The treatment of psychopathic sexual offenders : Exploring the influence of risk, change, subtype, and adaptation on recidivism

Abstract

Although their numbers are in the minority in the general offender population, psychopathic offenders are responsible for a significant proportion of the most serious offenses committed (Hare, 1993, 2003). A particularly serious concern is that they are a notoriously challenging population to work with clinically and effectively treat (Polaschek, 2014; Salekin, 2002). Recent findings suggest, however, that psychopathic offenders are able to demonstrate treatment changes that translate into reduced recidivism (Olver & Wong, 2009). A greater understanding of the etiology and treatment responses of psychopathic offenders is needed (Salekin, 2002). Consequently, the present archival dissertation program of research aimed to explore the etiological and treatment response variables of psychopathic and nonpsychopathic sexual offenders in a sample of 302 federal inmates. The influence of psychopathy, risk, and treatment change as it pertained to rates of long-term recidivism was explored. Further, to add to the growing body of literature suggesting that psychopathy may be best conceptualized as different subtypes, cluster analysis was utilized to examine the potential of subtypes of psychopathic offenders who respond differently to treatment. Finally, it has been proposed that psychopathic traits may be adaptive and thus, treatment resistant (Harris & Rice, 2006). Therefore, the relationship between treatment response and evolutionarily relevant variables was explored. Phase one results were consistent with past findings (Olver & Wong, 2009; Olver, Stockdale, & Wormith, 2011) where psychopathic offenders demonstrated higher rates of treatment drop out, but the majority did complete treatment in the current sample. Furthermore, although psychopathic offenders amassed fewer risk relevant treatment gains than their nonpsychopathic counterparts on the whole, there was a group of psychopathic individuals whose therapeutic gains were high and resulted in similar recidivism rates to the nonpsychopathic offenders. Finally, after controlling for comprehensive baseline risk level and treatment change, the PCL-R no longer significantly predicted violent or sexual recidivism. Moreover, treatment change was associated with reduced recidivism, regardless of risk level or psychopathy. This provided support for Wong and colleagues (2012) two component model for the treatment of psychopathy, wherein if service providers can manage and respond to the specific responsivity issues with psychopathic individuals and increase their engagement in treatment, then risk relevant changes that result in lower recidivism are possible. In phase two, two subtypes of psychopathic offenders were found using PCL-R facet scores that were consistent with the primary and secondary distinction. The primary subtype demonstrated a high degree of the classic psychopathic personality traits, whereas the secondary type had more behavioral and lifestyle traits and to a lesser degree, the callous personality. In terms of external variables, the secondary group had slightly higher risk levels, treatment change, and rates of violent reoffending, but the differences failed to reach statistical significance. Finally, in phase three, there was evidence for psychopathy’s relationship with proxies for adaptation, but the evidence for adaptation had little bearing on treatment response. Furthermore, the adaptive markers were largely accounted for by the general antisociality of psychopathy, rather than the psychopathic personality itself. The results were then integrated and implications for the future treatment of psychopathic offenders were discussed.