- People with psychopathic traits may seek out therapy. True psychopaths will not.
- Psychopaths can manipulate everyone around them, including their therapists.
- There may not be a cure, but certain therapies may stop the most violent of psychopaths from re-offending.
An estimated 1 — 2% of men and 0.3 — 0.7% of women in the general population are psychopaths. However, the number of people who have psychopathic traits is probably a lot higher.
Psychopathy is a spectrum, and we all fall on it somewhere, according to neuroscientist and psychiatrist Dr Tara Swart. The traits of a psychopath include ruthlessness, narcissism, persuasiveness, and the inability to feel guilt.
What separates most of us from people with psychopathic disorder, though, is the ability to feel empathy, says therapist Dr Perpetua Neo.
Usually, if someone shows unfavourable traits in a way that is pushing other people away, they will stop when they learn they are acting inappropriately. They may even choose to go to therapy to learn why they behave in such a way, and adjust accordingly.
However, a true psychopath will never choose to go see a therapist because they don’t think there’s anything wrong with the way there are. They will also never change, according to Neo.
A true psychopath will never change.
“People with traits, they’re going to be ok,” Neo told Business Insider. “[But] from what I’ve read, what I’ve heard, what I’ve seen and experienced so far, people with dark triad personality disorders cannot and will not change.”
Neo has worked mainly with women who have come out of abusive relationships with narcissists and even psychopaths. She usually works with them on their own while they are still with the abuser, or after they have been discarded.
Sometimes, though, a psychopath and their partner will go to counselling to try and fix their broken relationship. Neo says the only time a psychopath will agree to do this is if they can see how it will benefit them, and if they still have some use for their partner.
Even therapists can be fooled by them.
Psychopaths are often masters of manipulation, and by this point they have already managed to skew the whole relationship. They are very charming, and know how to tug at your heart strings, according to Neo. Unfortunately, even therapists can be fooled by them too.
“They orchestrate this show, put on a false self in front of the therapist, and they know how to push the buttons of their partner, so their partner looks extremely unstable in these situations,” she said. “The therapist may collude unknowingly with the dark triad person against the partner who really has been the one suffering.”
The psychopath may say that their partner is the “mad” one, gaslighting them into believing that it’s true.
“It’s very difficult for you to realise, because they can seem so stable and so rational,” Neo said.
Psychopaths don’t think there’s anything wrong with them.
It’s also difficult for therapists to know how to treat narcissists and psychopaths, because the research and knowledge on the topic is fairly limited. There are several tests to help diagnose psychopathy — such as the Hare Checklist — but these are far from perfect.
To further complicate matters, psychopathy is a wide-ranging personality disorder, and those who have it don’t tend to think there is anything wrong with them. Also, their traits can mimic many other problems, such as substance abuse, domestic abuse, or a gambling addiction, making them hard to identify.
“The psychopath or narcissist, anyone who is very abusive, they tend to be the master of smoke and mirrors,” Neo said. “It could look like something else — it could be the fact he has a difficult mother, so he drinks, and after he drinks he hurts me. Or he has a drug problem. Or he has this convoluted history of paranoia, because people are unfaithful to him and hurt him. So you’re always jumping from one thing to another.”
They could also be misdiagnosed as having a different personality disorder, because the therapist could pick up on something else. Depending on how cunning and manipulative the psychopath is, they may only show the therapist what they want them to see.
“I’ve met quite a few who learn symptoms and pretend to have them,” Neo added. “And a lot of therapies are about believing in a person’s ability to change their lives. If you build a relationship with somebody, you don’t want to believe they are bad. And if they have narcissistic personality disorder, or they’re a psychopath, they are a bad person. So there is this inherent conflict.”
A ‘cure’ might not be the answer.
With violent and criminal psychopaths, their lack of empathy and care for themselves means they have no guilt about what they have done and do not have any problems going to prison.
According to the work of Dr Kent Kiehl, a neuroscientist who has studied psychopaths for over 20 years, if you think going to therapy for a “cure” is the answer, you’re probably asking the wrong question.
In his book “The Psychopath Whisperer,” he outlines some treatment options for highly dangerous psychopaths. In these cases, they are already incarcerated, and so haven’t opted in for therapy, but are forced to go.
For example, at the Mendota Juvenile Treatment Center in Wisconsin, high risk youths are taken in and treated with intensive programs to try to reduce the chance they will re-offend.
The treatments are based on positive reinforcement rather than punishment, such as being given a reward, like a video game in their cell for the weekend, if they respond positively.
“The treatment doesn’t necessarily cure individuals with psychopathy, but it helps provide insight on how to reduce impulsivity and/or poor decisions that contribute to relapse to crime or antisocial behaviour,” Kiehl told Business Insider.
“This program reduces violent recidivism by over 50%, which is a huge decrease and evidence that scientific-based treatment can effect positive outcomes in individuals with these traits.”
According to Kiehl, though, 10 to 15% of kids still re-offended violently, so the psychological treatment isn’t always effective. After all, there is still a lot we don’t know about the psychopathic brain.
In fact, some forms of therapy can actually make psychopaths commit more crimes than if they had none at all, Kiehl writes in his book.
This means research into the brain patterns, upbringing, and behaviour of psychopaths is needed to better understand the chance somebody will become a psychopathic abuser, criminal, rapist, or murderer.
MRI scans could also help to determine whether treatment is really working, by looking at whether the brain activity in areas that regulate emotions, impulses, and morality increases over time.
The most important thing is to help the victims.
Whether somebody becomes a psychopath or is born that way is still a grey area, so the way they are treated is going to be a work in progress for a long time.
Neo says that right now, the most important thing in her own work is to help the people who are the victims, and aid them with getting out of dangerous situations.
“When I see there is clearly abuse going on, regardless of whether it’s emotional, financial, or physical, I will call it out,” she said.
“I will say it’s not healthy behaviour, and this is not how anybody should be treated. I won’t mince my words. It’s tough, though, because [nobody] wants to hear they are with a psychopath.”
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