Book review: Antisocial Personality Disorder A Practitioner’s Guide to Comparative Treatments

I had a nice conversation with a friend today. She said that part of healing from a relationship with a sociopath is getting to the point where one realizes that sociopaths deserve pity for being disordered. In that regard, we both hope that science will progress to the point where sociopathy is preventable and fully treatable. In this blog I will discuss treatment options for those diagnosed with antisocial personality disorder. Following the format of the book I am reviewing, this disorder is called sociopathy or ASPD and the personality traits that give rise to the disorder are called “psychopathic personality traits.”

Regarding whether sociopathy and psychopathic personality traits are currently treatable, Sandy Brown and I had a bit of a disagreement when we wrote Women Who Love Psychopaths. Although I told her the literature indicates sociopathic behaviors are to some degree treatable she was very insistent we emphasize that psychopathic personality traits are not treatable. She won out because she convinced me of the need to communicate to women that men with these personality traits usually do not change. In her experience, giving a woman any hope her man could improve, discourages her from leaving the relationship. I offer this book review and discussion of treatment of sociopathy/psychopathy to keep you informed, NOT to encourage you to stay.

I also recognize that spouses may choose to stay married to those with ASPD for any number of legitimate reasons. There are also people who have sons, daughters, parents, uncles, aunts and cousins with ASPD. All want to know if there is any effective treatment for the disorder. People want to know what treatment gives their loved one the best shot at improving.

If you have a close family member who is a sociopath and are involved in that person’s treatment, I strongly recommend you read Antisocial Personality Disorder: A Practitioner’s Guide to Comparative Treatments. Although the book is written for mental health professionals, I believe any person with some background in psychology can understand most of it. What you don’t understand, you can look up and so become better able to communicate with therapists. This book is an absolute must read for all professionals who deal with sociopaths and their families.

To give you an idea of why I give this book 5 stars, I will describe it and discuss the content. The book is edited by two psychologists experienced in the treatment of sociopaths, Drs. Rotgers and Maniacci. In the second chapter, they give detail s of the case of Frank a classic sociopath. Although they do not say so in the book, Dr. Rotgers told me that Frank was an actual person he evaluated.

I was very impressed with the way the authors presented Frank and his history. In particular, the clinicians interviewed Frank’s wife. Her statements about him and their relationship are characteristic of the kinds of things spouses of sociopaths say. Frank’s aunt and brother were also interviewed. The editors agree with me that the best sources of information regarding the nature of sociopaths and sociopathy are the family members of the disordered person.

Frank’s wife Jennifer says the following, “ The most exciting year of my life (was the first year of our relationship). He was so spontaneous and full of energy. His charm and good looks just swept me off my feet. Being with him was just so exhilarating. “ and later, “it suddenly dawned on me that I didn’t know anything about him.”

Having presented the case of Frank, the editors then invited 8 professionals representing 8 different treatment approaches to answer a series of explicit questions about their formulation of the case, understanding of the disorder and approach to treatment. The contributors were as follows:

1. Debra Benveniste, MA., MSW; Putnam, CT-Psychodynamic Approach
2. Michael Maniacci, Psy.D.; Chicago, IL-Adlerian Psychotherapy
3. Darwin Dorr, Ph.D.; Wichita, KS-Million’s Biosocial Learning Perspective: Personologic Psychotherapy
4. Glenn D. Walters, Ph.D.: Schuylkill, PA-Lifestyle Approach to Substance Abuse and Crime
5. Arthur Freeman, Ed.D. & Brian Eig; Fort Wayne, IN and Philadelphia, PA-Cognitive Behavioral Treatment (CBT) Approach
6. Robin A. McCann, Ph.D., Katherin Ann Comtots, Ph.D., & Elissa M.Ball, M.D.; Denver, CO-Dialectical Behavior Therapy
7. Joel I. Ginsberg, Ph.D., C.A. Farbring, M.A., & L. Forsberg, Ph.D.; Stockholm, Sweden-Motivational Interviewing
8. Sharon Morgillo Freeman, Ph.D., MSN, RN-CS, & John M. Rathbun, M.D.; Fort Wayne, IN- Integrating Psychotherapy and Medication

In the last chapters the editors compare and contrast the different treatment approaches. Family members of sociopaths should be aware of two important points. First all but one of the therapeutic approaches (psychodynamic) involves family members in the treatment. Family members are considered by the 7 to be important sources of information. Given the importance of family to the treatment, do not expect therapists to discourage you from being involved in a sociopath’s life. Therapists often encourage family members to stay with the sociopath and support him/her. This may benefit the sociopath at the expense of his/her family.

The chapter on medication discusses medication that can help the poor impulse control and aggression seen in sociopaths. I completely agree with the recommendations made and think that if a person with ASPD is willing medication should be tried.

What about prognosis then, and how long does it take to treat a sociopath? The CBT chapter gives some interesting statistics. The authors state, ”Psychotherapy is associated with a sevenfold faster rate of recovery compared to the naturalistic studies”¦ Without treatment, estimated recovery rates are about 3.7% per year, and with active treatment the rates increase to 25.8% per year.” Also the longer the treatment continues the more improvement there is. They also say, “Unfortunately, people with ASPD have a very high drop out rate.” It makes sense then for family member to encourage those with ASPD to stay in treatment. Don’t expect that treatment to turn a sociopath into a loving, empathetic person, though. All of the authors say that is not a realistic treatment goal. When professionals say a sociopath “has improved,” they mean he/she is not as dangerous and is less impulsive. As Dr. Rotgers’ email to me said, “Harm Reduction: ‘80% of something is better than 100% of nothing’ Alex Wodak”


Donna sent me the following comment. Your post today leaves a huge question in the mind of a reader: What can treatment accomplish? Can you please address this?

I will address this question in detail next week. For now I wanted to introduce the names of the psychotherapies. To cover all in one week would have been too much.

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60 Comments on "Book review: Antisocial Personality Disorder A Practitioner’s Guide to Comparative Treatments"

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The two kinds of “forgiveness” you speak of, the “dumb” kind and the real kind is one of the hardest things I had to overcome in dealing with the Ps.

My mother had programmed me as a child that “forgiveness” meant that you “pretended it never happened” over and over and over. Of course, since then I have learned that “forgiveness” (to me anyway) does not mean let’s play “pretend” it means getting the bitterness out of my heart about what someone did, it does NOT MEAN that I will ever trust them again or let them get within a mile of me again, it just means that I am not bitter, I won’t let their behaivor, their actions, their bad deeds, ruin the rest of my life and make my soul bitter.

There is a GREAT thread here somewhere a few months back about apologies that is “have to” reading. ONe of the best on here I think.

I do love your name Kat!

To all who read my comments, please forgive my exuberance and silliness as it is in no way, shape or form meant to trivialize, nor dismiss your tender pain and suffering at the duplicitious, heartless, cruel hands of a full fledged predator.

I know your pain and have lived it countless times in the past 20+ years, so I do truly understand.

Our gracious and loving Father in Heaven has blessed us humble human beings with the fantastic capacity to laugh even in the most difficult, emotionally/physically/spiritually trying of times. It helps us to maintain our equilibrium, our balance, our humility, our generous and loving natures even in the darkest of midnights.

I gots a lotta love in my heart and I’m able, willing to share it with any person, any critter, any insect (haha) who wishes it. 🙂

Except…..PDIs, of course.

Jane Smith- I love your exuberance and silliness. You make me smile…..

There is no treament for a Sociopath. I was married to one for 15 months (last year). Identified by our marriage counselor within 6 months of the marriage, I was told that it “sounds like he’s tring to set you up”. With over 52 calls to the local sheriff’s office, lying his ass off and getting away with it. I was arrested 3 times for domestic violence, after I left the home and he put scratch marks, etc on his face. I am on probabtion for this, only because I didn’t have the money to protect myself with a real lawyer. I have lived in this town for over 30+ years and caused so much embarrassment for me and the business I am in, and cannot get a decent paying job because of my past “record”. He has totally f***ed me up…..but I am on the road to recovery. I want him out of this town so bad, that I found my own method of “recovery” First, I grew a set of balls. Secondly, I called the IRS and reported to them that he had not filed a tax return in over 30 years. I reported him to the Securities and Exchange Commission for selling securities without a license. Third, I reported him to the local Property Appraisers office for fraud, as he filed homestead in both homes. This little a$$hole now owes the IRS over $300k, is being investigated by the SEC, and his boss will not have him back. He’s been out of work for over 4 months. And the local Property Appraisers Office only went back 3 years, but they doubled his property taxes for all 3 years. Doing this has soooooo helped me in the recovery process. I think now he knows he should have written me a fat check that I requested from him a few months back. I could have saved him alot of money! (hehe). He still sees our counselor, which I consider fraud by her since there is NO treatment for a Sociopath who meets all of the 20 characteristic behaviors. These people are basically “f****d”. In fact, from what I have read, the prison system contains about 90% Sociopaths. I only hope that my “ex” winds up there, because I am sure I am not the first female to suffer the consequences from being with this whack-job.

Dear Cherly, I am so sorry that you have had such a terrible time from this man. You have found a healing community of people who have suffered as you have at the hands of these predatory monsters. I am glad thatyou were able to expose some of his crimes so that he will get the consequences of them from the IRS SEC etc. Many times we get no justice and just have to go on with our lives without it.

None of us here as far as I know think that there is “successful” treatment for these predators at least in the full blown adult state which is what we are dealing with.

Come here often post 100 times a day if you need to, and be assured that you are very welcome here in this caring community of people trying to heal from the devestation of these monsters.

I suppose there will be predators as long as there are victims (ei. nice people), and vice versa.

Thank you Oxy lol.

You know guys, of all the stuff my first husband did to me.. the only one I can’t forgive him for, absolutely can’t.. is this one time we were desperate for food, and the baby had no milk or anything. I asked him to give me one dollar for some milk, and he just slammed the door in my face. So my little baby cried herself to sleep while her father and grandparents sat right next door watching movies and eating pizza. It still brings tears to my eyes, though she is 14 now.

omg did anyone see or is anyone watching DR.Phil 3pm eastern time today. im watching it right now. this guy on there reminds me so much of my ex. im not saying that guy is a sociopath but i would run so fast away from that guy. he is all about him self, wants to be in control. Thats the first sign!!!! women run!!

wow..this story is making me sick! he is lying on his online dating site! goddd…sociopath…sorry just my opinion

Blonie and Kat, as lsong as there are people in the earth there will be good ones and bad ones, and the good will be taken advantage of by the bad ones. Even if you dont’ take the story of Cain and Abel literally, you can see that there have always been Ps and people who will resent other’s success and doing right, and hate, resent and be jealous of them.

Jesus ddn’t pull any punches in his teachings either, he told his disciples that they would be persecuted for doing RIGHT. People who are wicked, and evil, resent others who are not. They turn and use our good natures against us.

There is no “cure” for an evil heart, a jealous mind, and a soul without a conscience.

Yeah so true. I decided today what to do with my rage as long as it lasts. I think I should get serious about improving my body and my life. It will be much easier to take if I feel good about myself I know that.

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