Treatment of psychopathy: a conceptual and empirical review [2018]

For decades, psychopathy has been thought to be untreatable. Yet, conceptualisations, and indeed its assessment, have deviated away from viewing the disorder as personality pathology towards a behavioural focus where the core underlying deficits in cognition and affect have been ignored. Interventions have followed suit leading to a premature discounting of the role of therapy in adjusting psychopathic traits. The paper aims to discuss these issues.

The review critically evaluates the conceptual and empirical evidence relevant to the treatment of psychopathy, deciphering components integral to the disorder that require intervention. Psychopathy is approached from a developmental perspective, with the review identifying several mechanisms thought to be responsible for precipitating and perpetuating its expression.

There appears some utility in targeting psychopathy from multiple angles, addressing experiences of trauma, associated schemas and the underlying cognitive-affective dysfunction noted to give rise to psychopathic traits. A new model for treatment was proposed integrating these factors to encourage the design of effective interventions that will address the origins and underlying deficits of the disorder, rather than symptomology.

The review encourages future research to consider the aetiology of psychopathy, with the aim of informing early intervention and containing the disorder whilst in its infancy, as well as addressing neurobiological dysfunction when most malleable.

Michael Lewis

Journal of Criminological Research, Policy and Practice, 2018