There is a growing body of research demonstrating that the therapeutic alliance (TA) affects outcomes among specialized forensic populations, including sexual offenders. Despite this consensus, researchers continue to question whether higher levels of psychopathic traits are conducive to the formation of a therapeutic relationship for high-risk sexual offenders. Thus, the current study adds to the literature by examining the relationship between the TA and levels of psychopathy among a sample of incarcerated sexual offenders participating in sexual offender treatment. Overall, we found no significant relationships between Psychopathy Checklist–Revised (PCL-R) scores and the Working Alliance Inventory (WAI) for either client or therapist ratings. However, when we excluded those offenders who were participating in aftercare, a significant negative relationship was found between client ratings of the Bonds subscale and PCL-R total scores. Next, after controlling for risk and group status (aftercare/non-aftercare), we found no significant differences between either client or therapist total WAI scores when compared by level of psychopathy as measured by the PCL-R (low, >20; moderate, 20-30; and high, >30). Furthermore, when Factor 1 and Factor 2 scores of the PCL-R were examined individually, neither factor significantly predicted either client or therapist total WAI score after controlling for risk and group status. Findings are discussed as they pertain to the treatment of sexual offenders with elevated levels of psychopathic traits.
Could you talk us through where the idea for the research came from?
My colleague Brandy Blasko and I have been interested in process issues in sex offender treatment for a while now. We decided to start assessing the therapeutic alliance in the treatment programs she was overseeing to determine what factors influenced the formation of the therapeutic alliance and ultimately how the therapeutic alliance would relate to treatment outcome. As many of the individuals in the sample were high risk sex offenders they were also given the PCL-R as part of their assessment battery. I also teach the treatment and rehabilitation of offenders and one of the issues that we discuss is the treatment of offenders who have elevated levels of psychopathy. The clinical lore still remains that these individuals cannot be treated and thus many are excluded from treatment programs. I discussed this issue with one of my Master’s students and she was interested in assessing how psychopathy influenced the formation of the therapeutic alliance among those who have committed sexual offenses as part of her Master’s thesis and hence the idea for the study was born.
What kinds of challenges did you face throughout the process?
We struggled as to how to define psychopathy, and the SAJRT reviewers were ultimately very helpful with this issue. In the literature various cut-offs for psychopathy are used ranging from anywhere from 20 to 30 on the 40 point scale. The offenders in our sample were not selected based upon psychopathy and thus we had a range of PCL-R scores. Additionally I believe that there is no specific cut score that makes someone psychopathic but rather that psychopathy is a continuum of traits and behaviors. Thus with the reviewers’ feedback we conducted the analyses two ways to capture this continuum but still remain true to the existing literature by conducting a separate analysis where we divided the offenders into groups based upon low (under 20) moderate (20-30) and high (greater than 30) scores on the PCL-R.
What kinds of things did you learn about co-authorship as a result of producing this article?
As a professor, I often work with my students to get their manuscripts published. As this is often the first time that they have ever published anything the manuscripts often require multiple drafts and lots of back and forth. Dr. Blasko as third author was instrumental in the process as it is nice to have a fresh set of eyes on the manuscript. I always find that having co-authors makes a paper stronger as you challenge one another to do better work.
What do you believe to be to be the main things that you have learned about Psychopathic Traits in treatment?
I think that our study further adds to the research suggesting that those with elevated levels of psychopathy can participate in treatment. Before conducting the study I thought psychopathy scores may be inversely correlated with the therapeutic alliance as clients with elevated levels of psychopathy are viewed to be difficult in group. However, the findings are in line with the more recent research suggesting that those with psychopathy can benefit from treatment and engage in the treatment process.
Now that you’ve published the article, what are some implications for practitioners?
I think that the findings of this study underscore the fact that those with elevated levels of psychopathy can benefit from treatment and they appear to be no less likely to form an alliance than any other client. It also suggests that elevated levels of psychopathy may not be related to disruptive behaviors in group as it would stand to reason that therapists would rate difficult clients more negatively than non disruptive clients. Therefore the take home message for therapists is that psychopathic traits may have little bearing on the treatment process.
Elizabeth Jeglic, PhD