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Book review: Antisocial Personality Disorder A Practitioner’s Guide to Comparative Treatments

I had a nice conversation with a friend today. She said that part of healing from a relationship with a sociopath is getting to the point where one realizes that sociopaths deserve pity for being disordered. In that regard, we both hope that science will progress to the point where sociopathy is preventable and fully treatable. In this blog I will discuss treatment options for those diagnosed with antisocial personality disorder. Following the format of the book I am reviewing, this disorder is called sociopathy or ASPD and the personality traits that give rise to the disorder are called “psychopathic personality traits.”

Regarding whether sociopathy and psychopathic personality traits are currently treatable, Sandy Brown and I had a bit of a disagreement when we wrote Women Who Love Psychopaths. Although I told her the literature indicates sociopathic behaviors are to some degree treatable she was very insistent we emphasize that psychopathic personality traits are not treatable. She won out because she convinced me of the need to communicate to women that men with these personality traits usually do not change. In her experience, giving a woman any hope her man could improve, discourages her from leaving the relationship. I offer this book review and discussion of treatment of sociopathy/psychopathy to keep you informed, NOT to encourage you to stay.

I also recognize that spouses may choose to stay married to those with ASPD for any number of legitimate reasons. There are also people who have sons, daughters, parents, uncles, aunts and cousins with ASPD. All want to know if there is any effective treatment for the disorder. People want to know what treatment gives their loved one the best shot at improving.

If you have a close family member who is a sociopath and are involved in that person’s treatment, I strongly recommend you read Antisocial Personality Disorder: A Practitioner’s Guide to Comparative Treatments. Although the book is written for mental health professionals, I believe any person with some background in psychology can understand most of it. What you don’t understand, you can look up and so become better able to communicate with therapists. This book is an absolute must read for all professionals who deal with sociopaths and their families.

To give you an idea of why I give this book 5 stars, I will describe it and discuss the content. The book is edited by two psychologists experienced in the treatment of sociopaths, Drs. Rotgers and Maniacci. In the second chapter, they give detail s of the case of Frank a classic sociopath. Although they do not say so in the book, Dr. Rotgers told me that Frank was an actual person he evaluated.

I was very impressed with the way the authors presented Frank and his history. In particular, the clinicians interviewed Frank’s wife. Her statements about him and their relationship are characteristic of the kinds of things spouses of sociopaths say. Frank’s aunt and brother were also interviewed. The editors agree with me that the best sources of information regarding the nature of sociopaths and sociopathy are the family members of the disordered person.

Frank’s wife Jennifer says the following, “ The most exciting year of my life (was the first year of our relationship). He was so spontaneous and full of energy. His charm and good looks just swept me off my feet. Being with him was just so exhilarating. “ and later, “it suddenly dawned on me that I didn’t know anything about him.”

Having presented the case of Frank, the editors then invited 8 professionals representing 8 different treatment approaches to answer a series of explicit questions about their formulation of the case, understanding of the disorder and approach to treatment. The contributors were as follows:

1. Debra Benveniste, MA., MSW; Putnam, CT-Psychodynamic Approach
2. Michael Maniacci, Psy.D.; Chicago, IL-Adlerian Psychotherapy
3. Darwin Dorr, Ph.D.; Wichita, KS-Million’s Biosocial Learning Perspective: Personologic Psychotherapy
4. Glenn D. Walters, Ph.D.: Schuylkill, PA-Lifestyle Approach to Substance Abuse and Crime
5. Arthur Freeman, Ed.D. & Brian Eig; Fort Wayne, IN and Philadelphia, PA-Cognitive Behavioral Treatment (CBT) Approach
6. Robin A. McCann, Ph.D., Katherin Ann Comtots, Ph.D., & Elissa M.Ball, M.D.; Denver, CO-Dialectical Behavior Therapy
7. Joel I. Ginsberg, Ph.D., C.A. Farbring, M.A., & L. Forsberg, Ph.D.; Stockholm, Sweden-Motivational Interviewing
8. Sharon Morgillo Freeman, Ph.D., MSN, RN-CS, & John M. Rathbun, M.D.; Fort Wayne, IN- Integrating Psychotherapy and Medication

In the last chapters the editors compare and contrast the different treatment approaches. Family members of sociopaths should be aware of two important points. First all but one of the therapeutic approaches (psychodynamic) involves family members in the treatment. Family members are considered by the 7 to be important sources of information. Given the importance of family to the treatment, do not expect therapists to discourage you from being involved in a sociopath’s life. Therapists often encourage family members to stay with the sociopath and support him/her. This may benefit the sociopath at the expense of his/her family.

The chapter on medication discusses medication that can help the poor impulse control and aggression seen in sociopaths. I completely agree with the recommendations made and think that if a person with ASPD is willing medication should be tried.

What about prognosis then, and how long does it take to treat a sociopath? The CBT chapter gives some interesting statistics. The authors state, ”Psychotherapy is associated with a sevenfold faster rate of recovery compared to the naturalistic studies… Without treatment, estimated recovery rates are about 3.7% per year, and with active treatment the rates increase to 25.8% per year.” Also the longer the treatment continues the more improvement there is. They also say, “Unfortunately, people with ASPD have a very high drop out rate.” It makes sense then for family member to encourage those with ASPD to stay in treatment. Don’t expect that treatment to turn a sociopath into a loving, empathetic person, though. All of the authors say that is not a realistic treatment goal. When professionals say a sociopath “has improved,” they mean he/she is not as dangerous and is less impulsive. As Dr. Rotgers’ email to me said, “Harm Reduction: ‘80% of something is better than 100% of nothing’ Alex Wodak”

Adendum

Donna sent me the following comment. Your post today leaves a huge question in the mind of a reader: What can treatment accomplish? Can you please address this?

I will address this question in detail next week. For now I wanted to introduce the names of the psychotherapies. To cover all in one week would have been too much.



60 Comments on "Book review: Antisocial Personality Disorder A Practitioner’s Guide to Comparative Treatments"

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  1. OxDrover says:

    Dear Cherly, I am so sorry that you have had such a terrible time from this man. You have found a healing community of people who have suffered as you have at the hands of these predatory monsters. I am glad thatyou were able to expose some of his crimes so that he will get the consequences of them from the IRS SEC etc. Many times we get no justice and just have to go on with our lives without it.

    None of us here as far as I know think that there is “successful” treatment for these predators at least in the full blown adult state which is what we are dealing with.

    Come here often post 100 times a day if you need to, and be assured that you are very welcome here in this caring community of people trying to heal from the devestation of these monsters.



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  2. kat_o_nine_tales says:

    I suppose there will be predators as long as there are victims (ei. nice people), and vice versa.

    Thank you Oxy lol.

    You know guys, of all the stuff my first husband did to me.. the only one I can’t forgive him for, absolutely can’t.. is this one time we were desperate for food, and the baby had no milk or anything. I asked him to give me one dollar for some milk, and he just slammed the door in my face. So my little baby cried herself to sleep while her father and grandparents sat right next door watching movies and eating pizza. It still brings tears to my eyes, though she is 14 now.



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  3. blondie says:

    omg did anyone see or is anyone watching DR.Phil 3pm eastern time today. im watching it right now. this guy on there reminds me so much of my ex. im not saying that guy is a sociopath but i would run so fast away from that guy. he is all about him self, wants to be in control. Thats the first sign!!!! women run!!



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  4. blondie says:

    wow..this story is making me sick! he is lying on his online dating site! goddd…sociopath…sorry just my opinion



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  5. OxDrover says:

    Blonie and Kat, as lsong as there are people in the earth there will be good ones and bad ones, and the good will be taken advantage of by the bad ones. Even if you dont’ take the story of Cain and Abel literally, you can see that there have always been Ps and people who will resent other’s success and doing right, and hate, resent and be jealous of them.

    Jesus ddn’t pull any punches in his teachings either, he told his disciples that they would be persecuted for doing RIGHT. People who are wicked, and evil, resent others who are not. They turn and use our good natures against us.

    There is no “cure” for an evil heart, a jealous mind, and a soul without a conscience.



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  6. kat_o_nine_tales says:

    Yeah so true. I decided today what to do with my rage as long as it lasts. I think I should get serious about improving my body and my life. It will be much easier to take if I feel good about myself I know that.



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