Treatment of psychopathic offenders: Evidence, issues, and controversies

Abstract

Psychopathic offenders are a notoriously challenging population to treat, who are often recalcitrant to change and at high risk for program non-completion and recidivism. The present work is a review and synthesis of the evidence, issues, and controversies in the treatment of psychopathic offenders. The operationalization and measurement of the construct of psychopathy via the Hare Psychopathy Checklist–Revised is reviewed to give context to the population being treated and to identify latent features of the syndrome that have risk and treatment implications. A discussion of the issues and challenges in the treatment of psychopathic offenders is then provided to contextualize the source of therapeutic pessimism with this population, followed by a review of the existing psychopathy treatment literature. The characteristics of unsuccessful and encouraging treatment programs, including a promising model of treatment, are subsequently reviewed, and the article finishes with a synopsis of recent treatment outcome findings published subsequent to previous psychopathy treatment reviews or inadvertently overlooked by past reviews. Although psychopathic offenders are a challenging population to treat, I argue that they are not immune to making positive lifestyle and behavioural changes, and that these individuals have the potential to benefit if they can be retained in treatment.