Psychotherapy for a Client with Antisocial Personality Disorder (ASPD)
Personality disorders are a distinct diagnostic group of disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DM-5). Antisocial personality disorder (ASPD) is one of them and is characterized by disregard for the feelings, rights, or needs of others. It is sometimes referred to as sociopathic personality disorder (Sadock et al., 2015; APA, 2013). The person suffering from this mental health condition is therefore usually a sociopath. According to the American Psychological Association (APA, 2013) in the DSM-5, the defining feature of disregard for and violation of the rights of others in ASPD often starts in childhood or early adolescence and continues to show well into adulthood. Psychotherapy for a Client with Antisocial Personality Disorder Essay The purpose of this paper is to identify ASPD as one of the personality disorders described in the DSM-5; and to recognize an appropriate psychotherapeutic modality effective in managing it. In this case, the psychotherapeutic approach identified as the most efficacious and evidence-based in managing ASPD is cognitive behavioral therapy or CBT.
DSM-5 Diagnostic Criteria for Antisocial Personality Disorder (ASPD)
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For the diagnosis of ASPD to be made, there must be an insidious pattern of disregarding and blatantly violating the rights of others. This must be apparent from the age of 15 years, as shown by three or more of the following symptoms (Sadock et al., 2015; APA, 2013):
- Inability to abide by social norms set by society or exhibiting lawful behaviors. This is shown by the person repeatedly displaying acts that can have them arrested (arson, theft, aggression, assault, and so on).
- Inability to plan ahead and impulsive behavior.
- Deceitful behavior such as recurrent lies, conning other people of their properties, and using aliases. All this for the sole purpose of personal gain.
- An attitude that is reckless with blatant disregard for the safety of oneself others too.
- Recurrence of assaults and physical fights indicative of aggressiveness and irritability.
- Indifference to the hurt or mistreatment caused to others indicating lack of remorse.
- Irresponsibility that is repeated, as manifested by the person’s inability to honor financial obligations or to keep a job.
Aside from the above criteria, the person also has to be at least 18 years of age with evidence of a disorder in conduct with onset before the age of 15 years. Lastly, the manifested antisocial behavior cannot be attributed exclusively to bipolar disorder or schizophrenia. Psychotherapy for a Client with Antisocial Personality Disorder Essay
An Appropriate Psychotherapeutic Approach to Managing ASPD
The most evidence-based psychotherapeutic modality for treating ASPD is cognitive behavioral therapy or CBT (Wheeler, 2020; Corey, 2017; Black, 2017). The available evidence supporting CBT in ASPD management is not copious. However, it is sufficient to warrant its use for the condition (Black, 2017). CBT involves changing the thought process of the patient through talk therapy. It is hoped that by changing their thoughts, they will eventually change their behavior. The process is of cognitive remodelling and restructuring and can be done individually or as a group (Wheeler, 2020; Corey, 2017). CBT is elected in this case because it is the only treatment modality with some peer-reviewed scholarly literature supporting efficacy available. There is also enough circumstantial evidence and anecdotal reports supporting its efficacy in ASPD. Primarily targeting thoughts as a driver of behavior, CBT is appropriate for the required behavior change in sociopaths.
Therapeutic Relationship in Psychiatry
Therapeutic relationship in psychiatry refers to the mutual ties that unite the therapist and the patient, making the patient benefit by getting healed psychologically. The therapist guides the patient to find solutions to their behavioral inappropriateness (Wheeler, 2020). To avoid damaging the therapeutic relationship, the patient will be informed of their diagnosis in a non-declarative manner and statement. The difference is that in a family I would not share explicitly that the patent is a sociopath. In a group, I will be a bit more explicit with the consolation that group therapeutic factors like altruism and universality will cushion the impact.
Conclusion
Antisocial personality disorder is a condition that does not have many options for treatment. However, one of the psychotherapeutic modalities with evidence for efficacy is CBT. With a good therapeutic relationship, CBT can be effective in reducing the antisocial behaviors and restructuring the thought process. References used in this paper are considered scholarly because four are respected book on psychology and psychiatry while the fifth is a peer-reviewed article published in a respected journal.
References
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Author.
Black, D.W. (2017). The treatment of antisocial personality disorder. Current Treatment Options in Psychiatry, 4(4), 295–302. https://doi.org/10.1007/s40501-017-0123-z
Corey, G. (2017). Theory and practice of counselling and psychotherapy, 10th ed. Cengage Learning.
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.
Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice, 3rd ed. Springer Publishing Company, LLC. Psychotherapy for a Client with Antisocial Personality Disorder Essay