Interview with aftermath: surviving psychopathy

Ask the Expert: Dr Randall Salekin
by David Kosson on October 9, 2018 in Uncategorized

Dr. Randall Salekin is a Professor in the Department of Psychology at the University of Alabama. He is also the Editor-in-Chief of the Journal of Psychopathology and Behavioral Assessment. Dr. Salekin has answered some questions on adolescence and psychopathic traits.
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1. How did you get involved in the area of psychopathy research?
Growing up in British Columbia, I was fortunate to be able to attend Simon Fraser University, where I was exposed to researchers conducting cutting edge studies on psychopathy. David Cox, one of Bob Hare’s first graduate students, was one of my professors. He had just finished a study with British bomb disposal experts in Northern Ireland, and Stephen Hart, who was on post-doc at Simon Fraser University (and also a recent graduate student from Bob Hare’s lab) was working on clinical interviewing methods for the assessment of psychopathy. David and Steve’s offices were just down the hall from mine, and fortuitously, I was exposed to their work, including the development of the Psychopathy Checklist: Screening Version (PCL:SV).

2. Is it possible to identify psychopathic-like traits in adolescents? Can you give a brief description of these traits?
I believe it is quite possible to identify psychopathic traits in children and adolescents although I think it is also important to keep in mind that they are only moderately stable during this stage.
These traits include grandiose-manipulative characteristics (charm, arrogance), callous-uncaring traits (lack of remorse, lack of empathy), and daring impulsive features (risk-taking, proneness to boredom). Although some take issue with extending the construct to children, the condition has to have roots somewhere. However, like Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD), there have been criticisms that the characteristics of the conditions are normative in children and adolescents. While these statements are, to an extent true, the aim of understanding personality pathology early is to determine when the traits are non-normative (for that age group) and then to provide some type of intervention or prevention that can reduce or eliminate the problem. Edward Barker and his colleagues (Barker et al., 2011) have noted prenatal risks that might be avoided to reduce the risk of psychopathy.

3. What type of interventions would you recommend for incarcerated adolescents with psychopathic-like traits?
Although there is a long-standing belief that psychopathic individuals are not treatable, I have ar-gued that this is likely too pessimistic of a view. This does not mean that it is not difficult to treat, but rather that, if carefully tailored, the intervention could have some benefit. Several decades ago, Herbert Quay realized that you need to tailor the treatment to the individual. At the University of Miami, Quay designed a treatment for psychopathic youth that was able to accommodate their sensation seeking abilities. In this same vein, we have designed a treatment that is tailored to the specific sets of symptoms that they have. We contend that it is important to provide the youth with a little information about the potential mechanisms of psychopathic personality, and then focus on planning abilities and even some exercises that work on emotional processing of events. That said, there are probably other generic programs that would help reduce these symptoms (Family Functional Therapy, Multisystemic Therapy).

4. What are the challenges faced with providing intervention to youth with psychopathic-like traits?
Although there has been some recent optimism about the treatment of psychopathy, I have learned that it is also important to acknowledge that there are barriers. Working with the youth them-selves can be difficult. Common barriers include motivation to change and potential deception and manipulation during therapy, as well as emotional deficits, and low levels of arousal which can lead to proneness to boredom. It would be naïve not to recognize these barriers. Treatment requires an extra level of thought regarding how to deal with the barriers.

5. Considering research is generally ahead of application in the field, what is one improvement in the field of psychopathy that you hope to see take place over the next five to ten years?
I hope there is an improvement realized in the mechanisms for psychopathy. At present, there is still far too little known about the brain and how it operates with respect to psychiatric conditions. And we are not always clear about the regions of the brain implicated in deficits (lack of fear). This was recently illustrated by LeDoux (2013, 2014) who suggested that the fear circuitry needs to be reconsidered, noting that some of the fear processing likely occurs in the prefrontal cortex. Sylco Hoppenbrouwers, Berend Bulten, and Inti Brazil’s (2016) paper, like Smith and Lilienfeld’s (2015), has also been influential in critically rethinking mechanisms. My hope is that in the next decade, these types of questions and subsequent research will improve what we know about causes of psychopathy and correspondingly improve interventions. The largest gains will likely be made if we examine the broader construct of psychopathy and its underlying dimensions and their relation to Conduct Disorder and potentially Oppositional Defiant Disorder (ODD).