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”
Adendum
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.
If sociopathy and psychopathic personality traits are treatable, I think that is great. There would be more caring in this world and less people getting hurt.
But. how can they get treatment for something they don’t admit they have? My ex nsb once told me he was so perfect, he was almost Godlike. I thought he was joking, when I told him his arrogance was not a good trait to have, he became enraged. They can’t help who they are, and yes, I do have compassion for what kind of childhood he had, but that is no excuse for what he did. Sorry, today is one of my feeling very bitter days.
Thanks for bringing this book up, Liane.
I am in the middle of re-reading “Emotional Intelligence” by Dr.Daniel Coleman. In it he quotes from Garners’s book in 1983, “Frames of Mind” definiing Interpersonal intelligence as
“the ability to understand other people: what motivates them, how they work, how to work cooperatively with them…..leaders are all likely to be indificuals with high degrees of interpersonal intelligence.”
He goes on to define INTRApersonal intelligence as “is a correlative ability, turned inward. It is a capacity to form an accurate, veridical model of oneself and to be able to use that model to operate effectively in life.”
Coleman also cites a research project on impulsivity done with 4 year olds and followed up when they were adults.
Children age 4 were presented with a marshmellow. They could have it right then, OR they could not eat it until a few minutes later when the tester returned from an “errand” they could have TWO marshmellows.
The children who grabbed the presented marshmellow (lack of impusle control) vs the ones who waited (more impusle control) so they could have two, were looked at years down the road.
Those children who had waited (demonstrated more impulse control) were much more likely to be successful in school and in life, there was much less delinquiency, drug use, etc.
As adults after school, these children demonstrating more impulse control had much more satisfying personal relationships as well.
This “impulse control” study was also more predictive of “success” than the SAT scores or any other indicator of “success” currently used. Interesting, I thought.
I also highly recommend “Emotional INtelligence” as a book to help victims heal after the P-experience. Though it is not specifically about Psychopaths, yet it gives medical and research information about how and why various emotions effect us and ways to counter them in a beneficial way.
This book was probably one of the best things I did for my son C after his now X-wife and her BF-P tried to kill him.
Rperk,
I started to answer your question about how do you trust yourself to knwo the differences between “normal” people and the psychopaths, but thought I would do it here. Learning the RED FLAGS is a matter of educating yourself, reading the PATTERNS that they all seem to have, and being able to set boundaries of the way you will allow people to treat you. If you see that the person is a LIAR, that is a BIG RED FLAG, etc. so when you see red flags waving in behavior, you put up a GUARDIAN WALL of suspicion between you and that person. You watch them to see if there are more red flags waving.
My personal boundary is that I will allow NO liars into my circle of trust. I may be friendly with these people on a superfiscial level, but I will NEVER TRUST them. I will never be in any kind oif an intimate friendship with them, because I know you cannot depend on someone who is a liar. Another one is people who are easily provoked to anger and rage, or rudeness to others. If they will be rude to others they will be rude (eventually) to me, etc. Slowly you will begin to trust your own judgment. You won’t be paranoid of everyone, but you will be REALISTIC and CAUTIOUS about people. (((hugs)))
I think this book proves professionals can have malignant optimism too… I think physicians are famous for esp. with cancer patients. They mean well,hope and care but…their txt fails.
We can drug them up, to stupetfy them…but without a firm resolve ” to go and sin no more” nope….they need exorcism.
It’s a personality disorder NOT mental illness– we may dangle a persuasive carrot like free room and board or drugs they liek to take…but until you change their choices…they are just doped up sociopaths. Or even better trained at conning.
I do think this post is misleading, and will re-egnite hope that needs to be doused.
HWS,
My take on this is not that they can make the psychopath NON-psychopath, but hopefully make them at least LESS DANGEROUS by changing their behavior. Of course there are those like my P-son, that I truly feel that there is NO WAY to make him “less” dangerous than to keep him locked up safely behind bars for the rest of his life.
There are others who would be “high in psychopathic traits” but might be able to alter their behavior to at least make them hurt others less.
Believe me, I do NOT have the “malignant” hope for my son any longer. I have NO hope for him. He is so much like my P-bio-father that the genetics are without dispute, and he never met my P-bio-father except for what he read about him or heard about him.
I think there are “degrees” of “danger” in the psychopaths, some are not physically or criminally dangerous and maybe they could be redirected to better live in society. If only THAT would be possible, then it might be a benefit to society as a whole. Getting these people to PARTICIPATE in therapy would be difficult at best though. I don’t think they are going to be able to make a “silk purse” (caring individual) out of a “sow’s ear” (full blown psychopath) but if they could at least make a person who was not dangerous out of one who was, it might help some poor souls that come into contact with them.
It has not been so long ago that people with schizophrenia were thought to be the result of poor parenting. I just finished reading a book written in the 1980s by professionals who still “blamed” the parents for creating this illness in these poor people. Now, we know that there is medication and therapy that can make these people in many cases, live good lives. Not perfect maybe, but function in society in a form that is good for society and good for the people themselves.
Schizophrenia is known now to be an inherited problem, not caused by “poor potty training” as previously believed, and there is some hope. Hopefully, there will be eventually some way to treat the personality disordered as well. If medical science had “given up on” schizophrenia back when it was thought by all scientists that it was “totally environmental” no one today who has this terrible mental illness would have any treatment available.
I’ll reveal this story about my Dad, such a loving man, loved unconditionally. There were times when I was growing up my father would ask “Wini, what’s the matter with you today”, knowing I was off balance (aka pi–ed off) emotionally that day. My father would take the time to talk with me, not talk at me or lecture me, just take time for one of his four children to discuss the day’s events with him. I told my father that I was in an argument with this or that friend and I was feed up and tired with her selfishness. My father would say “what else is going on besides what you think is the obvious?”. I would answer, no, it’s just she’s very selfish and I’m tired of her trampling on my emotions. My father would give me maybe 45 minutes to an hour, maybe longer, depending how long it took me to calm down and get out of my sour mood … while I told him my story (yes, we’re very emotional growing up). Then my dad (very wise man) would say “Wini, I can tell that you are very upset with this incident. I want you to step back a few paces, think about the bigger picture of what else is going on. Tonight, write down all the specifics, put it on a list (good and bad) about the situation with your friend and we will talk more tomorrow when I get home. I agreed. What my father was teaching me (and all his children, but some of them didn’t listen … they too, living from their big egos) was to step back, take a deep breath, look at the bigger picture of what was happening, not just my myopic viewpoint of where pain was occurring in my life with this particular friend, take the subconscious from the background and bring it to the foreground (conscious), realize that I already learned this lesson and it was just disguised in another form, remember and reflect on lessons already learned prior and so and so forth. When I talk with my father the following evening I was better prepared, put my emotions in check, had a bigger view on the issue, could now see clearly the situation for what is was instead of mixing my emotions that got carried away with me. Adding, another tool to my tool belt of life.
Peace as you step back to view from another perspective.
Wini, I have been appreciating your insights a lot in the last few weeks of posts. And Oxy D, always with a thoughtful take.
What you said about schizophrenia, etc, very true. What is so DIFFERENT abaout the PSN’s is that they do NOT SUFFER. They learn to fake suffering, and feelings, and so on. Schizo’s are tormented, bi-polars are tormented. They seek help, often.
PSN’s just game the system. If there was a drug they would only pretend to take it and fake it’s results. Taking it might put them off their game. Not to stretch the analogy, but it is a bit like a giant pinball game to them, others are only targets or levers. Why would they want a cure? They see us caring empathetic types as patsies, hopelessly caught up in stuff that has no reward. Helpless victims of their take on what really matters.
Sorry to be so cynical, but I have talk therapied, and dragged to therapy, and discussed and agreed and sworn, together with my ex P, and he faked every single ethic and emotion.
The worst part is he is proud of himself. He thinks he is smart and victorious. I now know for a fact that he scorned every aspect of my being, which is one of caring and truthfulness and ethics.
There is no drug or therapy to fix that. If their whole lives they could not find meaning in a sunrise or a thunderstorm, or a peal of children’s laughter, this can not be medicated or implanted.
It is simply lacking.
I have recently met a family heavily impacted by a P, but they do not understand yet. So hard to watch. They are explaining and taking the blame, in terms of our reality. They believe that every one has a soft squishy middle somewhere. So hard to watch. Not much to say until they are ready.
Hugs to all,
DEar Eyeswideshut,
In the main, I absolutely agree with you–it is back to the old “you can lead a horse to water” routine as far as treatment is concerned. That said, I do hope that medicine and psychotherapy don’t “give up” on the Ps, at least to MODIFY BEHAVIOR with some form of treatment at some point in the future.
As things stand now medically, you are so right, and statistics apparently show that “therapy” ujst makes them worse! By giving them new “tools” in the tool belt of “things to fake.”
Right after my P-son was arrested for murder, I’d say 4 or 5 months after, I took a job at a psych hospital and one of my jobs was to do intake interviews with parents of “budding Ps” who were bringing them there for inpatient treatment. In a way that was a Godsend job for me, because as I did intakes I found out that my murdering little P was NOT the worst case in the world. There ARE things worse than murder.
While I could not of course let these parents know that I TRULY knew the depth of grief that they were experiencing with their own children, I DID know. To this day I believe that job saved my sanity after my son was arrested. At that point I hadn’t worked in psych any, but that job gave me an “education”–looking back now, I just wish I had applied more of it to my own situation and walked away from my son 20 years ago. I would have saved myself a lot of grief.
With the human genome project having identified the genes that cause various emotional or mental problems and with the chemical changes being noted which are indicitive of various things like depression, bi-polar etc. I am hopeful that at some time there will be something found that can help or modify the behavior of these people–whether or not it is chemical, therapy by talk, or intervention at an early age environmentally. We know they don’t “bond” right/adequately but is the lack of bonding the CAUSE or is it a sympton? How much is genetic and how much is environmental?
We already know that there are some genetic defects like PKU that are tested for in every baby born in the US and if the kid tests + their diet is changed and presto, a normal kid. If the chld is not immediately started on the altered diet at birth, bingo, irreversable retardation. Who the heck at this point in time knows if something like that may turn up? I pray that it does.
I’m so glad that Wini got so much out of Tolle and his writings, and I am a much more spiritual person than I was before all this happened, but no matter HOW good the Bible is or Tolle, trying to force-feed any kind of behavior modification or spriitual modification to anyone is a lost cause, much less to the psychopaths. They might fake it if the electric prods the “teachers” had were high enough voltage, but that would be the extent of their “learning”—and none of it would get past the ear drums because the Ps aren’t as open as our Wini to hearing the lessons.
It’s kind of like taking a snake and thinking that if you are kind enough and loving enough that some how it will grow fur and love you back like a puppy. It just ain’t gonna happen.
“The saddest word of tongue or pen, IT MIGHT HAVE BEEN.” And it IS sad that there is no treatment for the adult psychopath and I have seen very little successful treatment of the younger “budding” psychopaths, although legally and medically you can’t “label” one a psychopath until they are 18 at least, so they call it oppositional definace behavior or 50 other things until they turn 18, then they can have the “label” on their way to jail or prison much of the time, and unfortunately, while they are in prison they can get a Ph.D in psychopathic behavior, if my son is any indication of the “education” there.
Eyeswideshut, I just finished reading a book written in the 1980s “explaining” how poor family dynamics produces schizrophrenia (which we know now is mostly genetic) and how all we had to do to prevent this terrible disease was to do xyz in family dynamics and presto–no more problem. It seems to me that laymen seem to think that just about any “psychological” problem can be cured and the patient “fixed.” I’m not sure that the practitioners sometimes don’t think almost the same thing. Of course we DO have much better medication for schizrophrenia, depression, bi-polar etc. but about zip for any of the personality disorders.
I’ve seen families in our community financially and emotionally “ruin” themselves trying to “save” a psychopathic member of the family. Some very close neighbors are and have been for years doing just that, and are now raising five of the offspring from this female P and her numerous boy friends. The woman’s 4th child was born in prison and her father and step mother tried to talk her into getting her tubes tied, and she refused because “I might want to have another baby some day.” HUH?? Four children that someone else is raising and she MIGHT WANT MORE? Well, she did have the 5th child which her father and step mother are raising as well. She’s back in jail, but, she did get her tubes tied when her father finally laid down the “law” to her and told her that any more she had would be turned over to the state. It is sad to see this, and sad for the children as well and the family trying to “help”—anything to save their loved one from themselves.
I’m sure that Tolle’s book (I do have a copy by the way Wini) has done many people good, but people who are RECEPTIVE to the message.
eyeswideshut I haven’t been focusing on the absolutes of diagnosis. I’m working from the spiritual level you reach after you work through the pain, frustration and all the other emotions that come into our paths after dealing with them … getting to forgiveness … from forgiveness to compassion and love … healing ourself as we excel higher and higher into God’s virtues … seeing it from our spiritual perspective, not human perspective. Thinking from our Right side of the brain.
Another thing is having the knowledge from Tolle’s book “A New Earth”. This guy hit rock bottom … as he was working through his pain he asked God to help him understand (wisdom) … God guided him. I did the same thing when I hit rock bottom in pain … I asked God to guide me. God does the rest … he opens the doors … so you can get where he knows you need to be. Oh, and knowing him as YHVH … there’s more to this too. When you give it over to God, he’ll lead you to uncovering this too.
Peace.
how do you guys feel about forgiveness? im not sure what i expect from myself. do u ever forgive them for what they did to you and all the pain they caused? just thinking about how much time and energy and love you put into someone and they are sitting there not giving a damn about you. it wasnt a normal relationship where u break up bc it didt work anymore and you can be civil and be friends. to me you have to run away from these evil people or they will continue to hurt you. what do u forgive? the person they are, or what they did? in time in might now hurt anymore, but you will never forget what they did and how foolish you felt.