Violent offender rehabilitation programs

Results indicated that compared to a group of high psychopathy adolescents from traditional correctional institutions, high psychopathy youths incarcerated and treated at the MJTC were significantly less likely to violently recidivate at two year follow-up.

These findings were replicated again using a treatment as usual control comparison group with a larger sample and follow-up period ranging from 24 to 79 months Caldwell, Additionally, Caldwell, McCormick, Umstead, and Van Rybroek found that among adolescent offenders treated at the MJTC, no relation between psychopathy scores and violent or general recidivism existed at 4 year follow-up, despite psychopathy being associated with historical severity and onset of behavioral problems and to initial institutional misconduct.

In turn, these changes also predicted improved institutional behavior and treatment compliance. As a whole, data from Caldwell , Caldwell, Skeem, et al. In summary, the findings from general forensic populations are limited and divergent. Of the two identified studies, Olver et al.

Further substantiating this finding, psychopathy predicted violent recidivism post-treatment in both the community and while still incarcerated. In contrast Richards et al. However, there are several issues with selection bias that limit the ability to interpret these outcomes. Three studies used forensic psychiatric populations; two of the three Chakhssi et al. Notably, there were significant group differences at baseline in the Rice et al. The third study Skeem et al.

However, these significant differences dissipated after the first follow-up period so that there were no differences between high and low treatment psychopathic groups at the remaining follow-up assessments. Additionally, there are significant limitations placed on interpretation due to selective attrition rates in this study.

The most extensively researched population was sex offenders and these studies proffered the most consistent pattern of findings even when considering the two adolescent studies that included sex offenders : high psychopathy persons were repeatedly at continued risk for violent sexual and nonsexual recidivism and at rates faster than their low psychopathy counterparts.

Nearly all of the studies in the sex offender populations looked at psychopathy simply as a moderator; only one of these studies Abracen et al.

Although these authors reported no difference between treated and untreated psychopaths for violent recidivism, they also found no effect for the sex offender treatment program in general. Finally, in adolescent populations there were five studies by three research groups. The two studies that included sex offenders as part of, or all of the sample Gretton et al.

However, Caldwell, Skeem, et al. Despite strong speculations for and against the efficacy of treatment for psychopathic individuals, there is a relative dearth of research on this topic, particularly when addressing violence as an outcome. Setting aside the methodological limitations of extant research for a moment, the literature on treatment outcomes for psychopathic violence paints a potentially bleak picture in that there is a general lack of consensus.

The most optimistic interpretation is that with intense and rigorous intervention, risk for violence can be reduced in psychopathic persons, but data supporting this supposition are seemingly the minority Caldwell, ; Caldwell, Skeem, et al.

Alternatively, the less encouraging interpretation is that treatment, or certain variants of treatment, are iatrogenic with at least a subset of adult psychopathic persons Chakhssi et al.

Skeem et al. In the interim, there are several steps researchers can take to enhance our knowledge of treatment outcomes for psychopathic individuals and to form stronger conclusions about the efficacy of these treatments at reducing future violence.

Perhaps one of the most critical issues contributing to the lack of consensus on whether psychopaths can be effectively treated is that the studies that do exist are beset by methodological problems which temper interpretation D'Silva et al. For example, only two published studies examining violence as a treatment outcome Abracen et al. Additionally, one study examined effects of the dosage of treatment by comparing high and low treatment contact groups with results indicating lower rates of violence among psychopathic patients receiving greater doses of treatment Skeem et al.

However, the authors were not able to control for treatment modality or attrition of potentially high risk participants from the high dosage group due to hospitalization or incarceration. Two studies did utilize treatment as usual comparison groups Caldwell, ; Caldwell, Skeem, et al. Nevertheless, it is worth noting that this is the only intervention showing reductions in psychopathic violence that has been replicated. In addition to addressing methodological limitations and replicating research findings, it is also essential to be more explicit about the types of research questions being answered by studies with widely varying designs and methodological approaches.

For example, a study design that utilizes a no treatment control group e. In contrast, a study that compares treatment outcomes for individuals with high versus low psychopathy scores e. In fact, few of the studies we reviewed examined interventions designed for psychopathic persons but rather examined psychopathy as a moderator of response to treatment that might otherwise be efficacious e.

This is not to say that research of this nature does not offer important information about breaking the link between psychopathy and violence.

Given the dearth of research available on treatment for psychopathy and impact on violence, valuable information can and must be gained from a variety of research methodologies. However, caution is necessary as the implications of these studies are directly tied to the design and analytic approach used to evaluate the treatment under question.

Thus, our understanding of each treatment's relative effectiveness should be placed in this context. Another relevant issue in evaluating treatments for psychopathy is to consider the sample receiving treatment and whether they are representative of all psychopathic individuals or could more accurately be described as a specific subtype with potentially unique treatment needs e.

One generally consistent set of findings comes from studies conducted with sex offenders, which represent the majority of treatment studies conducted. This was also true for the adolescent studies that included sex offending youths Gretton et al. This has been interpreted to mean that psychopathic persons can successfully be treated to reduce risk for violence if there are sufficient resources available to retain them in treatment.

However, this interpretation is problematic because it may be that a creaming selection bias exists, wherein, the treatment completers generally have a better preexisting prognosis than noncompleters and comparison groups. Thus, sex offenders may represent a distinctly violent population resistant to treatment independent of psychopathy. Alternatively, psychopathic sex offenders may represent a distinct type of violent psychopaths with a different prognosis.

This would seemingly argue for the strong need to develop tailored treatments which may vary based upon being a generally violent or sexually violent psychopathic individual.

Thus, it would be important to understand the context as well as typology of the violence perpetrated. Research indicates that interventions that are responsive to the criminogenic needs i. An additional potentially distinct type of psychopathic persons that requires further study is the female psychopath. Despite rather abundant research on the relationship between psychopathy and violence in men, there is a notable dearth of such research that focuses on women.

At this stage, less is known about female psychopathy and how women's psychopathic traits and treatment needs may vary from the more heavily studied male population. However, it seems particularly noteworthy that among investigations utilizing general forensic populations, only the Richards et al.

In fact, this was the only study we identified that included women in the sample. Laboratory research suggests that the emotion dysfunction central to psychopathy may be less dysfunctional for women relative men e.

Future research on psychopathy may benefit from examining whether protective factors for aggression are also more present in female psychopaths and whether high psychopathy women may be more responsive to treatment than their male counterparts. The reduction in violent infractions identified by Richards et al. For example, there were several methodological limitations, including the use of a restricted range for psychopathy scores i.

In addition to using an exclusively female sample, this study was also unique in that the treatment applied was aimed primarily at substance abuse, unlike other treatment approaches described in this review, and higher levels of psychopathy remained associated with community recidivism upon release. Thus, there may be alternative explanations for the effectiveness of this treatment that go beyond its focus on women as a subtype of psychopathic persons. It is, therefore, unclear whether the phenomena identified in men parallel those in women.

It will be important for future research to identify which treatments reduce violence with psychopathic women as well as men. Given the presence of potentially different subtypes of psychopathic persons e. For example, Chakhssi et al. The findings of Chakhssi and colleagues highlight the need to consider the unique individual dynamic factors when developing interventions for offenders, particularly considering a subset may become more violent as a result of otherwise seemingly harmless interventions.

A tailored treatment approach seems to be one of the hallmarks of the Heuristic System described by Richards et al. Developed as a substance abuse treatment, Richards describes this approach as a structured method of tailoring treatment to the individual through comprehensive assessment. This method allows the addiction problem to be placed in the context of each individual person's history, personality features, and stage of recovery, from which optimal treatment strategies are then selected that are most relevant to the individual Richards, While creating individualized approaches further complicates efforts to evaluate treatment effectiveness due to participants receiving different interventions , flexible treatment approaches may be necessary to produce optimal outcomes among this population.

The value of creating treatments that are expressly tailored to address psychopathy traits are highlighted in research by Caldwell and colleagues, who set out to create an intervention specifically customized for highly violent adolescents. In doing so, they appear to have developed an intervention that may reduce aggression by the most violent adolescents, including those that are highly psychopathic Caldwell, ; Caldwell, Skeem, et al.

The MJTC seemingly applies basic principles of behavioral conditioning and token economies to shift reinforcement to prosocial behaviors. Although it has not been replicated by independent research groups, these authors have consistently replicated these findings and found reductions in psychopathy traits themselves Caldwell, ; Caldwell, Skeem, et al.

The MJTC may be particularly suited for psychopathic individuals, as they are not responsive to punishment but display normal or even heightened responsivity to positive reinforcement e. This suggests that strategies which focus on positively reinforcing prosocial behaviors while extinguishing reinforcement of violent behaviors may proffer the most efficacy with highly psychopathic individuals.

Notably, Hawes and Dadds reported on the differential influence of psychopathy traits on reward strategies e. They found that boys high in psychopathic traits, according to parents' reports, were less responsive to punishment tactics and evinced less negative affect in response to punishment than boys low in psychopathic traits.

However, psychopathy traits were unrelated to parents' ratings of reward strategies. Thus, highly psychopathic boys were less responsive to punishment strategies but not necessarily less responsive to positive reinforcement strategies.

Again, this pattern of results suggests that interventions employing principles of positive reinforcement for prosocial behaviors may be most ideal for psychopathic individuals.

However, these studies have only been implemented with child and adolescent populations. Thus, it is not clear if adult psychopathic persons would demonstrate a similar pattern of change. It is possible that violent behavior has already been too strongly reinforced in adult psychopaths to be counter-conditioned. Nevertheless, from a prevention standpoint and a public health perspective, it is likely most beneficial to implement interventions with psychopathic individuals at an early age before their violent behavior can become engrained.

Considering the substantial economic burden psychopaths pose to society in a single year, the economic consequences they inflict across their lifetime are staggering as are the emotional consequences. Congruently, the benefit of intervening in youth and preventing a lifetime of violence to society would be substantial.

Developing and evaluating more focused and tailored interventions for psychopathic individuals may be even more crucial when one considers factor structure of psychopathy, with Factor 1 representing characteristics associated with emotional detachment and Factor 2 encompassing traits associated with social deviance. This distinction further underscores the need for interventions that can address the multifaceted nature of psychopathy. Furthermore, the studies in this review all examined treatment impact on violence outcomes and recidivism data, but an examination of violence typologies is noticeably lacking from the psychopathy and violence treatment literature.

Violence that tends to be driven by extreme anger and in response to perceived provocation will have different antecedents and points for intervention than instrumental acts which may arise from aberrant empathy and socialization stemming from neurobiological development e. Admittedly, this will be difficult and problematic in its assessment as pure acts of either form may be rare, but a number of research groups have developed rigorous methods of parsing these two constructs for a review see Reidy, Shelley-Tremblay, et al.

By examining specific forms of violence outcomes, we may be able to shed light on the discrepant findings among interventions for subgroups, including psychopathic individuals. In addition, it is our belief that knowledge of what does and does not work to reduce psychopathic violence will be greatly augmented by more transparency in the assessed interventions. There was a surprising lack of detail about interventions in the majority of the treatment outcome studies we identified.

This deficit in information limits our ability to determine those components of interventions which may provide or preclude the desired therapeutic gains. Many of the studies reviewed here describe the therapies as employing cognitive-behavioral strategies which will bring to mind a number of specific activities e.

Efforts to identify the effective components of interventions will greatly advance the development of new interventions and elucidate discrepant findings within the extant literature.

It is certainly important to investigate existing interventions that are effective at reducing violence of nonpsychopaths; however, considering the substantial socioeconomic burden of psychopaths' violence it is imperative that we develop interventions that are specifically designed for psychopathic violence. In conclusion, the state of the literature precludes the ability to speculate with great confidence about the amenability of psychopathic violence to treatment.

Nevertheless, we believe that there is good preliminary evidence to suggest that although they are more treatment resistant likely requiring more resources and dosage, a specifically and carefully crafted intervention may be effective in reducing violence by psychopathic individuals. However, great caution is warranted in the development and employment of such interventions because it is very possible that with at least a subset of psychopathic persons, the wrong components of an intervention may exacerbate their violent behavior.

We urge clinicians and researchers to provide more transparency in publishing treatment outcome studies. By increasing transparency and improving the design and sophistication of research evaluating existing treatment approaches, greater advancement can be made in alleviating the significant burden that psychopathic violence poses to society.

As such, the term psychopath is commonly interpreted to mean individuals scoring at or above 30 sometimes 25 on the PCL-R. However, for the sake of brevity and in recognition of the dimensional nature, we use the terms psychopath and nonpyschopath to refer to those individuals scoring at the higher or lower ends of the spectrum respectively, and not to suggest reference to any cut score or dichotomous classification.

However, unlike other research studies included in this review, this sample did not utilize one of the PCL measures and instead used the MMPI-2RF to estimate psychopathy scores on the Psychopathic Personality Inventory.

However, Skeem and colleagues selected a subsample of patients scoring the highest levels of psychopathy. Considering greater prevalence of psychopathy traits in men relative to women e.

However, no information about gender was provided for the subsample analyzed in the paper. We attempted to contact authors to determine what proportion of the sample, if any, was female but did not receive response to our correspondence in time for this publication. National Center for Biotechnology Information , U. Aggress Violent Behav. Author manuscript; available in PMC Mar Dennis E. Kearns , and Sarah DeGue. Author information Copyright and License information Disclaimer.

Copyright notice. See other articles in PMC that cite the published article. Abstract Psychopathy reflects a pathological form of personality that predisposes individuals to risk for perpetration of chronic and severe violence across their lifespan. Introduction Violence is a ubiquitous social problem spanning communities, countries, and continents. The question s at hand Much as the constructs in this domain of research have been conflated, so too may the questions that are asked and answered be conflated.

Table 1 Summary of treatment outcome studies for psychopathy and violence. Study Population Sample size a Gender Primary treatment orientation Outcome measures Post-treatment follow-up period in months b Results Abracen et al.

Caldwell, Skeem, et al. Caldwell et al. Chakhssi et al. However violence was measured in 6 month increments for 18 months as treatment was ongoing. Gretton et al. Hildebrand et al. Langton et al. Looman et al. Olver et al. Richards et al. However, violence was measured in 10 week increments for 12 months as treatment was ongoing. Spain et al. Open in a separate window. Where available we report means and ranges of follow-up periods in parentheses.

Review of studies 4. General adult forensic populations As one might expect, most of the research conducted with violent psychopathic individuals has focused on forensic populations. Adult psychiatric populations There has also been interest in establishing the relationship of psychopathy to treatment outcome in civil psychiatric settings.

Adult sex offender populations Much of the research on psychopathy treatment has been conducted specifically with sex offender populations. Adolescent populations Gretton, McBride, Hare, O'Shaughnessy, and Kumka examined charges and conviction rates for adolescent sex offenders mandated to an outpatient treatment program.

Summary of treatment studies In summary, the findings from general forensic populations are limited and divergent. Summary and conclusions Despite strong speculations for and against the efficacy of treatment for psychopathic individuals, there is a relative dearth of research on this topic, particularly when addressing violence as an outcome. Recidivism among treated sexual offenders and comparison subjects: Recent outcome data from the Regional Treatment Centre Ontario high-intensity Sex Offender Treatment Programme.

Journal of Sexual Aggression. The aggregate burden of crime. Journal of Law and Economics. Human aggression. Annual Review of Psychology. Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. Sex differences in aggression in real-world settings: a meta-analytic review.

Review of General Psychology. Psychopathy, treatment behavior, and recidivism: An extended follow-up of Seto and Barbaree. Journal of Interpersonal Violence. Aggression: Its causes, consequences, and control. New York: McGraw Hill; Gender differences in aggression as a function of provocation: A meta-analysis.

Psychological Bulletin. Here it needs to be mentioned that the drug and alcohol addiction is not a cause of such behaviours, but only worsens the situations. The steps include:. Many feminist theorists have expressed their opinions that the root cause behind such abusive behaviour towards the spouse or a partner comes from a patriarchal thought process that is built on the notion that men are more powerful and privileged than women and here, Anger Management can have no positive outcome.

The abusers create an atmosphere of fear and violence in the domestic setting. The reason behind this is that they have either grown up in a similar circumstance or they are suffering from a mental disorder. The victim is also in need for treatment, when she is in the abusive relationship.

The basic requirement would be to grow courage and strength in the victim to prevent the abuse or at least leave the situation or the offender. It is in most cases that the lack of confidence to prevent the abuse is the root cause behind the suffering.

Along with that, the victims are also supported to live a life without any dependence on drug and alcohol. Since addiction to drug and alcohol is a common outcome for domestic violence, the victims need support to get rid of such a condition. However, of course, the success of this entire program lies in the fact that the abuser is ready to take the entire responsibility of the situation.

If he refuses to accept the severity of the torment he executes on the partner or other family members, or if he blames others for the abuse, these are signs that the treatment may not be working very well. Every state and all major cities have their own domestic violence rehabilitation programs that are mostly conducted in association with the local government. Professional experts, counsellors and psychologists work in collaboration with each other and offer inpatient rehab programs or outpatient programs.

Depending on the situation and requirements, the program needs to be chosen. If you need help for preventing or coming out of an abusive relationship and are afraid of your partner, you can get legal and social help and escape the abusive relationship.

Women with PTSD United — Offers a collective of trauma-related resources for survivors of rape, domestic violence, and more. Family Medical Practice — Based in D1 and D2 and offering a variety of medical and psychiatric services. Vietnamese speaking counseling is available. Local Resources — Hanoi Hanoi Psychological Counseling Group — Offers victims psychological assistance and can refer victims to medical clinics if medical assistance is requested.

Hagar International — Hagar supports women and children survivors of human trafficking, domestic violence, and sexual abuse. They provide victims with free and safe accommodation, healthcare, psychological counselling, legal aid, and career training. Domestic Violence:. Department of Justice Office on Violence Against Women — Information about local domestic violence victim assistance coalitions.

They also have a list of state and international organizations that can assist domestic violence victims. Please click here for information on how to contact their international toll-free crisis line. Families and Friends of Murder Victims:. POMC, Inc. Victims and Families of Drunk Driving Crashes:. General Victim Assistance:.