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Originally Posted by pegasus
A little about me - I've spent much of my working life with people with a variety of disorders having worked with people with severe personality disorders in 'halfway' houses and day centres. I don't want to say too much about that as that would not be good for confidentiality etc. I've also worked with learning disabilities adults and children, and people with physically disabilities with psychological problems.
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Worked with how? Therapy? Volunteer work? Sponsoring?
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My favourite therapy methods are Motivational Interviewing, Rational Emotive Behaviour therapy and CBT and holistic therapy. I have a great fondness for transactional analysis as knowing about all parts of the personality lead to a better understanding of self. Physical exercise has been shown to be very beneficial in the early stages of treatment.
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Have you applied any of these methods to antisocial or psychopathic patients? If so, which proved most effective? You described knowing all parts of the personality. But how do you achieve this when the psychopaths constantly lie and feel the overwhelming desire to manipulate and argue with the therapist? And if by chance the patient decides to try to be honest, how do you deal with his or her lack of insight?
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I'm not saying that someone with a severe personality disorder will suddenly become a different personality, I'm saying that there is a way to cope with it, once able to cope and have learnt strategies to deal with feelings/or lack of!
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And how do you teach them those skills?
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You are right in that some therapists will not work with particular people with a certain diagnosis and there is the fact that many antisocials/psychopaths won't engage in the process or drop out. Therapy can take years. In my view and from experience many are extremely intelligent and will try all sorts of ploys and threats but I look on this as testing the trust (or lack of) of the therapeutic relationship.
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Psychopaths can and do engage in therapy sessions (usually as a court ordered alternative to a prison sentence). The problem many therapists have is the psychopaths' desire to manipulate. There was one case study of a psychopathic patient, an unemployed highschool drop-out, who completely obliterated his psychologist's mental health. The poor man fell into depression after that experience. Antisocials and psychopaths see therapy as a game of wits. (Clearly, in the aforementioned case, the psychopath won that particular game.) It really has nothing to do with trust.
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You said that some antisocials become worse with therapy. Actually you'll find that an awful lot of people (pretty much anyone) get worse before they start to feel better! You can see where that drop out rate is coming from yeah?
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When I say antisocials and psychopaths get worse with therapy, I mean they learn emotional cues and the importance of remorse. They then use that knowledge to sharpen their manipulation techniques. It really has nothing to do with feeling better or worse. And their behavior never improves. The therapist might find that their mental health is gradually declining though...
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Regarding your questions about testing, I don't do testing, I'm a psychologist, not a psychiatrist. In my country that's the psychiatrists job, I just do therapy, sorry. 
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So you do practice... But you're not a doctor...