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.
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
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
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,
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.
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 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,
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
Psychopathy has been an elusive and emotionally charged
concept. Getting started in its assessment is labor-intensive and accomplished
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
construct whose time has come”. With the addition of this book, Gacono
rightly claims that “Psychopathy is a construct that is likely here
References available on request.