Walton, A., Jeglic, E. L., & Blasko, B. L. (2016). The Role of Psychopathic Traits in the Development of the Therapeutic
Alliance Among Sexual Offenders. Sexual Abuse: A Journal of Research &
Treatment, first published online March 2016.
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
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