working therapeutically with thank you women with psychopathy dr - PDF document

12.10.2010 working therapeutically with thank you women with psychopathy dr ghitta weizmann ‐ henelius what women can tell you about men dr jane martin & dr mette kreis OR what (more) women can tell you about men caroline.logan@gmw.nhs.uk overview 1. women and psychopathy, violence and risk women and psychopathy, 2. working therapeutically with violence and risk psychopathic women 3. recommendations and conclusions gender stereotypes general conclusions 1. gender stereotypes dictate our expectations about the behaviour of men and women 2. men and women are more alike than they are different – but they are not the same, the greater greater differences are important identification identification 3. measures of psychopathy, which reflect the with peers with intimates behaviour of men and ignore the social context of violence and aggression, have limited utility with women (and men) Paris (2007) Rosenfield (2000)

12.10.2010 gender stereotypes gender stereotypes aggression and violence aggression and violence contd/… male offenders have similar histories as female offenders abuse and victimisation, mental disorder, social disadvantage, etc. held responsibility male violence is viewed as consistent with the accountable, ‘neutralised’ male stereotype without accountability question denied but female violence is inconsistent with the female stereotype Adshead (2011) gender stereotypes aggression and violence contd/… therefore, violence in women is neutralised, violence in men is not i.e., the use of narrative devices that allow the offender to maintain a social identity as a good person (Sykes & Matza, 1957) is women’s violence neutralised because it is intolerable? or does neutralisation enable those working with women to feel sympathy not antipathy? (Adshead, 2011) only up to a point though – re. ‘double deviance’ or violent women as ‘doubly damned’ (Chesney ‐ Lind, 1984; Heidensohn, 1991; Lloyd, 1995) “who is Amanda Knox?” gender stereotypes aggression and violence contd/… conclusions 1. gender stereotypes dictate our expectations about the behaviour of men and women 2. men and women are more alike than they are different – but they are not the same, the differences are important 3. measures of psychopathy, which reflect the behaviour of men and ignore the social but how can context of violence and aggression, have this be so? limited utility with women (and men)

12.10.2010 surely this means men same but different same but different and women are very different – so require measuring differences between men and women different standards of measurement and most empirical studies to date have not captured treatment? gender differences small numbers of women in research on violence women are treated in research as just different kinds of (abnormal) men (Showalter, 1987) the enquiring point of view is usually male – women are measured against a male template of violence (Adshead, 2011) violence measured in terms of convictions – undetected violence will be excluded feminist studies emphasise victimisation (Adshead, 2011) same but different same but different individual factors relevant to violence measuring differences between men and women antisocial, pro ‐ history of violence criminal attitudes women’s violence explained (away) in terms of personality major mental pathology disorder mental disorder and trauma using the language of disease to explain social rule ‐ problems with stress harm to substance misuse breaking (Foucault, 2008) and coping others yet violence is a relational event, involving multiple factors, requiring complex explanations addressing the meaning of poor professional victimisation/trauma and personal support the event to main parties involved poor self ‐ awareness non ‐ compliance so men and women same but different same but different look different on the surface , but there are contextual factors relevant to violence contextual factors relevant to violence several plausible explanations, which could point to greater similarity “it appears self ‐ evident that the power one peers vs intimates, ‘the mask of maternalism’ Kreis & Cooke, 2011 holds in the domain in which one holds it will influence the method used to abuse that power to the detriment of others” relational vs physical aggression (hidden) emotional harm vs (visible) physical violence Logan, C. & Weizmann-Henelius, G. (in press). Psychopathy in women: Presentation, Assessment and Management. Chapter to appear in H. Häkkänen-Nyholm & J.O. Nyholm (Eds), Psychopathy and Law . Chichester: John Wiley & Sons, Ltd.

12.10.2010 same but different so what? conclusions 1. gender stereotypes dictate our expectations why is it essential what we give proper about the behaviour of men and women consideration to the issue of women’s 2. men and women are more alike than they are harm? different – but they are not the same nor there are harmful women out there totally different and we have a duty to protect their victims, 3. measures of psychopathy, which reflect the and to guide these women towards a less harmful behaviour of men and ignore the social way of living context of violence and aggression, have limited utility with women (and men) psychopathy psychopathy relevance to women? empirical research Psychopathy Checklist ‐ Revised (PCL ‐ R) we have a problem with women who are Hare (2003) harmful but who are not mentally ill for whom there is no easy way to 20 items, total score = 40 neutralise their harm 28+ diagnostic ‐ in men who has this problem? no diagnostic cut ‐ offs for women 2, 3 and 4 factor models practitioners & the courts psychopathy psychopathy empirical research using the PCL ‐ R empirical research using the PCL ‐ R prevalence: women (9 ‐ 23%) < men (15 ‐ 30%) deficient affective experience severity: women < men psychopathy measured reliably in women using the PCL ‐ R (and PCL:SV) construct comparable in women and men: antisocial lifestyle 3 factor PCL ‐ R solution best fit – antisocial poor Logan, C. & Weizmann-Henelius, G. (in press). Psychopathy in women: Presentation, Assessment and Management. Chapter to appear in H. Häkkänen-Nyholm & J.O. Nyholm (Eds), Psychopathy and Law . Chichester: John Wiley & Sons, Ltd.

12.10.2010 psychopathy psychopathy empirical research using the PCL ‐ R empirical research using the PCL ‐ R deficient affective does this mean women have more experience healthy, resilient personalities than men …? ✗ or or it just down to the poor measurement of personality and the social context in which antisocial lifestyle women are harmful? symptoms more relevant symptoms more relevant psychopathy more empirical research to psychopathy in men to psychopathy in women empirical research relevant other studies www.gcu.ac.uk/capp what is psychopathy then if it’s not well captured by the PCL-R? two things … Kreis, 2009; Kreis & Cooke, 2011 Kreis, 2009 contd/… Kreis, 2009 low PCL:SV ratings high PCL:SV ratings

12.10.2010 psychopathy psychopathy empirical research, the second thing … risk risk of what? structured tools mainly professional help HERE judgement capture the phenomenology of treatment psychopathy in women risk through formulation relevant factors FORMULATION risk management protective monitoring supervision (victim safety planning) psychopathy psychopathy formulation formulation organise decision theory mutual understanding why has this client decided to be violent before? why might she (or he) do so again? connections (a) entertained notion of violence and not dismissed (b) positive consequences were identified intervention (c) negative consequences acceptable (d) options for being violent were/are feasible communication psychopathy formulation conclusions 1. gender stereotypes dictate our expectations decision theory about the behaviour of men and women 2. men and women are more alike than they are why has this client decided to be violent different – but they are not the same, the before? why might she (or he) do so again? differences are important scenario planning 3. measures of psychopathy, which reflect the behaviour of men and ignore the social under what circumstances might she (or he) context of violence and aggression, have decide to be violent again? limited utility with women (and men)

12.10.2010 working therapeutically with psychopathic women working with psychopathic women top tips conclusions (2) 1. mainstream interventions for women emphasise vulnerability and neediness, trauma and loss – these interventions are not suitable for women with psychopathic traits 2. supplement assessments of psychopathy using the PCL ‐ R with additional evaluations 3. make interventions formulation ‐ driven 4. use a systemic as well as individual approachs re. Logan, C. & Weizmann-Henelius, G. (in press). Psychopathy in women: Presentation, Assessment and Management. Chapter to appear in H. Häkkänen-Nyholm & J.O. Nyholm (Eds), Psychopathy and Law . Chichester: John Wiley & Sons, Ltd. managing harmful women managing harmful women top tips ‐ one to one meetings top tips ‐ one to one meetings interpersonal measure of psychopathy (IMP) Kosson et al, 1997; Kosson et al, 2000 capturing “ thin slices of behaviour ” Fowler, Lilienfeld & Patrick, 2009