What works in reducing re-offending in individuals with high levels of psychopathy?

What works in reducing re-offending in individuals with high levels of psychopathy?

Jenny Tew

Psychopathy

“far more has been written about the subject than is actually known about it”

(Hemphill and Hart, 2002)

Why does psychopathy

matter? Links to institutional behaviour

(Dolan & Davies, 2005; Langton, Hogue, Daffern, Mannion, & Howells,

2011)

Why does psychopathy

matter?

Links to re-offending

(Rice & Harris, 2013; Yang, Wong & Coid, 2010

Links to institutional behaviour

(Dolan & Davies, 2005; Langton, Hogue, Daffern, Mannion, & Howells,

2011)

Why does psychopathy

matter?

Links to re-offending

(Rice & Harris, 2013; Yang, Wong & Coid, 2010

Links to institutional behaviour

(Dolan & Davies, 2005; Langton, Hogue, Daffern, Mannion, & Howells,

2011)

Links to response to treatment

(D'Silva, Duggan, & McCarthy, 2004; Thornton & Blud, 2007)

“……..psychopathic individuals are not uniquely ‘hopeless’ cases who should be disqualified

from treatment, but instead are general ‘high-risk’ cases who need to be targeted for intensive treatment to maximize public

safety.”

(Skeem, Polaschcek, Patrick & Lilienfeld, 2011)

Psychopathy and RNR

• Risk:Higher levels of psychopathy relate to higher levels of risk.

PCL-R Factor 2 found to be stronger predictor of recidivism than Factor 1.

• Need:Suggested link with higher psychopathy having higher levels of need

Traits can give some information about need

• Responsivity: Higher levels of psychopathy more likely to drop out and gain less benefit

PCL-R Factor 1 found to be more associated with treatment behaviour than Factor 2

Some treatment approaches …..

• Guidelines for a psychopathy treatment programme (Wong & Hare 2009).

• Violence Reduction Programme (Wong & Gordon, 2013)

• High Risk Personality Programme (Wilson & Tamatea, 2013)

• A two component treatment model (Wong, Gordon, Gu, Lewis & Olver, 2012).

• High risk special treatment units (Polascheck & Kilgour, 2013)

• NICE guidelines for treatment of anti-social PD (2010).

Motivation & Engagement

Schema TherapyPhase One:Formulation

Creative ThinkingComponent

Progression andResettlement

Schema TherapyPhases 2 & 3:

Behavioural Experiments/Maintenance

Problem SolvingComponent

Handling ConflictComponent

The Structure of Chromis

Does it work?

Engaging

• Component completion rate of 82% - 98%

• 93% judged to be making some progress by the clinical team.

• Staff reported less resistance, more engagement, more focused on working together in groups sessions and trust staff more over time.

• Over 800 activity hours delivered during 1 week in January.

• A thematic review of art classes found evidence of engagement and gaining benefits that related to desistance.

Gaining benefits from treatment

• HCR-20 reviews show some evidence of reductions in risk.

• Changes in verbal and physical aggression.

• Those who have completed have been considered to progress in some way – further treatment, PIPE, reduced security category.

Principles underpinning the Chromis approach

Personal relevance

Principles underpinning the Chromis approach

Personal relevance

Future focused

Principles underpinning the Chromis approach

Personal relevance

Control & Choice

Future focused

Principles underpinning the Chromis approach

Personal relevance

Control & Choice

Future focused

Transparent & Collaborative

Principles underpinning the Chromis approach

Personal relevance

Control & Choice

Future focused

Novelty & Stimulation

Transparent & Collaborative

Principles underpinning the Chromis approach

Personal relevance

Control & Choice

Future focused

Novelty & Stimulation

Transparent & Collaborative

Status & Credibility

Consistent Ideas for treatment

• Treatment targets being criminogenic needs

• Core personality traits considered responsivity issues

• Cognitive behavioural approaches

• Individualised yet structured

• Phases of treatment: developing motivation, learning skills, generalising skills.

• Motivation is important

• Positive and rewarding rather than punitive approaches

• Staff are important

• Problematic behaviour being a target rather than obstacle

• Treatment that considers strengths

• High dose treatment

• Generalisation