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Monday, April 09, 2012

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Not only is there a tendency to reject psychotherapy for psychopaths in the penal system, but Hare has emphatically tried to spread the word that such attempts actually have been shown to make many psychopaths worse. Being incapable of conscience or empathy, they apparently just use the sessions to learn better how to manipulate others.

From what I read he was on a mission to try to change how psychopaths are dealt with in the Canadian penal system because of just this phenomenon.

Great post.

Until last month, I provided psychotherapy to prison inmates (about a third my case load). I loved working with inmates, but the crushing paperwork made managed care look like a walk in the park, and that's why I got out of it.

Conventional clinical and counseling psychology really doesn't have useful theoretics or treatment approaches for the antisocial. But the penal system has developed its own entire branch of clinical psychology, about which outsiders know almost nothing. If you're interested in working with this population, the classic text is the three-volume The Criminal Personality by Yochelson and Samenow.

As for Hare, *shrug*, I don't get the impression he's doing anything particularly useful, but I suppose you'll never know what he'll turn up.

My inmates were seeing me as a part of a package deal: earlier release if they submitted to a substance abuse treatment program, which I was attached to as a mental health specialist. So they opted in to the program, and were warned it involved cooperating with therapy. So it was at least somewhat a voluntary experience.

It is rare, but not unheard of, for inmates in our program to find treatment sufficiently helpful that upon their release, they elect to continue treatment with their therapists on a voluntary basis. I have two such patients right now.

You'll note I don't use the term "psychopathy" in this comment. We use neither the psychoanalytic "psychopathy" nor DSM "antisocial personality" concepts, particularly, in our work. It's not that they don't have merit as concepts. It's that we have a different conceptual construct. I'm not trained in diagnosing "psychopathy", I'm trained in recognizing criminal mentality. (I'm trained in dxing "Antisocial Personality D/o", of course, I just have rarely had occasion to use it, even with violent inmates.) I expect there's considerable overlap in our concepts, but I'm not quite sure how they'd line up.

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