Because I had such fits trying to make my links work in the response box to the message below. Here are the articles I mentioned in my reply!
Insight oriented therapy with Psychopaths
And an alternative perspective on the underlying causes of Psychopathy
Thanks for letting me know it wasn't working, Psychgrad!
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Mamabeek
I am a student, slogging my way through a Clinical Psychology PsyD with concentrations in Family Forensics and Neuropsychology.
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3 comments:
Fascinating articles...Although it's contradictory, it seems that a problem is that therapists are not empathic enough (or too empathetic in general) to do a good job of subjectively evaluating the effectiveness of treating a psychopath.
I didn't know that "therapists" evaluate psychopath's. I thought that job was for the Shrink.
Well, Daily Dose, if 'diagnose' includes a complete psychological evaluation then no, a psychiatrist cannot, legally, do that. A masters level person can administer and score the test; as could a psychiatrist, but only a doctoral level psychologist has the training interpret the results. It is the main thing that sets psychologists apart from masters level psychotherapists and psychiatrists.
On the other hand, if you leave out the testing portion, which is nowhere legally required to make a diagnosis, an MFT can diagnose and a Clinical Psychologist can diagnose and a Psychiatrist can diagnose, and any of those three professionals may call themselves a psychotherapist or just a therapist, though not many psychiatrists do therapy these days. If that were not the case there is no way you could get an insurance company to pay for any sort of therapy!
It's also important to know that psychopathy is not a diagnosis in the DSM at this point,it is really more of a forensic term. A dual diagnosis of Narcissistic Personality Disorder and Antisocial Personality Disorder (and a high score on the PCL-R) is currently the accepted standard for Psychopathy by most forensic psychologists and judges familiar with the "state of the art." One of my profs who does bunches of expert witness work with this population says that the first thing a defense lawyer will do is haul out the DSM and ask him to point to Psychopathy, knowing full well it's not in there. He says this argument no longer works with educated judges, but it's still standard legal practice.
But the important thing about diagnosing this problem is exactly what psychgrad is pointing out; that we therapists, whatever our training, aren't able to use the same clinical judgment with this set of the population that serves us well in others. We are trained that you NEVER use the results of test instruments alone to diagnose anything, instead you combine multiple tests with a clinical interview and collateral information to get the complete picture... and the impressions formed during the clinical interview alway trump everything else. But in this case, the clinical interview is the part where the client can subtly charm you into believing anything s/he says. They can fake lie detector tests (that are measuring galvanic skin response) fly right through personality tests with built in fake good/fake bad scales and so forth. The one test that consistently seems to work is the Psychopathy Checklist (PCL-R) developed by Dr. Hare. It's also helpful to use instruments like the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG) rather than trusting your clinical judgment, as they have proven to be much more reliable predictors of recidivism than therapists' clinical judgment. Not only can these people convince you they are just about anything they want you to believe, they can also convince you that your therapy has been successful when it has not.
I just spent 45 minutes tonight with a young man who attacked several people with a lethal weapon, killing one. He's one of the nicest, most enjoyable clients I have ever worked with! He has also utterly faked out one of our staff psychiatrists on several counts, as the Doc believes everything this very charming client tells him and has no other tools beyond his own clinical judgment to use. I'm pushing as hard as I dare to bring the Psychopathy Check List - Youth Version (PCL-YV)into our system to screen for this kind of person.
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