Psychopaths and Treatment

Clinicians often describe psychopaths as people whose psychological defense mechanisms are so effective that they can suppress feelings of anxiety and fear. Laboratory research supports this idea and suggests there may be biological foundations for their ability to handle stress. This might sound enviable, but the reality is more complicated. For psychopaths, the line between fearlessness and recklessness is blurred: they constantly get into trouble, mainly because they don’t act out of anxiety or heed warning signs of danger. Like people who wear sunglasses indoors, they may look “cool,” but they miss a lot of what’s happening around them.

Why Nothing Works

The foundation of psychotherapy is the assumption that the patient needs and wants help overcoming their psychological or emotional problems: anxiety, depression, low self-esteem, shyness, obsessive thoughts, and so on. Successful treatment requires the patient’s active participation in finding ways to relieve their symptoms. In short, the patient must recognize there’s a problem and try to solve it.

This is the core issue: psychopaths don’t believe they have psychological or emotional problems, and they see no reason to conform to social standards they find unacceptable.

To be more precise, psychopaths are satisfied with themselves and their inner world, no matter how empty it may seem to others. They see themselves as perfectly fine, experience minimal personal distress, and believe their actions are rational, purposeful, and satisfactory. They never look back with regret or forward with anxiety. Psychopaths see themselves as superior beings in a hostile, ruthless world where everyone is fighting for money and power. They believe they have the right to deceive and manipulate others to achieve their “rights,” and their interactions are fundamentally defensive against what they perceive as hostility from the outside world. It’s no surprise, then, that no psychotherapeutic method resonates with psychopaths.

Why Psychopaths Are Poor Candidates for Therapy

• Psychopaths are not weak-willed. Their thoughts and actions stem from a steadfast character that resists outside influence. By the time they enter therapy, their views and behavioral patterns are so deeply rooted that changing them is extremely difficult, even under the best circumstances.
• Many psychopaths are shielded from the consequences of their actions by well-meaning family and friends. Their behavior often goes unnoticed and unpunished. Others become so skilled that they easily avoid trouble. Even those who are caught and punished blame the system, fate—anyone but themselves. Those who escape punishment simply enjoy their lifestyle.
• Unlike others, psychopaths rarely seek professional help on their own. They are usually forced into therapy by desperate relatives, the court, or the possibility of early parole.
• Psychopaths gain nothing from therapy because they lack the capacity for deep emotional experiences and self-reflection that clinicians value. They also don’t care much about interpersonal relationships, which are the foundation of therapeutic success.
• One psychiatrist described psychopathic (or “sociopathic”) patients this way: “…sociopaths don’t want to change; they justify their actions by saying they simply wanted to do them; they have no concept of the future; they hate authority, including medical authority; they find the patient role humiliating; they turn therapy into a farce, and clinicians into targets for deceit, threats, seduction, or exploitation.”
• This is hardly the introspective search for personal insight that clinicians hope to encourage. Psychopaths usually don’t participate in the “dance” of psychotherapy, and many clinicians don’t even try to make them.
• Most therapy programs only give psychopaths new excuses and justifications for their behavior, as well as new ways to exploit human weaknesses. Learning new and possibly better manipulation techniques, psychopaths rarely try to change their views or empathize with others—to feel their needs, experiences, and rights. Attempts to teach psychopaths to “truly feel” are doomed from the start.
• This applies to both individual therapy, where doctor and patient meet one-on-one, and group therapy, where several people with different problems try to use each other’s experiences to see themselves and others in a new light.
• As noted, psychopaths often dominate both individual and group therapy sessions, imposing their ideas and interpretations on others. One prison therapy program leader described an inmate with a high psychopathy score: “He refuses to speak if someone else sets the topic. He dislikes criticism of his behavior. …He ignores anything that blocks communication and dominates therapy sessions with boring monologues to distract the group from discussing his actions.” Later, the psychiatrist wrote, “I’m sure he’s changed for the better. He accepts responsibility for his actions.” The prison psychologist added, “He’s made progress. …He’s more empathetic, and his thinking is less criminal.” Two years after these optimistic statements, a graduate student interviewed the inmate for a research project. She said he was the worst criminal she’d ever met, and he openly bragged about fooling the prison staff and pretending to reform. “I can’t believe it,” he said. “Who gave them a license? I wouldn’t let them near my dog! He’d mess them up as bad as I did.”
• A forty-year-old man with fifty-five charges of fraud, forgery, and theft (tried in three countries) tried to avoid deportation from Canada by claiming he’d been reformed by a friendship with a seventy-six-year-old blind woman. In a 1985 report, he was described as “consistently pleasant, polite, intelligent, and charming.” However, it was also noted that he was a pathological liar “with a well-developed personality disorder.” An immigration lawyer called him “a pathological liar who could charm the bark off a tree,” “a chronic liar unable to distinguish reality from fiction,” and a classic con artist. The lawyer noted that the man had been paroled in the U.S. in the late 1980s, violated parole, fled to Canada, and settled in Vancouver, “leaving behind a trail of worthless checks.” Now, the criminal claimed he’d changed thanks to self-analysis sessions at a Christian center run by the aforementioned woman. His claims of reform contradicted witness testimony showing he continued to write bad checks and ignore bills.