in order to verify the validity of their hypothesis. They
also put forward a number of suggestions for therapy formats with a view to establishing effective working
relationships with psychopathic patients.
Key words
Attachment, antisocial, mentalisation, object, psychopathy, psychotherapy, research, self, subject,
therapeutic relationship
Introduction
The quality of patient–therapist relationships is
a powerful predictor of therapy results (Lambert,
1992). It is, however, notoriously difficult
to establish therapeutic relations with those
forensic patients who suffer from a severe degree
of psychopathy. The general assumption is that
the difficulty lies in certain personality traits
that prevent such patients from entering into
any reciprocal relationships (Cleckley, 1982).
Typical traits, for instance superficial charm or
the inability to really love others, are believed to
make meaningful and reciprocal relationships –
indispensable as they may be for the establishing
of therapeutic relations – impossible for those
who suffer from psychopathy. In this article, we
address the question of how we may break out of
this circular argument. Unsurprisingly, numerous
therapists and researchers in forensic psychology
have come to the conclusion that psychopathy is
untreatable (Cleckley, 1982; Strassburger, 1986).1
1In empirical research it has been suggested that psychopathic patients will be more dangerous after treatment (Rice et
al, 1992). However, more recent reviews show that there is no evidence for the untreatability of psychopathic patients
(Salekin, 2002; D’Silva et al, 2004). Nowadays the opinion is, based on empirical research, that psychopathy is treatable
(Skeem et al, 2002, Caldwell et al, 2006). Former skeptics even endorse this (Harris & Rice, 2006).
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