Encyclopedia of Psychology and Law

predicting early termination or poor treatment perfor-

mance rather than targets for intervention themselves.

This is particularly evident in the substance abuse lit-

erature, where the primary intervention target is sub-

stance use rather than psychopathy or psychopathic

traits, even after numerous studies have demonstrated

that psychopaths show fewer treatment gains using tra-

ditional interventions for substance use. Despite the

limitations, these studies have a few hopeful findings

that deserve greater attention. First, several programs

found some positive benefits from treatment, even for

individuals with high levels of psychopathy. Second,

longer, more intensive treatments generally showed

better effects, consistent with the view of psychopathy

as a pervasive and destructive personality disorder.

The primary conclusion we can draw from past

work in this area is that much more intensive and

thoughtful research is needed if we are to further facil-

itate practice with psychopathic individuals. At pres-

ent, there are few specific programs designed for

treating psychopathy itself, and there are mixed find-

ings regarding behavior and compliance while in treat-

ment. It would be naive to conclude that treatment

would not be difficult, particularly given what we

know about the treatment of other severe forms of psy-

chopathology; however, it is equally naive to conclude

that psychopaths cannot benefit from treatment simply

because of the complexity of the disorder. Working

between these two extremes, the literature reviewed

above indicates that more research is needed to study

the risk, protective, and causal factors of psychopathy

as well as to begin intervention development.

Ultimately, the goal should be to test the efficacy and

effectiveness of informed treatment programs.

Directions for Future Studies

In many clinical settings, psychopaths are seen as

untreatable despite a lack of scientific support for this

claim. Three problem areas are clear from the research

that exists on the topic. First, classification is a critical

issue with regard to treatment. Further clarity regarding

the features of the disorder is necessary to accurately

assess treatment amenability. This clarity can be gained

in part by specifying the conceptualization of psychopa-

thy used in treatment-outcome studies as well as the spe-

cific symptomatology present that makes it difficult (or

easy) to treat them. Also necessary for understanding

treatment effectiveness is work on the temporal stability

of psychopathy. Few studies have examined the

psychopathy-treatment relation from contemporary

concepts of the disorder or compared treatment effects

across broad models. In a meta-analysis by Salekin, the

Cleckley psychopath was the most frequently investi-

gated conceptualization of psychopathy in treatment-

outcome studies, yet most current research uses Hare’s

conceptualization of psychopathy. Given that his defini-

tion differs from Cleckley’s, treatment-outcome studies

that employ this definition are necessary, particularly if

psychologists are to make statements about treatment

amenability based on the PCL–R.

Third, to better understand the psychopathy-treat-

ment relation, several issues should be addressed in

future studies. Treatment programs specifically aimed

at reducing psychopathic characteristics should be

developed and ought to be based on theory regarding

the etiology and maintenance of psychopathy. These

studies should be controlled and systematic to deter-

mine the effectiveness of different treatment modali-

ties. For example, researchers should use psychopathy

instruments pre- and posttreatment to examine the

changes in symptom level, and raters should be blind

to previous scores or intervention group membership.

These studies should also investigate whether external

criteria, such as recidivism and conduct problems, are

reduced following treatment. This type of information

would inform psychologists whether there is evidence

that psychological change implies reduced risk of re-

offending. In addition, in light of the characteristics of

psychopathy, research needs to evaluate the possibility

that clients are “faking good” rather than showing evi-

dence of substantive changes in psychopathic traits.

In sum, the literature on the treatment of psychopa-

thy has changed from pessimistic to cautiously opti-

mistic with the notion that carefully designed and

focused interventions may be able to produce measur-

able change in psychopathic individuals. Through

careful design and evaluation of treatment intervention

programs, it is hoped that the second generation of

research on treatment outcomes will allow for earlier,

more effective intervention with psychopathic individ-

uals to reduce the high societal cost of persistent

offending. The eventual goal should be to use theories

of etiology to initiate prevention and intervention

efforts before the development of the disorder causes

the individual, and society, substantive harm.

Randall T. Salekin and Ross D. Grimes

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