Book Review: The Clinical and Forensic Assessment of Psychopathy: A Practitioner’s Guide

Carl B. Gacono, Ph.D. Editor
Published by Lawrence Erlbaum Associates,
Personality and Clinical Psychology Series (Irving B. Weiner, Editor)
available at

Review by David S. Prescott, LICSW
ATSA Forum, Spring 2001

Although the core elements of psychopathy have been recognized in numerous cultures across the centuries, it has only been ten years since the publication of the Hare Psychopathy Checklist – Revised (PCL-R). This standardized measure has proven to be a robust predictor of criminal recidivism, possesses strong psychometric properties, and has many potential applications. Its current two-factor structure emphasizes both affective and interpersonal elements of the disorder as well as its associated behaviors. It therefore provides more useful information than the diagnosis of Antisocial Personality Disorder.

This comprehensive and user-friendly volume will be of primary importance to practitioners who may have contact with psychopaths, including those who evaluate and treat sexual abusers. Recent research has been disturbing: Seto and Barbaree found that, among 224 adult sex offenders, higher levels of psychopathy combined with apparently good treatment progress were associated with serious recidivism. A number of studies have shown that psychopaths with measurable sexual deviance recidivated in significantly higher numbers than their non-psychopathic counterparts. There have been no studies to date showing treatment to reduce recidivism.

Dr. Gacono has assembled this volume thoughtfully. An extensive overview of the construct includes discussion of the information processing and emotional experiences of psychopaths as well as an introduction to the PCL-R and its Screening Version. Diverse clinical applications follow, ranging from legal and ethical issues to clinical interviewing and report writing. Serin and Brown provide a succinct chapter on risk assessment that will serve as a reference standard for forensic evaluators.

A key feature of this volume is an emphasis on psychopathy throughout the individual’s life span. Paul Frick presents his most comprehensive chapter to date on the emergence of psychopathic traits in childhood and describes the development of his “Psychopathy Screening Device”. Forth and Mailloux present new and fascinating information that has accrued in the development of the Hare Psychopathy Checklist – Youth Version. Among other findings noted here was a retrospective study where non-violent psychopathic offenders were as likely to be violent in the follow-up period as psychopaths previously know to have been violent.

Also of interest is a section on special applications. Michael Seto and Martin LaLumière contribute a chapter on psychopathy and sexual aggression. The interrelationships among sexual deviance, mating effort, and antisociality are explored with a review of the literature. The authors also address Risk assessment and management and describe the use of the Sex Offender Risk Appraisal Guide (SORAG) in predicting violent behavior.

Seto and LaLumière further address the controversial topic of treatment for psychopathic sex offenders. They point out that many treatment programs for sex offenders have emphasized such areas as social skills, victim empathy, and responsibility that are better suited to non-psychopaths. Referring to other areas of criminology they argue for the development of specialized cognitive-behavioral treatment that addresses areas of antisociality related to general recidivism, such as procriminal attitudes and peers as well as learning prosocial strategies within a framework of tight supervision.

Other areas of special interest include modified scales for use in hostage negotiations. Paul Babiak contributes a chapter on “psychopathic manipulation at work” that expands his earlier work on understanding how sub-criminal psychopaths operate in organizations. Other chapters include discussions of criminal lifestyles and substance abuse. Finally, the four appendices include practical information such as an alternative semi-structured interview schedule for the PCL-R, a sample forensic evaluation by Reid Meloy, and numerous references.

Dr. Gacono stresses numerous benefits of assessing psychopathy, including training front line staff in residential settings, the presentation of new areas of inquiry for evaluators, diagnostic refining, the informing of supervision decisions, and the development of specialized programs. He emphasizes the need for high standards of training and assessment. His thoughts are particularly timely given the potential misuses of the Hare scales.

Psychopathy has been an elusive and emotionally charged concept. Getting started in its assessment is labor-intensive and accomplished best with specialized workshops. The strength of this volume is its ease of access into an area of mental health where solid knowledge and rigorous assessment standards are essential. In 1996, Robert Hare described psychopathy as “a construct whose time has come”. With the addition of this book, Gacono rightly claims that “Psychopathy is a construct that is likely here to stay”.

References available on request.