Dr. Mark Olver is an Associate Professor and Director of Clinical Training for the Department of Psychology, University of Saskatchewan. Dr. Olver has answered some questions on the treatment of adult offenders with psychopathy.
Question 1. How did you get involved in the area of psychopathy re-search?
There were a couple of avenues for me. For as long as I can remember, I have had much interest in the criminal justice system and understanding the things people did to wind up there. As I moved into the field of psychology as a university major, I stumbled across forensic psychology in a course I took as a young undergrad at Simon Fraser University in Burnaby, BC from Chris Webster. I wished to pursue an honors degree, but didn’t know who to approach. As it turns out, Stephen Hart did a guest lecture for Dr. Webster’s course and I was extremely fortunate that he was willing to take me on as an honors student! Building on the foundation from my undergraduate coursework, Dr. Hart provided me with an in-depth exposure to the field of psychopathy, pointing me in the direction of key works and references (such as Without Con-science), mentoring me in the field of psychopathy (and psychological assessment in general), and creating the opportunity for me to pursue psychopathy assessment re-search in a sample of forensic psychiatric inpatients. This created an excellent foundation for me to move on to the next leg of my training as I pursued graduate studies at the University of Saskatchewan with Stephen Wong, another leader in the psychopathy field. At the U of S, Dr. Wong created myriad opportunities for me to pursue further research in the assessment and treatment of psychopathic offenders and I was fortunate enough to be able to integrate this with my clinical psychology training.
Question 2. Why do you think some clinicians and researchers believe that psychopaths are untreatable?
It is a serious personality disorder, generally persistent across the lifespan without intervention, with such destructive consequences. In his seminal book, Hervey Cleckley himself identified psychopaths as not being responsive to treatment. The traits and behaviors are ingrained, and psychopaths are notorious for offering up their “word of honor” to repair trust when confronted on having wronged or harmed somebody, only to turn around and do it again either to the person or somebody else. They fail to profit from experience and they often don’t particularly care. When somebody lacks empathy or guilt, two really big incentives for non-psychopaths to change or to not harm people, it is hard to envision them changing without there being some external incentive in place. And the track record of psychopaths in treatment programs is not very positive; old research based on inappropriate programs only served to heighten therapeutic pessimism. Fortunately it seems times are changing as we learn more about what might work therapeutically to help psychopathic men and women to move on to less destructive lives.
Question 3. What are the challenges faced by clinicians providing treatment to adult offenders with psychopathic traits?
Perhaps the biggest impediment [is] what Steve Wong and colleagues refer to as treatment interfering behaviors. The features of psychopathy are not particularly conducive to therapeutic progress. Psychopathic offenders can be abusive, intimidating, bullying, manipulative, controlling, and resistant to change. They can be very disruptive in treatment groups or on therapeutic units, and can sabotage the progress of other patients. They are adept at pushing other people’s buttons, may split staff (forming alliances with vulnerable staff), and may circumvent institutional rules, creating security concerns. They also often lack motivation, struggle in forming affective bonds, and fail to accept responsibility or take accountability for their behavior. All of this translates into decreased therapeutic progress, increased treatment drop-out, and weaker working alliances with therapists.
Question 4. What forms of treatment are most effective with adult of-fenders with psychopathic traits?
The interesting thing is, secure, high intensity treatment programs have been treating psychopathic offenders for years without even realizing it. For the past 25 years, the principles of risk, need, and responsivity have been the driving force be-hind correctional treatment programs around the world, many of which are taken by psychopathic offenders. In short, this would refer to a high intensity program (10-15 hours a week), targeting the manifold dynamic risk factors of psychopathic offend-ers, using cognitive behavioral methods of behavior change. But there is more to it than that; part of this also involves having a treatment culture where staff from multiple backgrounds and roles within the setting monitor the individual’s behaviors and risk factors and maintain clear lines of communication to maintain an environment that is conducive to treatment. Savvy staff are aware of the treatment interfering be-haviors of psychopathic offenders, and through careful monitoring and regular communication, can help keep these behaviors in check to prevent small issues from escalating into big problems. In their guidelines for a psychopathy treatment program, Wong and Hare (2005) identify the interpersonal and emotional features of psychopathy as a responsivity issue; a collection of characteristics to manage rather than change, while the criminogenic issues associated with Factor 2 are directly targeted through treatment programming.
Question 5. Considering research is generally ahead of application in the field, what is one improvement in the field of psychopathy that you hope to see take place over the next five to ten years?
I would love to see an increase in coordinated and evidence backed treatment programs, linked with strategies to promote smooth reintegration back to the community. Staff need to be carefully trained, people need to work together, and then we need to continually evaluate our efforts to see how we are doing.
