Since the first conceptualization of psychopathy in modern psychiatry, this condition has been considered practically incurable. However, there is an experimental approach that may refute such a view. Schema therapy is a psychotherapy for the treatment of personality disorders that has performed well in the therapy of borderline personality disorder, but has also been adapted for patients with other problems, including those with high levels of psychopathy.
There is a case study of schema therapy for psychopathy in a 25-year-old rapist. His father was a cruel man who subjected him to beatings and authoritarian upbringing. From the age of 8, the patient exhibited serious behavioral problems; at 17, he was first convicted of assault causing grievous bodily harm, and at 19, together with an accomplice, he committed rape, after which he tried to shift all the blame onto the victim (calling her a prostitute and claiming she had consented) and the accomplice (saying that he had forced him into it).
First, the patient took the PCL-R test. He scored 4 out of 8 on the interpersonal component (dishonesty, manipulativeness, etc.), 7 out of 8 on the affective component (lack of empathy, guilt, other emotions, and failure to take responsibility for his actions), 6 out of 10 on impulsivity, and 8 out of 10 on antisociality (history of behavioral problems and criminality). Considering additional traits outside the components (sexual promiscuity and a tendency toward multiple short-term relationships), he scored 28 out of 40—a high level of psychopathy.
The therapy lasted 4 years. In the first year, the therapist earned the patient’s trust and worked on his control over impulsive aggression. He also discussed his early behavioral problems and encouraged him to evaluate his emotions. Initially, the patient had difficulty with this and did not want to admit guilt for his actions. However, later, a sense of guilt was successfully evoked in him. He burst into tears, admitted responsibility, regretted that he could not restrain himself, and said that he deserved to pay for this act for the rest of his life. After a year, the therapist managed to establish a close emotional bond with the patient by employing empathic confrontation (convincing the patient of the sincerity of his intentions).
In the second year, the patient decided to make peace with his past. Additionally, he entered a relationship with a girl (who often accompanied his mother when visiting the clinic), after which he began to have conversations with the therapist about friendship and love. Although the relationship was later broken off due to the girl’s infidelity, he still wanted to build a healthy relationship.
In the last two years, the patient underwent imagery exercises in which he imagined, described, and worked through memories of his father’s cruel acts. After this, he was allowed to leave the clinic, he started a new relationship, and underwent resocialization. At the end of the 4 years of therapy, he was released, found a job, had a child, and no longer participated in criminal activities.
For another 3 years, he was monitored by the therapist and took the PCL-R test again. Now he scored only 1 out of 8 on the interpersonal component, 1 out of 8 on the affective component, and 3 out of 10 on impulsivity. Of course, the antisocial component remained unchanged, but this was primarily due to its historical nature. In total, he scored 14 out of 40, which is no longer a high indicator of psychopathy.
Of course, such an approach is very long. The creation and application of pharmacological agents to correct the dysfunction of the violence inhibition mechanism—due to which the interpersonal and affective components of psychopathy and the lack of certain emotions in a person manifest—could potentially yield a faster and more reliable result. But at the very least, it shatters the myth of the incurability of psychopathy and violent behavior, which gives us huge prospects in eradicating the problem of violence in human society. It should also be noted that congenital predispositions to weak violence inhibition tend to manifest in practice due to the negative influence of the environment, which is why proper psychological work with children is very important.
