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Understanding and Treating the Sociopathic Client For Addiction Professionals, Social Workers, Counselors, Psychologists, Family Therapists by Francis J. Deisler, Ph.D ISBN 1-891429-41-8 Health $11.95 |
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Positive Path Recovery by Gary Blanchard, MA, CAC-AD ISBN 1-891429-40-X Health, 102-pages $9.95 |
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Introduction Sociopathy is a behavioral disorder and social problem that receives most of its attention from experimental psychologists and scientifically oriented investigators. As a result, volumes of studies and journals have been written offering hypotheses and suggestions for future research, but no solutions to a problem that has destroyed many individual lives, families, devastated communities, and cost the public billions of dollars annually. I have spent the majority of my professional life focusing on the treatment of offenders, particularly those diagnosed as being sociopaths. My interest in research, and attitudes toward research on sociopathy are evident, it offers absolutely nothing towards the solution of the problem. What research has provided us with is a reinforcement that sociopaths are incurable, hopeless, untreatable and must be locked away. Research appears to have focused on the obvious negative traits, defense mechanisms, psychodynamics, and behaviors of sociopaths with no solutions. So what the clinician treating the offender is left with is no direction, no hope, and a sense of hopelessness, which eventually burns them out or even drives them into seeking a new career. This book represents a clinician’s approach to the treatment of sociopathy which focuses on hope, treatment successes, change, growth and recovery. This book is intended for mental health students, practicing clinicians, as well as those who must deal with the sociopath in the course of their work. Included in this latter category are probation officers, parole agents and correctional personnel. If there is ever going to be a reduction in recidivism, it will be through the hard work, and effort of the therapist on the front line, the therapist who cares enough about the offender, and believes that change is possible. If we continue to depend upon researchers identifying problems, we will never see a reduction in re-offending, but rather the development of new social problems created by the problems that were previously identified, but never solved. As mental health professionals employed in offender programs, we will encounter almost daily one of the following types of offenders. The First Offender who is processed through the criminal justice system for evaluation or counseling, and is never seen again in the system. For one reason or another, the arrest itself was a learning experience never again to be repeated. The second type of offender we see is who I label as the Reactive Recidivist. This is the offender that suffers from a primary co-occurring disorder to antisocial personality disorder or sociopathy, such as, major affective disorder, schizophrenia, alcoholism, drug addiction, neurological disorder, or other disorder which hastens the occurrence of delinquent behavior. The reactive recidivist many times creates a problem in making an accurate diagnosis, prognosis, and treatment selection. To often the reactive recidivist is confused with the multi-recidivist, not treated, and continues the ride on the criminal justice merry-go-round. The final group of offenders are the multi-recidivists. The multi-recidivist presents with a primary diagnosis of sociopathy, and represents approximately seventy five percent of a prison population. This book is about the multi-recidivist. The preparation of this book, as well as support in writing it, was facilitated by financial support from the National Association of Forensic Counselors. I thank those who assisted in the preparation of the manuscript: particularly my wife, Karla, who did most of the typing, provided encouragement, and along with those many counselors, clinical social workers and psychologists, whose efforts in treating offenders makes possible the many successful recovering offenders, and a safer community... THANK YOU.
About the Sociopath The current American Psychiatric Association term for those described as sociopathic, or psychopathic personalities, is the antisocial personality disorder. Antisocial personality is a less useful term which describes the person solely on the basis of their disobedience to society. When this disobedience is channeled into a subcultural value structure, such as with adolescents, the Diagnostic Statistical Manual refers to them as conduct disorders. In later chapters, the author will discuss the distinct differences between conduct disorder, antisocial personality, sociopathy , and psychopathy, as well as the progression of these disorders. The term sociopathy refers to a special categorization of personality which manifests itself through “acting out behaviors”, which become so deeply ingrained in the personality it results in a dysfunctional lifestyle. Historically, sociopathy has been called many things: moral insanity, dysocial personality, psychopathy and antisocial personality disorder. The former in my opinion, does not accurately describe the sociopath. In the eighteenth century, the sociopath was described by Phillip Pinel as “La folie Racsonnarte” which is a form of madness. In fact, Pinel was so in awe of the sociopath and their self destructive behavior, he later re-classified them as “Manic Sans Delire”, insanity without delirium. Cleckley (1964) probably provides the most accurate description of the sociopathic or psychopathic personality based on his extensive experience. He describes the sociopathic or psychopathic person as being superficially charming, of good intelligence; absence of delusions and irrational thinking; the absence of “nervousness” or neurotic manifestations; unreliability; untruthfulness and insincerity; lack of remorse or shame; antisocial behavior without apparent compunction; poor judgment and does not learn from experiences; pathologic egocentricity and incapacity for love; general poverty in major affective reactions; specific loss of insight; unresponsiveness in general interpersonal relations; fantastic and uninviting behavior with drink, and sometimes without; suicide threats rarely carried out; sex life impersonal , trivial, and poorly integrated; failure to follow any life plan. The first three characteristics Cleckley describes are really very positive, and do indicate that the psychopath’s behavior is not the result of a mental illness or disease. He also indicates that the sociopath or psychopath lacks the ability to experience emotional components relating to personal, and interpersonal behaviors. In other words, the sociopath is unable to experience the feelings you and I experience. Therefore, their verbalizations such as “I’m sorry I hurt you” sound good and appear socially appropriate, are devoid of any emotional meaning, which Cleckley has termed “semantic dementia”. With such a description of the sociopath, it’s no wonder that clinicians, when presented with a sociopathic client, view them as being almost like a cyborg; intelligent, no feelings of guilt or shame, poor in interpersonal relationships, not in touch with human feelings, and an incapacity for love. |
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Understanding and Treating the Sociopathic Client For Addiction Professionals, Social Workers, Counselors, Psychologists, Family Therapists by Francis J. Deisler, Ph.D ISBN 1-891429-41-8 Health, 106-pages $11.95 |
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Gary Blanchard, MA, CAC-AD, is an addiction counselor working in Baltimore, Maryland and is director of the Center for Positive Path Recovery. |
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Introduction
From the time of the founding of Alcoholics Anonymous (AA) in the 1930’s, the Twelve Steps have been a primary tool for the treatment of substance abuse. Originally created to deal with alcohol addiction, the steps were later adapted by Narcotics Anonymous (NA) and Chemically Dependent Anonymous (CDA) for the treatment of addiction to drugs other than alcohol.
While the Twelve-Step approach has been successful for many people, there are others who do not respond to it. I knew people in both groups before I became involved in addictions counseling, and I met many more once I began working in the field. Those who did not respond to the Twelve Steps often cited particular reasons. Many people expressed discomfort with the “spiritual” nature of the steps. Others felt that they were made to feel that they were in some way inferior or “stupid.” Still others felt that the Steps discouraged the use of intellect.
Unfortunately, those who express discomfort with the Twelve-Step approach are often dismissed as being “in denial” or as not being committed to recovery. There is a need within the addiction treatment field to recognize that different people need different methods of recovery. Some attempts have been made to develop alternative approaches to the Twelve Steps; these approaches, however, usually dismiss the Twelve-Step approach. I feel there is a place for an alternative to the Steps that recognizes that the Steps do work for many and are a viable treatment tool, but not the only viable treatment tool.
Positive Path Recovery (PPR) is just that: a complementary alternative to Twelve-Step recovery. It is based on academic study and clinical experience. There are some small areas where the Positive Path differs in belief from the Twelve Steps; these differences, however, are outweighed by the similarities and should not lead to opposition. Positive Path Recovery and the Twelve-Step approach can exist side by side as allies in the treatment of substance abuse.
The development of Positive Path Recovery has been influenced by many of the major writers and theorists in the field of addiction treatment. The work of Alcoholics Anonymous (AA) is highly influential in addiction treatment and cannot be ignored. Albert Ellis, with his Rational Emotive Behavior Therapy (REBT) also makes a major contribution to this work. Terence Gorski, considered to be an expert in relapse prevention and treatment, is another person whose work helps to form a basis for the Positive Path approach. The work also includes a survey of the theories of other people that have written about addiction treatment.
Positive Path Recovery draws from all of these influences. The result is a cognitive and behavioral approach to addiction treatment that has elements of spiritually based ideas as posed by AA and Transpersonal Psychology. These ideas are presented in a cognitive framework. Positive Path Recovery is not opposed to spirituality, but is designed to respect that spirituality is an individual matter, and to recognize that spirituality can help recovery but is not a requirement for recovery from addiction.
Obviously, my own discomfort with the Twelve-Step approach prompted this search for an alternative. I make every effort, however, to recognize that the Twelve-Step approach has been, and continues to be, effective for many people. I have also made it a point to create a program that is, in large part, completely compatible with the Twelve-Step approach. The result is a program that is based on scholarship and practical experience offering choice to clients and clinicians and recognizing the need for diversity in treatment approaches.
Each chapter of this book explores various aspects of Positive Path Recovery (PPR). The first chapter presents the three basic views of addiction and describes the modified disease concept that is the basis for PPR. This chapter also explores various approaches to addiction treatment and their influence on PPR.
The second chapter explores the philosophy of PPR. The formation of the Principles is presented, along with a list of the Principles and some background for each one. The fact that these are not progressive steps is stressed, as well as the fact that the Principles are designed to provide recovery skills. Chapter three includes a definition of self, the effect of addiction on the self-image, defining the true self, the need for incorporating the true self into the self-image, and techniques for discovering and restoring the true self.
The fourth chapter examines the cognitive and behavioral effects of addiction. The basic concept of Ellis’ Rational Emotive Behavior Therapy (REBT) is presented as well as how it has been used in addiction treatment. The use of REBT within the Positive Path is be explored. Chapter five looks at the importance of communication skills in recovery. It explores how poor communication can hurt recovery and the areas in which proper communication skills can enhance the process of recovery. A variety of communication skills are presented.
Chapter six, dealing with relapse prevention, presents the idea that recovery and relapse are two sides of the same coin. It suggests that building recovery skills is the positive side of relapse prevention. Important recovery skills are examined. The seventh chapter discusses how PPR can be used in the treatment setting. This includes information on how it is being used and offers comments from clinicians and clients about their experiences and reactions to PPR. This chapter also briefly discusses the advantages and disadvantages of group and individual counseling in addiction treatment. The eighth chapter discusses the ways that PPR and the Twelve Step approach compliment each other, and also looks at the differences and discuss how to reconcile them. The final chapter explores how to start a Positive Path Recovery support group, for those who are not comfortable with Twelve-Step groups.
There are several helpful documents provided in the appendices. There is a guided visualization that can assist the process of connecting with the true self. Several worksheets from the Positive Path Recovery Workbook are presented. These are the Principle Two Worksheet: Redefining and Restoring the True Self, Principle Six Worksheet: Relationships, and the Principle Seven Worksheet: Identifying and Overcoming Recovery Barriers. I also include the group topic outline that is in use at Sinai Hospital Addiction Recovery Program in Baltimore. Finally, there is a sample press release for a Positive Path support group. |
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Positive Path Recovery by Gary Blanchard, MA, CAC-AD ISBN 1-891429-40-X Health, 102-pages $9.95 |
