Treatment of psychopathy: a conceptual and empirical review
| Pages | 186-198 |
| Date | 17 September 2018 |
| Published date | 17 September 2018 |
| DOI | https://doi.org/10.1108/JCRPP-06-2018-0019 |
| Author | Michael Lewis |
| Subject Matter | Health & social care,Criminology & forensic psychology |
Treatment of psychopathy: a conceptual
and empirical review
Michael Lewis
Abstract
Purpose –For decades, psychopathy has been thought to be untreatable. Yet, conceptualisations, and
indeed its assessment, have deviated away from viewing the disorder as personality pathology towards a
behavioural focus where the core underlying deficits in cognition and affect have been ignored. Interventions
have followed suit leading to a premature discounting of the role of therapy in adjusting psychopathic traits.
The paper aims to discuss these issues.
Design/methodology/approach –The review critically evaluates the conceptual and empirical evidence
relevant to the treatment of psychopathy, deciphering components integral to the disorder that require
intervention. Psychopathy is approached from a developmental perspective, with the review identifying
several mechanisms thought to be responsible for precipitating and perpetuating its expression.
Findings –There appears some utility in targeting psychopathy from multiple angles, addressing
experiences of trauma, associated schemas and the underlying cognitive-affective dysfunction noted to give
rise to psychopathic traits. A new model for treatment was proposed integrating these factors to encourage
the design of effective interventions that will address the origins and underlying deficits of the disorder, rather
than symptomology.
Originality/value –The review encourages future research to consider the aetiology of psychopathy, with
the aim of informing early intervention and containing the disorder whilst in its infancy, as well as addressing
neurobiological dysfunction when most malleable.
Keywords Psychopathy, Treatment, Cognition, Trauma, Affect, Schema, Cognitive remediation
Paper type General review
Introduction
Psychopathic individuals are a high-risk, high-need group (Simourd and Hoge, 2000), yet are
commonly thought to be untreatable (Salekin et al., 2010). These negative perceptions have become
engrained in clinical practice, demonising the disorder and hampering theoretical and practical
developments in its treatment. However, there have been a number of recent, albeit tentative,
indicators that treatment may in fact be successful (Polaschek and Daly, 2013). Substantial barriers
to further progress remain, with confusion surrounding how psychopathy is measured and defined.
The review will begin by considering how psychopathy has been conceptualised and assessed,
and the relevance this has to understanding, developing and evaluating treatment. It will then
move on to explore the empirical investigation of psychopathy-related treatment, identifying
potential reasons for prematurely discounting the role of therapy in adjusting psychopathic traits.
Finally, a more recent technologically-orientated therapeutic approach will be discussed prior to
outlining a new model of psychopathy treatment incorporating concepts highlighted as
important throughout this review. It is hoped that this model can then be applied to advance
understanding of the disorder’s aetiology, thus allowing for more meaningful treatment design.
Conceptualising psychopathy: what does this mean for treatment?
Research has drawn attention to a unique subgroup of offenders diagnosed with psychopathy
and characterised by a lack of psychiatric comorbidity (Blair et al., 2005), an inability to maintain
Received 17 June 2018
Revised 11 July 2018
Accepted 19 July 2018
Michael Lewis is a Lecturer in
Forensic Psychology at the
University of Central
Lancashire, Preston, UK.
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JOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE
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VOL. 4 NO. 3 2018, pp.186-198, © Emerald Publishing Limited, ISSN 2056-3841 DOI 10.1108/JCRPP-06-2018-0019
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