Does Therapy Work on Psychopaths? Detailed Analysis

Psychopaths Narcissists Therapy

Some people wonder whether deeply toxic and troubled characters like psychopaths and sociopaths can be somehow reformed and rehabilitated through some kind of therapy.

Both criminal and non criminal psychopaths can act in deeply disturbing ways, but many of us hold onto the belief that there is some good in everyone, and anyone can change if they get the right help.

But what does the research and anecdotal evidence say on this? Is there any evidence that engaging a psychopath through therapeutic means can improve their behaviour?

There is very little evidence that therapy or indeed any attempted form of rehabilitation has any positive effect on a psychopath. In fact, the research evidence appears to show that attempts to treat and reform psychopaths actually make them worse in their destructive and criminal behavior.

It appears from the research done so far that there is simply no helping the psychopath through therapy or any other means. This will be confirmed by anyone who has experienced a psychopath in their daily lives – no amount of appeals to humanity, decency or morals makes them change their destructive behavior.

It appears from all the research that psychopaths exhibit a predictable pattern of physical and psychological destructiveness towards others which remains the same throughout their lives. These toxic traits never leave them. They simply appear to be stuck the way they are.

Let’s examine the reasons for this in more detail, as well as summarizing what studies done on this subject have shown.

The Prognosis for Psychopathy is Very Poor

In technical terms, the prognosis for psychopathy is very poor. In other words, once diagnosed, there isn’t much that can be done to change or improve the condition. There is no evidence they can be successfully treated or cured. It appears to simply be the way they are.

Psychopaths remain completely unresponsive to any form of negative reinforcement (punishment), In others words, trying to mould or change a psychopath by punishing bad behaviors does nothing to change them. They simply carry on as they are.

This is not surprising when we realize the psychopath does not have the same filters or morality and conscience that normal people. They don’t “get” that certain things are acceptable whilst others aren’t. They don’t care about morality or values.

They may have an intellectual understanding that other people deem certain things right or wrong, but they don’t have this internal moral barometer in themselves.

There is some evidence that psychopaths are marginally responsive to positive reinforcement. In others words, giving rewards for good behavior does seem to enhance this behavior in them. This is at best only a very weak way of managing their condition though and it not a cure. Their underlying malignancy remains exactly the same.

Part of what makes treating psychopathy so difficult is that we simply don’t even fully understand where it comes from yet. The root causes of the condition are still uncertain, as researchers still tackle the issue of whether the condition is down to genetic or environmental factors, or a combination of both.

Not knowing exactly where psychopathy comes from or how it forms makes it very difficult to successfully treat, even if we assume it’s possible to treat anyway. The only thing that is certain is that as of the present time, nothing appears to work in treating psychopathy, even a little bit.

Punishment does nothing to deter the psychopath from their behavior

Therapy Makes Criminal Psychopaths Worse

“Many psychopaths describe the traditional treatment programmes as finishing schools where they hone their skills. Where they find out there are lots of techniques they had not thought about before”

Dr Robert Hare

However, even worse then therapy and other forms of treatment being ineffective, it actually appears to make psychopaths worse. See the study by Rice, Harris and Cormier from 1992, where they examine the effects of therapy on recidivism (relapse) rates in violent psychopaths.

They found that rates of relapse in violent psychopaths who were given therapy were actually higher than control groups where no therapy was given. Attempts to use therapy to treat them made them more likely to reoffend when released, not less likely.

Anyone who has followed the life of non violent psychopaths in everyday life will also find this trait. Any well meaning attempts by victims to try and reason with the psychopath and make them change their behavior are completely useless and futile. Victims will confirm this time and time again.

In fact, they simply pick up the jargon or emotional terms they hear others using and absorb them, not to change their fundamental nature, but simply to manipulate others even more effectively in the future.

As they move through their victims, psychopaths often refine and improve their act and facade to more easily and convincingly take in others.

They are picking up on certain therapeutic and emotional jargon they are hearing along the way from people trying to reform or change them, and merely parroting this lingo back out when it suits to give off a more convincing air of being emotionally literate and intelligent. They use it as a manipulative tool and couldn’t care less about growth, change or reform for it’s own sake.

It is as if any attempt to change a psychopath makes them ever more determined to be the way they are. This brings in the idea of psychopathy and evil in general being an act of free will and choice rather than an accident of genetics or fate. The psychopathy is wilfully being the way they are and actively resisting any efforts to try and change them.

So What Can Be Done About Criminal Psychopaths?

Given this extremely poor prognosis for treating psychopaths by therapy or any other means, how does this change how we approach dealing with them, both in the criminal justice system and daily life?

In the case of violent offenders who are diagnosed as psychopathic, this has serious implications for whether they should even be released, particularly for more serious crimes. If they remain the same way throughout their lives and any attempts to reform or treat them make them even worse, then should they ever be released again?

If the evidence is anything to go on, many will simply reoffend and cause more harm to others. And with no prospect of reform or change possible, there is a strong argument that they should never be released, such is their unwillingness to change.

This is brought into sharper focus when we see the proportion of violent crime psychopaths are estimated to be responsible for, despite making up only around 1% or the general population and around 15-20% of the prison population.

Lifelong psychopathy expert Dr Robert Hare brilliantly makes this point in the embedded video below:

“Critics and commentators have said in the past that to study 1% of the general population seems to be a waste of time. Why not spend our time studying criminals in general? There are a lot more criminals that there are psychopaths. Even when we get into prison, we are talking about maybe only 15-20% of the population , is it worth really paying attention to them?

It sure is. And the reason is, there may only be a small number of psychopaths in the population, but the damage they inflict in society is very widespread and in fact I would estimate that the 15 or 20% (of the prison population) I’m talking about are responsible for at least half of the violent crime in our society.

So we’ve got to understand this particular disorder.”

Dr Robert Hare

If this figure is accurate, then the sheer cost to society of this very small 1% is enormous, in the form of police work, court proceedings, financial losses, physical damage and destruction in the lives of others, plus other factors.

If releasing the more serious cases when the chance of reoffending is high and only adds to this burden of cost on society, then is releasing them justified?

In the meantime, if there is ever justification for directing public money into studying a certain portion of the population, this very small but destructive subset of psychopaths is it, simply because of the damage they cause to society.

Understanding what psychopathy is and where it comes from is vital in determing whether there is any way to limit the number of psychopaths that are created in society.

Psychopaths, Therapy & Hoovering

Much of the literature and online content on psychopaths, therapy and reform focuses on clinical psychopaths, that is, those incarcerated in prison for serious crimes. For obvious reasons, these are the subset of psychopaths who can be most readily observed and studied.

However, as we have pointed out elsewhere, most psychopaths are actually not violent criminals, but instead remain at large in the general population, seeking to cause harm to others in more covert, psychological ways that we cannot so easily detect and punish by law.

The behavior of these psychopaths is covered more by the informal, Cluster B abuse survivor online community, of which this blog is a part.

And we should state clearly that the same general principle holds for non violent psychopaths in the outside world – all attempts to get them to seek therapy and change are futile and achieve nothing. They never change their toxic behavior patterns.

It should also be mentioned however that promises to go to therapy are commonly used by these psychopaths to “hoover” or draw back in partners who have finally grown tired of their toxic behavior and discarded them.

Partners will often find they have been trying to get their psychopath or narcissist partner to go to therapy for months or years, and once they realize this, the disordered person will use it as a “carrot” to dangle in front of the person to try and “hoover” them back in to give them another chance.

Skilled therapists who are trained in personality disorders will tell you how appalling the act that psychopaths put on in therapy can be. They will feign sincerity, remorse and a desire to change, but really they are just playing a game in order to string along whoever they hoovered back in, pretending to be working on themselves when they aren’t.

Here are some common phrases or images a psychopath may like to project out to their partner and/or therapist:

  • “I’m really sorry for my hurtful actions.”
  • “I’m aware now. I want to change”
  • “I’m ready to grow and be a better person”
  • “This time you can fix me”
  • “This time I’ll work on myself”
  • “Just one more chance and I’ll change. I promise”
  • “I’m vulnerable and in touch with my emotions now. I really am”
  • They’ll also readily latch onto the “sob story” approach of how they are the way they are because of difficult things happening in their childhood. Whether this is true or not is irrelevant to them; it’s just used as another way to garner sympathy and attention and feign sincerity.

The psychopath/narc using therapy to “hoover” someone back in


To anyone with a degree of emotional literacy and intelligence, the act is not usually hard to see through. It will be glib, superficial and without substance as it always is with psychopaths.

As with any other human interactions, psychopaths view therapy with a cool amused detachment, running through the motions of telling partners and therapists what they want to hear about growth, change and remorse, but on a core level nothing is changing in their personality whatsoever. Even in therapy, they are manipulating all the time.

Should You Give Them Another Chance?


“Psychopaths and narcissists just run out the clock in therapy”

Richard Grannon

So even with non violent psychopaths you are dealing with in the outside world, the general conclusion remains exactly the same as it would be with a criminal psychopath in prison. Attempts to make them change through therapy or any other means will not work.

See our Resources page for some good books and videos on both criminal and non criminal psychopaths, which can help you better understand this disorder. Robert Hare’s “Without Conscience” is an especially good read.

See also the study by Rice, Harris and Cormier indicating that attempts to treat violent psychopaths with therapy appears to make them worse.

See also here for an excellent documentary on attempts to treat violent psychopaths in prison, featuring Dr Hare and other psychopathy experts.


I like to draw on my personal experience and research to write and raise awareness about pathological personalities in the modern world

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