Clients with Borderline Personality Disorder (BPD) are notoriously difficult to treat. This is so much the case that many therapists are loathe to even attempt the feat since their methods have such frustratingly poor success rates.
However, in the many years I’ve spent considering and researching BPD, I have come across two therapeutic approaches that seem to offer a glimmer of hope.
Well, now one professor is using the latter method, Schema Therapy, to treat some of the only clients considered even more complex and resistant than those with BPD – psychopaths.
The common wisdom, for some time, has been that psychopaths are virtually untreatable. The general recommendation that I’ve encountered from experts such as Robert Hare is that it is best to simply use very pragmatic appeals to self-interest to try to convince psychopaths to inhibit their destructive behaviors rather than even put forth a futile attempt to fundamentally change their condition.
But Dr. David P. Bernstein, Professor of Forensic Psychotherapy at Maastricht University in the Netherlands, is challenging this dogma.
Bernstein has an interesting background in that he has deep experience in both the use of Schema Therapy and the field of personality disorders and has devoted himself to investigating how the former can be helpfully applied with those who exhibit the latter. So you could hardly find a better person to carry out the research that he has been doing.
In 2007, Bernstein and his colleagues began a very careful, large scale, randomized clinical trial of the efficacy of Schema Therapy with psychopaths institutionalized in numerous forensic hospitals in the Netherlands. The trial randomly assigned psychopaths to a group receiving three years of Schema Therapy or a group receiving three years of the typical treatment offered in their institutional setting and compares outcomes on various measures, including during a three year follow-up period after the therapy sessions end. Bernstein says it is the largest study of any kind to date investigating whether psychopaths can actually be treated with psychotherapy.
Bernstein and his work came to my attention when I was directed to an announcement of a lecture he was giving entitled “Reparenting a Psychopath: Is it Possible, and Does it Matter?” in which he planned to make the case that at least some psychopathic patients could “benefit from reparenting, showing emotional breakthroughs that were not believed possible” when engaged in the kind of emotional bond formed with a trained therapist during Schema Therapy.
The Facebook page announcing the event had some postings linking to other relevant resources about Bernstein’s work.
These included a link to the first of a series of videos (embedded below) showing Dr. Bernstein being interviewed by Dr. George Lockwood, who is on the executive board of the International Society of Schema Therapy (ISST), shortly before Bernstein’s scheduled keynote address (with the same title and topic as his more recent lecture) at the 5th ISST World Conference in 2012. In the interview, Bernstein gives a preview of that talk, including discussion of:
- His work with forensic patients, especially those with Cluster B personality disorders, and including some previously thought to be untreatable such as psychopaths
- His experience that psychopaths, under certain conditions and contrary to conventional wisdom, can actually experience some emotional states such as vulnerability that, over time, can enable the formation of a therapeutic attachment
- How psychopaths’ crimes often stem from a situation in which their vulnerable side has been triggered and violence was used to cope with that
- Specific techniques for connecting with psychopaths’ vulnerable sides, triggering moral emotions in them
- How using Schema Therapy to treat psychopaths compares with using it to treat those with Borderline Personality Disorder
- The central role of the “mistrust/abuse schema” in psychopaths
- The early findings on various measures with the first thirty patients studied in the clinical trial
- How the cost savings of such treatment can ultimately result in the treatment paying for itself
- Why the largest benefits are seen in the most psychopathic patients
- How Schema Therapy can even help explain and address psychopaths’ lack of motivation in treatment
And here is the keynote address itself from the 5th ISST World Conference in New York:
I was also able to find this overview of a talk David Bernstein gave entitled “Schema Therapy for Psychopathic and Other Forensic Patients with Personality Disorders” which may be of interest.
It is important to note that, at least at the time of Bernstein’s keynote address, the results of the clinical trial were not yet statistically significant because the study needs to be continued with a larger sample size. But, he explains that the initial results are quite promising.
Regardless of the outcome, however, Bernstein’s work and this clinical trial are inspiring because they represent just the type of serious focus on investigating psychopathy that we, as a society and a global system, desperately need.
Bernstein says that this trial is the first time that these Dutch forensic clinics have banded together for any multi-centered clinical trial. He has received support from the Dutch Ministry of Justice through its Expertise Center for Forensic Psychiatry (EFP) and even the Dutch Parliament has become aware of his work. It has become, as he says, a national focus.
Imagine if rigorous studies of how to best manage psychopathy became a national focus in other countries around the world. Catalyzing progress toward that goal could be one of the most important benefits of the further establishment and recognition of ponerology.
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Tags: borderline personality disorder, cluster b, crime, david p. Bernstein, dbt, dialectical behavioral therapy, expertise center for forensic psychiatry, forensic psychology, george lockwood, international society of schema therapy, personality disorders, psychopathy, psychotherapy, reparenting, robert hare, schema therapy, the netherlands, violence
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