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.
takingmeback: As you practice remember all about everyone:
head, arms, torso, legs,. mind, emotions, life energy, body, intellect, desire, animation, matter,
human world, animal world, plant world, physical world, creator/consciousness of creation, impulse of creation, immaterial created universe, material created universe.
“that is so”.
Peace.
Knowledge is power … is that why ALL isn’t being revealed?
God reveals ALL to any ONE that is hungry for his knowledge.
Some Humans seem to always be playing the “power” game with knowledge … leaving many ingredients out.
Peace
takingmeback: Good post.
Peace.
I do not believe they are ill. In secular terms- that make bad choices on purpose. Why are they not impulsively kind?
WOW! What phenomenal posts! What deep thought! What intelligent, thinking people! You guys are awesome! I don’t know where to start.
Takingmeback, your ability to work with these people as clients, under what you know will be “not helpful” circumstances must be very frustrating to you. I worked at a psych hospital with adolescents who were “budding Ps” for quite some time (a year and a half) after my P-son murdered the girl and went to jail awaiting trial. I don’t think I did much good for the kids themselves, except I did teach them that I was consistent with boundaries and that I would enforce those boundaries and that I had (in that inpatient setting) the “power and control” to effectively enforce those boundaries. In other words our unit was effectively a jail venue.
It was a joke to them. It was a game to them. They spent every day all day figuring out ways around the rules. We spent every day all day trying to enforce the rules. At the end of the day, the kids tallied up the “score”—“Kids 5, Staff 3” or “Kids 0, Staff 6” That was all it amounted to. Who could “score” and “How”—They were so creative!—-
It almost mirrored my “home life” when my P-son was between puberty and arrest. He spent all his time getting around the rules, and I spent all my time trying to find out how he got around the rules and re-inforcing the “walls” of rules around him to try to keep him from going to jail.
I look back now and laugh at the futility of trying to enforce boundaries with a psychopath who is intent on breaking the rules and getting away with it. It is like the more rules and the more supervision you have the more determined they are to “score” on you. Just like a game. And to them it IS A GAME. It is a challenge to “break the rules” to “not follow the rules” because “rules are made to be broken” “rules are only there for the stupid” “rules are not for me” “i am above the rules” etc etc.
One of the interesting things with cattle is that once they are allowed to find out that a fence is merely a “suggestion” for them to stay on one side of it, you can rebuild that fence out of concrete blocks, or like the Great Wall of China, and they will keep working on it to break it down, and will eventually succeed.
Psychopaths seem to be like that. Once they find a “chink” in the rules, no matter how you reinforce that chink to shore up your boundaries or the rules, they will keep on keeping on until they break through it. No matter how severe the consequences become, they keep on.
It is like the more supervision they have to monitor their behavior the harder they will try to do something dishonest.
If you caught your BF flirting with another girl and start “watching” him, he starts having affairs with THREE other women, not just one. Of course WE take this kind of behavior “seriously” not as a “game,” but they (well most of the time anyway) seem to take it without more seriousness than a baseball game score.
Sometimes, though, if they see you as a “possession,” then for them, the game becomes quite “serious” as you are not allowed to “escape” their control. This can lead, as a friend of mine says, to “tissue damage” where they beat or kill their victim rather than let the victim escape their control.
My P-son seems to view all family assets as “his” and me as his “enemy” that he must over come in order to secure what he is “entitled” to. While I think he viewed me as a “worthy” enemy and enjoyed “counting coup” on me as an American Indian warrior would view a brave enemy as “worthy,” he seemed to despise easily deceived people such as my mother (in a letter, he advised the Trojan Horse P that “grandma always takes my side”). Yet, even thinking I might be a “worthy” adversary, he felt rage at me for standing between him and what he wanted. CONTROL. POSSESSION. AUTOMOMY. So, he not only wanted to “count coup” on me, but to destroy me entirely.
Strangely enough, he seemed to admire my late husband’s abilities and to compare his own to my late husband’s, and to aspire to be admired by my husband. He reserved his rage for me for turning him in to the cops for being a thief, though it was my husband who made the suggestion and made the telephone call, the entire rage was centered on ME, and none on my husband.
Though my husband and I both were the ones that walked out of the police station when he was 17 and we had gone to get him (on release) and he had looked at us with a sneer and said “What the F took you so long?” I looked at the cop and said “There’s been a mistake, this young man isn’t MY son, he looks like him, but MY son wouldn’t talk to me like that. Take this young man back up stairs.” and WE left. Again, the rage was focused on ME. Looking back now, I realize that I should have cut the umbilical cord at that point. RIGHT there. Forever.
Knowing what I know NOW I would, but at that time I was not as knowledgeable as I am now. I still clung to the malignant hope.
Seeing parents and others today holding on to that malignant hope must be difficult for you, Takingmeback, as a professional.
In my last job before the PTSD got so bad that I just didn’t have enough short term memory to function, and didn’t have the patience and restraint to remain professionally detached, I saw such pain in the families, stress in the staff, and so much futility that I couldn’t do it any more. I admire you so much for being able to function in your role.
I think the “trick” for us is to not let the psychopaths’ injury to our minds, spirits, and emotions, drive us to become bitter and hateful. Anger is a normal response to injury from another. But holding on to that anger and nurturing it into “wrath” instead of finding meaning in the suffering (as per Dr. Frankl) and growth from that meaning, is the big trick, at least for me.
I think it is only after the fact (after total NC with ALL the Ps in my life) that I was able to have enough clearness of mind and cessation of acute pain in which to process ANY of this into anything meaningful. As long as I was dealing with my P-father the pain was too intense to process it. Even after NC with him, I didn’t have enough knowledge of Ps or even knowledge of my own spirituality etc or emotions (I was so young and naive) to process it then or afterwards, and then when the puberty and P-ness of my son hit, I still didn’t have enough Knowledge or resources to deal with it, the enabling of my mother at that time, years ago, still kept me from realizing where I was etc. and what I needed to do. Then there were the “dormant” years when I didn’t feel the pain so much, I ignored the signs and symptoms of the “chronic disease” of the Ps in my life and the enabling and cling to the malignant hope that the “disease” of my soul, emotions, and spirit would some how spontaneously “heal”—it was only when the malignant hope allowed my “untreated” disease to come into full “bloom” and threaten my very existence that I finally gave up the malignant hope and went for the “radical surgery” to remove the “cancer” of my life, my body, my mind and my soul. Surgery that left no time for anesthetic to ease the pain; surgery that radically altered me, yet saved my life, my soul and my entirety. Only now that the bleeding has stopped and the pain subsided, can I go back and look at the process that lead up to the “emergency surgery.”
Or to see where I might have seen the signs of the disease before the “radical solution” had become necessary.
Last summer when I was so stressed out with the threats to my life, and living in hiding. I kept having “hot flashes” (I thought anyway) and thought I SAW these, noticed these, I never once did anything but pass them off as “stress”—when in actual fact they were intermittent fevers caused by Rocky Mountain Spotted Fever, a tick-borne disease that is 20% fatal in untreated patients, and 7% fatal in those that receive timely treatment. I obviously contracted it in early July from a tick bite that the tick stayed on me for a couple of days before being discovered (the tick must be on for more than 24 hours to transmit the disease) but it was in SEPTEMBER before I finally had the presence of mind to stick a thermometer into my mouth and discover I had 101 degrees of fever, and seek treatment.
The RED FLAGS of psychopathic behavior I had ignored, just like the RED FLAG of fever I had ignored. I saw both of these different types of red flags, but because of one thing or another, I IGNORED THEM or passed them off as something unimportant when in fact, they were VERY important warnings I should have heeded. Ignoring them was at my own peril.
Sometimes, but rarely, diseases have no “signs or symptoms” before disaster strikes in irreversible injury or death of a patient. Sometimes, but rarely, a psychopath waves NO red flags before some fluke reveals that they are psychopaths and the irreversible and/or fatal damage has been done. Most of the time though, when we in any way have “pain” or “signs or symptoms” of some dis-ease within our selves, we will do WELL to HEED those feelings, instincts, hunches, or whatever we are feeling. I think our society has trained us, however, to NOT heed these warning signs.
Sometimes, too, we can see the “signs” in others more easily than in ourselves. When I discovered by accident that my step father had been having intermittent fevers for several weeks, which he had essentially ignored, IMMEDIATELY RED FLAGS started to wave for me (an advance practitioner nurse) and I took him straight to the doctor, thinking of two things immediately, one being occult (hidden) cancer or tick fevers. Praying of course for it to be tick fever. Unfortunately, it was a very early cancer, but incurable.
PArt of finding “meaning” in our healing from the injury done to us by the Ps is to recognize and acknowledge these red flags when they are still in an “early stage” and we have not become deeply involved in the dis-ease of a relationship with the P. To enable us to get out relatively unscathed by injury from these types of people IN THE FUTURE, it is important that we are ABLE to acknowledge that in those cases where there WERE red flags with the Ps that we SEE what those flags were. If we can look back retroactively and SEE that there WERE flags, but we either didn’t recognize them for what they were (a sign or symptom) or that we saw it but “excused it” as something unimportant (like my dad did with his fevers, or like I did with my own fevers) then in the FUTURE we will not be as likely to ignore or excuse or not recognize a red flag for what it is.
In my step father’s case, recognising his “symptom” as significant wouldn’t have made a lot of difference in the outcome, his disease was fatal from the get go, but it did make a difference in the quality of his life because I did.
In my own case, my failure to recognize that I had a fever could have meant that I would have died or suffered irreversible damage. As it was, my treatment was delayed until I was so weak I could hardly stand up. It took me a lot longer to overcome the resulting weakness than if I had received treatment early on.
In the case of my failure to heed the “red flags” of psychopathic attacks over the years, I suffered much much more grief and pain than I would have if I had both recognized and acted to prevent further attacks. It isn’t about ‘blaming the victim” for the damage done either by disease or by failure to either know about the symptoms (red flags) or by failure to recognize or act on the significance of them, but to prevent FUTURE attacks by psychopaths.
I don’t blame myself for having tick fever. I didn’t “deserve” tick fever, and I wouldn’t have had it if I hadn’t been bitten by a diseased tick. I tried to stay out of the “way” of ticks, and I live in “tick country” so I tried to make sure I got them off promptly if I did get one, but as luck would have it, I got bitten by one, and I didn’t SEE it to remove it, so I got “blind sided” but I DID IGNORE THE FEVERS when they came. I explained them away as unimportant “hot flashes.”
Now, I do a daily “tick check” with a hand held mirror, I cover myself with tick repellent every time I go out, and if I were to run a fever, or even feel like it, I would stick a thermometer in my mouth immediately! I have learned a valuable lesson.
Now, I am learning to set boundaries with other people. I will enforce those boundaries, and if I see abusive red flags flying I will investigate those red flags, and I will act accordingly to prevent further dis-ease from “infected” people.
Takingmeback,
Yes, you do write quite a bit. But what you write is incredibly insightful, intelligent, wise as all get out! You being a mental health professional, as well as being a spiritual person, offers me valuable, priceless info from your own personal devestating experience with a PDI, formal education and experiences with PDI patients.
You are exactly the woman whose subject matter I most definitely need to read.
Thank you tremendously for your frank discussions regarding your personal history and your continuing work with understanding PDIs. Mucho appreciated!!
It’s crystal clear to me that I’m far removed from being the smartest kid in class, not even in the top 10%!
But I will confess that I’m that irritating brat who sits in the first seat at the beginning of the row, constantly raising my hand eagerly, with enthusiasm, asking questions of the instructor. While the egghead kids roll their eyes at me in exasperation….haha.
I was famous for it in High School and in college. The teachers/professors loved me for my knowledge hunger, but the kids/students probably thought I was a brown noser seeking attention. I wasn’t at all. Just inquisitive and hungry for an education. 🙂
Great posts by takingmeback and TrishNJ …..Both gave me lots to think about. I too found God after my socio. I was a widower by two and a half years before I met the socio, and during that time before the socio, many of my friends and family encouraged me to turn to God in my healing for the loss of my wife… but.. I was angry with God at that time, and blamed Him for her death. She was very young, 36 when first diagnosed and 39 when she died, leaving behind myself and our small son. During her illness, she was placed on huindreds of prayer lists nationwide and we received hundreds of cards and letters from people we never met. So, after her death, I was natually skeptical of God’s “purpose ” for me and that He even loved me…. Three and a half years later, after my year long socio relationship had ended, I was of course once again a broken man,….but.. I needed God.. I needed TRUTH since there had been none of that with the crazy…. My relationship with our Lord florished, and I eventually learned to TRUST Him with taking care of the socio.. meaning.. I gave her to Him….I had to go through the lengthy process of forgivenness, which as we all know is a DAILY process… Triggers come and the pain can come right back just as quickly…. I know that finding God and emersing myself in His word has been the foundation to my healing…. when ever I feel those triggers, or I am reminded of the darkness that comes with memories, or thoughts of “her”, I read in my bible…. Psalm 27 and Psalm 46 are favorites. In fact, stories of betrayal are all throughout the bible, and I am reminded at how people like Joseph, Jobe, Paul, and our Savoir delt with betrayal… and of course when I am reminded at the magnatude atjust how our Savoir was betrayed, I fell somewhat ashamed when I find myself focusing, not on him, but on the betrayal that was placed on me……
Wini…. I finished Tolle’s book, and will take many lessons from it…. I found it to be along the same lines as many of Jesus’s teachings of death to self (ego)…. I have started reading “The Shack” which is also good.. I don’t want to say what it is about, but through it I hope to understand a little more why bad things ahppen to good people, and what role God has in that.
Blessings to all…..
~Rick
myspace.com/southernman429
im angry today. i feel like the debt the ex has put me in will never end. i feel like im always going to have to pay on these bills. there is no point to ask him for money, he wont give it and i dont even want contact.
blonie: I don’t know your situation. If you were married to him or just dating him? If you were married and the bills are in both your name … then plug through the bills month by month, step by step. You’ll get them paid. If you weren’t married and the bills are in his name … I don’t believe you have a responsibility to pay them … that’s if your name isn’t attached to those bills. Let the chips fall were they may. If he was an EX boyfriend, go to your local police department and report what he’s done and they will assign a file # to your situation. Don’t expect them to do anything if he took off out of the area, but it is a report down at their station, it begins the paper trail for you documenting what this guy has done to you. If you were married to him … that’s a totally different ball game and you’d need professional help on the legal issues (aka retaining an attorney).
Good luck. Pray to God with your problems. He’d love to hear from you. Pray to God in Good time and Bad times. He’s never to busy for you.
Peace.