Adapting Dialectical Behavior Therapy (DBT) for the Treatment of Psychopathy

Abstract

Few mental abnormalities create more havoc for society than the psychopathic personality, however interventions specifically designed to address this form of psychopathology are few. One treatment that has received growing attention in the forensic mental health community is Dialectical Behavior Therapy (DBT). This paper describes an adaptation of DBT for the treatment of psychopathic offenders. A case study is used to highlight salient elements of this treatment approach, as well as the challenges to successful treatment posed by this population of offenders.

Keywords:

• psychopathy
• personality disorder
• treatment
• psychotherapy
• Dialectical Behavior Therapy

Acknowledgments

An earlier version of this article was presented, by Barry Rosenfeld, Ph.D., at the Bergen Conference for the Treatment of Psychopathy. The treatment study through which this DBT program was developed was supported by a grant from the National Institute of Mental Health, grant number R34 MH71841 (B. Rosenfeld, Principal Investigator). The authors wish to thank Trevor Barese and Michael Davenport for their assistance in preparing portions of the manuscript and Andre Ivanoff, who helped with the initial development of the program. In addition, we thank the staff of Project SHARP (in alphabetical order): Joanna Cahall, Sarah Coupland, Jacqueline Howe, Melodie Foellmi, Melissa Miele, Ashley Pierson, Lauren Saunders, and Zoe Turner-Corn.

Notes

It should be noted that considerable controversy exists about the specific characteristics that should be included in the construct of psychopathy. Indeed, research demonstrates substantial heterogeneity among individuals who would be classified as psychopathic (Patrick, 2007; Skeem et al., 2011). This debate, however, is beyond the scope of this manuscript.