Therapeutic responses of psychopathic sexual offenders: Treatment attrition, therapeutic change, and long-term recidivism.

The authors examined the therapeutic responses of psychopathic sex offenders (>or=25 Psychopathy Checklist--Revised; PCL-R) in terms of treatment dropout and therapeutic change, as well as sexual and violent recidivism over a 10-year follow-up among 156 federally incarcerated sex offenders treated in a high-intensity inpatient sex offender program. Psychopathy and sex offender risk/treatment change were assessed using the PCL-R and the Violence Risk Scale--Sexual Offender version (VRS-SO), respectively. Although psychopathic participants were more likely than their nonpsychopathic counterparts (<25 PCL-R) to drop out, almost 75% of the former completed treatment. Psychopathic offenders who failed to complete sex offender treatment were more likely to violently but not sexually recidivate than completers. Positive treatment changes were associated with reductions in sexual and violent recidivism after psychopathy and sexual recidivism risk were controlled. Overall, the results suggest that given appropriate treatment interventions, sex offenders with significant psychopathic traits can be retained in an institutional treatment program and those showing therapeutic improvement can reduce their risk for both sexual and violent recidivism.