What are the requirements for therapists when dealing with Sociopaths?

Mar 22, 2014, 03:54 PM

So because of some recent insights i have begun wondering what my therapist is going to do if she becomes confident that i have ASPD or am a sociopath. What I have yet to learn is how therapists deal with clients/patients when they believe they may be socio or psychopathic. I mean does anybody know what the guidelines are for when they think someone may have ASPD, and are there any ways to get a sense of what they think your diagnosis is without directly asking? I mean if my university counsler begins to feel that I may be a sociopath does she have some requirement to report me to someone, and force me to be admitted to a mental institution even though I have only mentioned that I have violent urges, and often feel irritable and aggressive? And if my therapist does have an obligation to report me, would it not be best to terminate now before such things happen and I am diagnosed to admitted???

Happy Camper · Mar 22, 2014, 04:46 PM

It depends on where you're at. I think in parts of the uk, people can be sanctioned just for having a personality disorder diagnosis that's considered dangerous. I'm not sure on that one, but it sounds a bit like nazi germany, detaining people deemed undesirable.

In the US, I believe that can only happen if you're deemed dangerous to yourself or others by a doctor.

When it comes to personality assessment, they'll probably have you take the MMPI2, which is 567 true or false questions. The test is considered a protected tool (it can be found on the internet if you look hard enough), and the results are meant to be interpreted by someone trained to administer it, and in the context of how you're being evaluated (custody cases, applying for government jobs that require a security clearance, court mandated after committing a crime, or when psychotherapy and medication have failed). Basically it's a crystal ball.

Therapy for aspd, I believe, is usually focused on controlling impulses and correcting problem behaviors through showing the patient why it's in their best interest to not be doing the things that gave them they're diagnosis.

On the MMPI2, there is a scale called psychopathic deviate, which I'll post the general description of, and the profiles associated with it:

Quote:

F. Scale 4: Psychopathic Deviate (Pd)
1) 50 items which assess a lack of concern about most social and moral
standards of conduct
a. Examples 54. My family does not like the work I have chosen (or the work I intend
to choose for my life work). (T)
79. I do not mind being made fun of. (F)
2) scale developed on individuals who were referred to a psychiatric service for a
clarification of why they had recurring troubles with the law even though they
suffered no cultural deprivation and despite their possessing normal intelligence
and freedom from other psychological disorders
a. tried to get at the Conduct Disorder/Antisocial Personality Disorder
folks
b. not too sure they made it
1. standardization with gangs?
3) Harris-Lingoes Subscales
a. familial discord
b. authority problems
c. social impurturbability
d. social alienation
e. self-alienation
4) T-Scores > 65 are indicative of persons who:
a. have difficulty incorporating values and standards of society into their
lives
b. may engage in social and antisocial acts, including lying, cheating,
stealing, sexual acting out, excessive use of alcohol and/or drugs
1. especially if T-Score > 75
c. are rebellious toward authority figures
d. have stormy relationships with their families
e. blame family members for their difficulties
f. have histories of underachievement
g. tend to experience marital problems
h. are impulsive and strive for immediate gratification of impulses
i. do not plan their behavior well
j. tend to act without considering the consequences of their actions
k. are impatient; have limited frustration tolerance
l. show poor judgment; take risks
m. tend not to learn from experience
n. are seen by others as immature and childish
o. are narcissistic, self-centered, selfish, and egocentric
p. are ostentatious and exhibitionistic
q. are insensitive to the needs and feelings of others
r. are interested in others only in terms of how they can be used
s. are likable and create good first impressions
t. have shallow and superficial relationships
u. seem unable to form warm attachments with others
v. are extroverted and outgoing
w. are talkative, active, adventurous, energetic, and spontaneous
x. are judged by others to be intelligent and self-confident
y. have a wide range of interests but lack a clear direction
z. tend to be hostile, aggressive, resentful, rebellious, antagonistic, and
refractory
aa. have sarcastic and cynical attitudes
ab. may act in aggressive ways
ac. if female, may expression aggression in more passive, indirect ways
ad. may feign guilt and remorse when in trouble
ae. are not seen as overwhelmed by emotional turmoil
af. may admit feeling sad, fearful, and worried abou the future
ag. experience absence of deep emotional response
ah. feel empty and bored
ai. if psychiatric patients, are likely to receive antisocial or passiveaggressive
personality disorder diagnoses
aj. have poor prognosis for psychotherapy or counseling
ak. may agree to treatment to avoid something more unpleasant
al. tend to terminate therapy prematurely (I see this tendency in your post)

am. in treatment, tend to intellectualize excessively and to blame others for
their difficulties
5) T-Scores 58-64 (moderate elevation) are indicative of individuals who:
a. may be genuinely concerned about social problems and issues
b. may be responding to situational conflicts
c. may have adjusted to a habitual level of interpersonal and social conflict
i. if the conflict is situational, the score should return to normal
levels once the conflict is resolved
6) Normal range: T-Scores 40-57
7) T-Scores < 40 are indicative of individuals who:
a. tend to be conventional, conforming, and accepting of authority
b. are passive, submissive, and unassertive
c. are concerned about how others will react to them
d. tend to be sincere and trusting in relationships
e. have a low level of drive
f. are concerned about status and security but tend not to be competitive
g. have a narrow range of interests
h. are not creative or spontaneous in their approach to problems
i. are persistent in problem solving
j. are moralistic and rigid in their views
k. if males, may not have much sex drive
l. are self-critical and dissatisfied with self
m. accept advice and suggestions
n. may become overly dependent on treatment
o. seem to be afraid to accept responsibility for their own behavior

Profiles :

Quote:

2-4/4-2
This high point pair is characteristic of two different types of clients. The most common is psychopathic
individuals who have been caught in some illicit or illegal behavior and are subsequently being evaluated. The
depression is a reaction to the constraints being placed on their behavior, such as being put in a prison or a hospital.
This depression abates when escape from stress is effected or when the constraints are removed. Nevertheless, the
presence of even this situational depression results in a slightly better prognosis than for individuals in similar
circumstances who do not admit this affect. The most valid interpretation for these psychopathic clients would use
primarily the correlates of Scale 4.
Other clients obtaining this high point pair are described as being extremely hostile, angry, and resentful.
Marital and/or family turmoil is prevalent, resulting in intense dissatisfaction with their present life situation. Clients
with this high point pair are immature, dependent, egocentric, and often vacillate between pitying themselves and
blaming others for their difficulties. Impulse control problems are quite prevalent, as they exhibit an apparent
inability to plan ahead if not a reckless disregard of the consequences of their behaviors. They may react to stress
with excessive alcohol consumption and/or drug abuse. They experience a failure to appreciate the interpersonal side
of life, have difficulty showing warmth, tend to resent authority figures and demands imposed on them, and may
misinterpret the meaning of social events and relationships. Psychotherapeutic intervention will prove difficult, as
numerous characterological difficulties exist, and the depressive features are chronic in nature and deeply ingrained
into the character structure.

Quote:

3-4/4-3
Individuals with a 3-4 high point pair have been found to display different behaviors than individuals with a
4-3 high point pair. The relationship between Scale 3 and Scale 4 serves as an index of whether clients will overtly
express or inhibit their socially unacceptable impulses–particularly anger, aggression, and hostility. If Scale 3 is
higher than Scale 4, then a rather passive-aggressive expression of anger is likely. When aggressive actions do occur,
individuals with this high point pair deny hostile intent and show a striking lack of insight. If Scale 4 is higher than
Scale 3, clients are likely to appear overcontrolled and bottle up their anger for long periods of time. They then
explode in a rage, periodically committing violent behaviors.
This high point pair reflects clients experiencing a chronic and stable character disorder and tending to be
extrapunitive in their reactions to stress and frustration. Individuals with this high point pair handle conflicts by
using provocation, manipulation, as well as blame, projection, and attempts at domination. Some of these individuals
are free of disabling anxiety and depression, but somatic complaints may occur. Individuals with this high point pair
typically experience marital disharmony, sexual maladjustment, and alcoholism. Interpersonal relationships usually
are tenuous, though many establish enduring, though turbulent, relationships with marginal, acting-out individuals,
thereby vicariously gratifying their own antisocial tendencies. Psychotherapeutic intervention proves difficult
because such clients are apt to use psychotherapy for voicing complaints about others instead of concentrating on
their own problems. Their motivation for help is typically weak and of questionable sincerity. Personality disorder
diagnoses are most commonly associated with this high point pair.

Quote:

4-5/5-4
This high point pair is most common among men, and it suggests a chronic character disorder in clients
appearing to experience minimal psychic distress. Any occurring depression or anxiety usually is situational in
nature. Individuals with this high point pair have nonconforming and defiant attitudes and values as well as
aggressive and antisocial tendencies. They exhibit emotional passivity and poorly recognized desires for
dependency. Dependency conflicts may be acted out and create masculine protest types of behaviors as well as a
variety of conduct disturbances. The guilt feelings and remorse about such actions may temporarily prevent further
expression. However, their strong tendency to narcissistically indulge themselves and their lack of frustration
tolerance probably will determine their behaviors. They tend to have sexual identity concerns and may, in fact, be
preoccupied regarding homoerotic impulses. There is a fear of female domination. Females obtaining this high point
pair usually are rebelling against cultural stereotypes of femininity and although they have strong needs for
dependency, they fear domination by significant others.

Quote:

4-6/6-4
Individuals with this high point pair are likely to accentuate their complaints by a tendency to be selfdramatic
and hysteroid. They can be expected to be chronically hostile and resentful and to use projection and acting
out as preferred defense mechanisms. Impulse control is likely to be deficient and ineffective, and difficulty will be
encountered in any enterprise requiring sustained effort. Individuals with this high point pair tend to be narcissistic,
dependent, and quite demanding of attention and sympathy, yet they will not reciprocate and resent demands placed
on them. They are extremely sensitive to criticism, mistrust the motives of others, tend to brood and harbor grudges,
and feel they are not receiving the appropriate treatment they deserve. A history of social maladjustment is likely.
Individuals with this high point pair are often seen by others as irritable, sullen, argumentative, and obnoxious.
Serious marital and sexual maladjustment is likely as well as excessive alcohol consumption and/or drug abuse.
While the most likely diagnosis is some type of character disorder, the possibility of a borderline or psychotic
disorder should be considered, especially if Scale 8 also is elevated. Individuals with this high point pair have
difficulty in psychotherapy because denial is prominent and their basic mistrust of the motives of others precludes
their acceptance of constructive criticism and attempts to help them. Furthermore, they will be reluctant to discuss
emotionally laden topics for fear that dire consequences will follow if they reveal themselves in any way.

Quote:

4-7/7-4
Individuals with this high point pair show numerous characterological difficulties as well as cyclical
patterns of acting out followed by periods of guilt, regret, and remorse for having done so. This guilt is usually out of
proportion to the actual acting-out behavior and frequently is accompanied by somatic complaints. While such
clients appear to be overcontrolled, these controls are not sufficient to prevent recurrences of acting-out behaviors
and gross insensitivity to the consequences. Episodes of acting out may include excessive alcohol consumption, drug
abuse, and sexual promiscuity. Individuals with this high point pair find rules, regulations, and limits imposed by
others to be quite irritating and anxiety provoking. Though quite concerned with their own feelings and problems,
they are markedly callous and indifferent to the needs and feelings of others. Psychotherapy may prove effective, as
such clients seek help when their guilt is most pronounced. However, the long-term prognosis is guarded.

Quote:

4-8/8-4
Individuals with this high point pair are experiencing considerable distress in addition to irritability,
hostility, suspiciousness, and even possibly ideas of reference. Projection and acting out in asocial ways are primary
defenses. Whenever they commit crimes, they tend to be viscous, senseless, poorly planned, and poorly executed.
The personality type is schizoid and these clients appear socially isolated and avoid close relationships because of
fear of emotional involvement. Social intelligence is likely to be limited and serious difficulties can be expected in
the areas of empathy and communication abilities. Individuals with this high point pair are moody, emotionally
inappropriate, and cannot express emotions in a modulated, adaptive way. In their behavior, these clients are
unpredictable, changeable, and nonconforming. Their educational and occupational histories are noted by
underachievement, marginal adjustment, and uneven performance. Serious sexual identity concerns are present and
excessive alcohol consumption and/or drug abuse is likely. Judgment tends to be poor and insight is extremely
limited. Suicide attempts are relatively common. Others perceive individuals with this high point pair as rather odd,
peculiar, different, and not seeming to fit into the environment. The diagnostic possibilities include a borderline
disorder, schizoid personality, or schizophrenia. The latter is most likely when Scales 4 and 8 are elevated above a T
score of 75. Psychotherapy is likely to be unproductive at worst and difficult at best.

Quote:

4-9/9-4
Individuals with this high point pair show numerous characterological difficulties and are described as
being impulsive and irresponsible in their behavior, and trustworthy, shallow, and superficial in relation to others.
They have easy morals, are narcissistic and hedonistic, but temporarily may create a favorable impression because
they are internally comfortable and free from inhibiting anxiety, worry, and guilt. However, they are actually quite
deficient in their role-taking ability. Judgment is likely to be poor and they do not seem to benefit from past
experiences. Their limited ability to intuitively sense the feelings of others persistently handicaps their development
of an effective adult role. Individuals with this high point pair have fluctuating ethical values and are prone to
continue activities so long that they exceed proprieties, neglect other obligations, and alienate others. They possess a
marked disregard for social rules and convention, and engage in behaviors with little or no forethought. Alcoholism,
legal difficulties, marital problems, and sexually acting-out behaviors are common. Individuals with this high point
pair are unwilling to accept responsibility for their own behavior and construct emotionally satisfying but irrational
explanations for their difficulties. They will rarely become involved in psychotherapy. The most likely diagnosis
appears to be some type of character disorder, with antisocial personality the most common.

Mar 22, 2014, 05:41 PM

Quote:

Originally Posted by Happy Camper

It depends on where you're at. I think in parts of the uk, people can be sanctioned just for having a personality disorder diagnosis that's considered dangerous.

Yes but being that it is left up to the individual therapist interpretation, what exactly constitutes a person being a danger to themselves or others beyond direct threats? Contrary to what my therapist may think, much of what I have shared with her insofar as my attitudes towards people is concerned has been relatively tame. I mean I've admitted that I tend to consciously and subconsciously antagonize and victimize other people, but short of saying I plan on murdering someone, can a therapist really take any action against me?

Happy Camper · Mar 22, 2014, 06:55 PM

If you've admitted you've done these things before, or have an established history of antisocial and violent behaviors, they'll take it more seriously. If you don't appear concerned about it, or the possibility of doing it again, they'll take it more seriously. I don't know specifics. I'd think they'd have to report crimes, or at the very least, the intent to commit them.

If someone with anxiety and ocd comes to a therapist and says they're afraid they may kill someone, and they appear neurotic and horribly guilty over having those thoughts, that they may be a psychopath, and then they tell a story about how they get scared in public because they think about hurting someone without meaning to, or that they killed bugs as a kid, it's a different story. Usually these people will get cbt, they'll be reassured that they're nothing at all like a psychopath, they might a get a benzo prescription, and at worse, they feel so guilty or panicked, they might voluntarily stay in inpatient because their guilt is causing them to think of suicide.

It all depends on how you present yourself, your behaviors, and the judgment of the therapist. The worst case scenario is that they'll call the police, and you'll be picked up and brought to a hospital for threat assessment. Beneath that, they may call the ER to let them know you're going to be there, as they want you to go get evaluated, but don't want to involve the police. The next level down, they may just feel that you're dangerous (which will create a tension), but they don't think you pose an immediate danger, so they won't bother.

At the hospital, they'll drug test you, look for signs of mental illness, ask you about stessors in your life (especially with work and family) and they'll try to pick your thoughts (they'll ask, but they care as much, if not more how you present--agitated, paranoid, vs calm, etc).

Mar 23, 2014, 09:42 AM

You can't be institutionalized just for having a personality disorder. You can't be institutionalized for having thoughts you don't intend on seriously carrying out. And if you did plan on carrying them out, telling a mental health professional is the dumbest thing possible, next to telling the police or FBI.

My therapist basically just lets me vent & tries to curb my impulsivity. Helps me deal more efficiently with boredom. I slip just about constantly, but it's better to be in therapy than to be in ruin... Or at least that's what I tell myself, so I don't skip out. Hahahahah

Mar 23, 2014, 05:33 PM

Quote:

Originally Posted by Shayatanica

You can't be institutionalized just for having a personality disorder. You can't be institutionalized for having thoughts you don't intend on seriously carrying out. And if you did plan on carrying them out, telling a mental health professional is the dumbest thing possible, next to telling the police or FBI.

Yeah no S*** that's stupid, but don't take what I'm saying out of context. I'm saying that if my therapist already thinks I have ASPD and I decide therapy isn't working for me, is there anything she can do to me?

Mar 23, 2014, 06:18 PM

No -- your life is your life. You're free to stop treatment whenever you'd like. They save drastic measures for people out of touch with reality or who are a CLEAR danger. Not a theoretical one.

Mar 23, 2014, 06:30 PM

Quote:

Originally Posted by Shayatanica

No -- your life is your life. You're free to stop treatment whenever you'd like. They save drastic measures for people out of touch with reality or who are a CLEAR danger. Not a theoretical one.

See that's all you had to say. Short and to the point, so as to not waste my time or yours. Now wasn't that easy?

Mar 23, 2014, 06:41 PM

I made the point in the first post... So in effect, you wasted my time by necessitating that I elaborate on a point I already made. That bit about admitting a crime was a joke. Dry humour? Sarcasm, in being pretty positive you're not that much of a retard?

Someone needs a therapy session on how not to take the words of internet people to heart. Or maybe just a hug.

Mar 23, 2014, 06:55 PM

Quote:

Originally Posted by Shayatanica

I made the point in the first post... So in effect, you wasted my time by necessitating that I elaborate on a point I already made. That bit about admitting a crime was a joke. Dry humour? Sarcasm, in being pretty positive you're not that much of a retard?

Someone needs a therapy session on how not to take the words of internet people to heart. Or maybe just a hug.

Oh that's cute so you want to sling petty insults over an Internet forum because I asked you to elaborate on a website meant for questions and answers...And that would make sense if you were just here to ask questions like myself. However judging by the sheer amount of posts you have, it would seem you have nothing better to do anyhow. It's ok though, you've served your purpose, so do feel free to not respond the next time compulsion takes over

Mar 23, 2014, 07:08 PM

And you're taking it personally again! Hahahahha wow. First I was helpful & jovial, then I explained myself clearer, then I made mention that you are not a retard [because for some reason that required further elaboration], & now I'm evidently the one hurling petty insults? If I had NOTHING better to do, I could find the time to unravel the sheer nonsense. But it seems I must have at least one or two things going on in my life... Damn!

For the record, I'm here for the same reason you are. I just don't post here because I'm just jaded - having seen the same posts on repeat for a number of years can get tiring! No offense intended, but that's just my perspective. I find it much better to talk one-on-one after I've become acquainted with someone. *shrug* So I just come here to provide useful input littered with sarcastic/cynical humour!! Didn't realize that was cause for criticism. If ASPD people can't take a joke, who ****ing can?

Mar 23, 2014, 07:36 PM

Quote:

Originally Posted by Shayatanica

And you're taking it personally again!

Trust me when I say there's nothing that you or anyone else on this board can say that is going to effect me in any meaningful way imaginable. I am here for what I am here for. I do not care about you, nor anyone else posting here to be clear. However, with that said I recognize that I have limited experience dealing with mental health professionals, hence me having to ask people here what they know or have experienced.

Quote:

Originally Posted by Shayatanica

For the record, I'm here for the same reason you are.

No you are not. I am here to gather information, and nothing else. I am not here to converse with anyone but make exceptions when and if the person I am talking to offers an insight that relates to issues I have. Beyond that I'm not inclined to participate in discussions which do not appeal to my intended purposes. Don't be offended, you simply don't mean anything to me just as I can imagine the feeling is mutual. Just as soon as I terminate my useless therapist you can be sure you won't be seeing my handle posting again...

Mar 24, 2014, 08:42 AM

Fair enough. :]

mycatsmokes · 11:18 AM

An offensive interchange full of insult and abuse between two antisocials. Now who could have predicted that would happen?

Apr 08, 2014, 04:01 PM

Surely not I! Preposterous.

Noela1 · Apr 12, 2014, 01:42 PM

Police tell me im a legal psychopath, i have no idea why or what one is, anyone?

mycatsmokes · 01:59 AM

Quote:

Originally Posted by Noela1

Police tell me im a legal psychopath, i have no idea why or what one is, anyone?

I would take anything a police officer tells you with a pinch of salt, especially if it came from a low rank "cannon fodder" officer. I have come across too many police who have very little knowledge of the law. Plenty of pig ignorance, but little knowledge.

The word "legal" means in or of the law. So, a legal psychopath would be someone who fits the criteria defined in law, of a psychopath. As an example , a person is legally blind, as defined by law, in many countries if their vision is 20/200 or less. That is the specific requirement, specifically mentioned in law or government procedural documentation, for a person to be legally blind.

There isn't a formal diagnosis of psychopathy in the Diagnostic and Statistical Manual (DSM). Whether or not there is such a thing as a "legal psychopath" depends if the term psychopath has been defined in law in the country you live in. I would think that it is more likely that this is not the case, and that it is just a case of ignorant police talking nonsense.

The next time you speak to the police in question, ask them what the legal definition of a psychopath is, and ask them to name the specific legal document in which it is defined.

marmaduke · Apr 18, 2014, 06:31 AM

Quote:

Originally Posted by Happy Camper

If you've admitted you've done these things before, or have an established history of antisocial and violent behaviors, they'll take it more seriously. If you don't appear concerned about it, or the possibility of doing it again, they'll take it more seriously. I don't know specifics. I'd think they'd have to report crimes, or at the very least, the intent to commit them.

If someone with anxiety and ocd comes to a therapist and says they're afraid they may kill someone, and they appear neurotic and horribly guilty over having those thoughts, that they may be a psychopath, and then they tell a story about how they get scared in public because they think about hurting someone without meaning to, or that they killed bugs as a kid, it's a different story. Usually these people will get cbt, they'll be reassured that they're nothing at all like a psychopath, they might a get a benzo prescription, and at worse, they feel so guilty or panicked, they might voluntarily stay in inpatient because their guilt is causing them to think of suicide.

It all depends on how you present yourself, your behaviors, and the judgment of the therapist. The worst case scenario is that they'll call the police, and you'll be picked up and brought to a hospital for threat assessment. Beneath that, they may call the ER to let them know you're going to be there, as they want you to go get evaluated, but don't want to involve the police. The next level down, they may just feel that you're dangerous (which will create a tension), but they don't think you pose an immediate danger, so they won't bother.

At the hospital, they'll drug test you, look for signs of mental illness, ask you about stessors in your life (especially with work and family) and they'll try to pick your thoughts (they'll ask, but they care as much, if not more how you present--agitated, paranoid, vs calm, etc).

It depends on where you're at. I think in parts of the uk, people can be sanctioned just for having a personality disorder diagnosis that's considered dangerous. I'm not sure on that one, but it sounds a bit like nazi germany, detaining people deemed undesirable.
Nope.
Nowhere in the UK will you be detained for having a PD. The only time you would be detained would be if you were dangerous, like threatening to stab people with a knife, that can't be ignored.
Got to say its nothing like 'Nazi Germany' where ever did you get that idea?

Happy Camper · Apr 18, 2014, 04:35 PM

If that was the case, then yeah, it would parallel nazi Germany, but I admitted I wasn't sure on that. Maybe I read that some people over there wanted to make it a policy to scoop up sex offenders and people diagnosed with antisocial personality disorder simply because it's not worth the risk letting them ever be free (which may have influenced my perception of the uk). Indeterminate psych holds do exist in 1st world countries. I didn't mean to imply aspd diagnosis=automatic sanction, but it seems like it would make it very easy, and perhaps this is abused over there due to different policies and attitudes.

That Jon Ronson fellow had met a man for his book that faked a psychiatric disorder to get out of a prison sentence. The psych doctors forced him to stay at broadmoor much longer than his sentence would have been, when they learned he had faked it. For years, they did not let him out simply because they said he was a psychopath (which is not even a formal diagnosis) and any plea that he made to them was considered psychopathic manipulation. They kept him there simply because they determined his baseline personality made him dangerous to society. I don't even believe his crime was violent.

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