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”

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.