Does criminal offender treatment work?

Antisocial personality disorder: new directions

Antisocial personality disorder is a complex condition carrying high rates of comorbidity and mortality for individuals as well as harmful consequences for their families and society. Despite the publication of National Institute for Health and Care Excellence (NICE) guidelines for the disorder, the evidence base and provision of effective treatments remain inadequate, and the belief that the condition is untreatable remains widespread among psychiatrists and other professionals. This article highlights current diagnostic controversies and summarises the evidence for conceptualising antisocial personality disorder as a disorder of attachment. Informed by this developmental perspective, we provide a framework for the management and treatment of adults with antisocial personality disorder, highlighting the importance of creating a safe setting and recommending adaptations of therapeutic technique to facilitate the engagement of this ‘treatment-rejecting’ patient population. We conclude with an outline of the current government policy on the treatment of high-risk offenders with personality disorder.

LEARNING OBJECTIVES

A review of effective interventions for reducing aggression and violence

This paper addresses the question of whether individual violence can be reduced in frequency or severity, if so to what extent and by which methods. It opens with a brief overview of the nature of personal violence and discussion of some key definitional and methodological problems. However, its principal focus is on the findings obtained from a series of meta-analytic reviews of structured programmes for adolescents and adults who have shown repeated aggression or been convicted of personal violence, drawing together the results of studies conducted in prison, probation, youth justice and allied services. Additional results are considered from a systematic review of studies of violence prevention among offenders with mental disorders. This incorporates the preliminary findings of a meta-analysis of controlled trials of psychosocial interventions with that population. Overall, it is concluded that there is sufficient evidence currently available to substantiate the claim that personal violence can be reduced by psychosocial interventions, but that much more research is required to delineate the parameters of effectiveness in this context. Proposals are made for future investigations with reference to the theoretical understanding of causal relationships and the design of experimental trials.

The intervention selection bias: an underrecognized confound in intervention research

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.

Object relations in criminal psychopaths

Although many empirical studies have documented the range and severity of problems caused by psychopaths, considerably less attention has focused on understanding its origins. Efforts to treat this potentially dangerous population have been equally frustrating, as psychotherapeutic approaches have almost always proven ineffectual. Because of the limited understanding of the psychological and interpersonal dynamics underlying psychopathy, the authors sought to assess the extent to which object relations theory could inform our understanding of psychopathy. In addition to eliciting background information, 74 men sentenced to probation following a criminal conviction were assessed using the Psychopathy Checklist: Screening Version, a clinician-rated measure of psychopathy, and were administered the BORI, a self-report measure of object relations. Results showed significant correlations between object relations dimensions, psychopathy scores, and childhood environment data. Furthermore, object relations scores added to the prediction of psychopathy even after demographic and behavioral variables were considered, suggesting that object relations deficits comprise a significant component of psychopathy. Results suggest that psychopaths harbor profound underlying psychosocial damage including intense anxiety, anger, bitterness, and resentment. Implications for interventions and future research are discussed.

Human aggression

Research on human aggression has progressed to a point at which a unifying framework is needed. Major domain-limited theories of aggression include cognitive neoassociation, social learning, social interaction, script, and excitation transfer theories. Using the general aggression model (GAM), this review posits cognition, affect, and arousal to mediate the effects of situational and personological variables on aggression. The review also organizes recent theories of the development and persistence of aggressive personality. Personality is conceptualized as a set of stable knowledge structures that individuals use to interpret events in their social world and to guide their behavior. In addition to organizing what is already known about human aggression, this review, using the GAM framework, also serves the heuristic function of suggesting what research is needed to fill in theoretical gaps and can be used to create and test interventions for reducing aggression.