 |
|||
 |
|||
|
 |
||
|
|||
 |
|||
|
|||
|
|||
 |
|||
|
|||
|
|||
 |
|||
|
Association for the Treatment of Sexual Abusers 4900 S.W. Griffith Drive Suite 274 Beaverton, OR 97005 Voice: 503.643.1023 Fax: 503.643.5084 E-mail: atsa@atsa.com Web: www.atsa.com |
|||
 |
 |
|
Volume XVI, No. 4 • Winter 2004
|
|
|
|
|
by Mark G. Koetting, Ph.D. Sharper Future San Francisco, California In 1991, Multi-Health Systems published the Hare Psychopathy Checklist-Revised (PCL-R), a 20-item clinical rating scale designed to assess psychopathy, which Hare (1998) defined as a "socially devastating" personality disorder characterized by egocentricity, impulsivity, irresponsibility, shallow emotions, lack of empathy and remorse, chronic deception, and persistent violation of social norms. The PCL-R has been described as "state of the art" (Fulero, 1995), and "unparalleled" in its ability to predict violence (Salekin, Rogers, & Sewell, 1996), including sexual aggression. High scores may also be associated with negative treatment outcome (Rice, Harris, & Cormier, 1992) despite ostensibly positive treatment performance among sex offenders (Seto & Barbaree, 1999). Given the status of psychopathy as "one of the most crucial factors to consider" in the assessment and treatment of sex offenders (Seto & Lalumiere, 2000), the recent release of the 2nd Edition of the PCL-R is a significant event for many ATSA members. In this review of the PCL-R, I will provide a summary of the changes from the 1991 PCL-R to its 2nd Edition, with mention of the nascent measure's strengths and weaknesses, and highlights of the data accumulated over the last 12 years pertaining to the PCL-R and its use with sex offenders. To start with, the 2nd Edition uses the exact same items and verbatim scoring criteria as the 1991 PCL-R, which affords continuity with the extensive literature from the past decade. There are several strengths of the PCL-R: Prodigious data- The chapter addressing validity in the new manual is four times longer than the 1991 version, with a separate section dealing with the PCL-R and sexual recidivism (see below). The data presented in the manual are based on a total of nearly 11,000 individuals and 33 North American samples. Expanded norms- Descriptive and validation data are now available for specific groups, such as female and African-American offenders, British and Swedish samples, substance abusers, and rapists and child molesters. Clinical and Research Utility- The two factors of the PCL-R (F1=Interpersonal/Affective, F2=Social Deviance) are now subdivided into four "facets": F1 entails the facets labeled "Interpersonal" and "Affective" and F2 includes the facets labeled "Lifestyle" and "Antisocial." In conjunction with their corresponding T-scores (which have replaced the percentile ranks and are listed on the PCL-R score sheet), these six clusters (two factors, four facets) will permit finer clinical discriminations both between subjects and within a particular subject. The four facets should also ignite research into potential subtypes of psychopathy that may ultimately bear on treatment and recidivism. Controversial Issues- In the manual, Hare directly responds to various criticisms and arguments advanced by psychopathy researchers on several provocative topics (e.g., "white collar" psychopaths, adolescent psychopathy and early labeling, and psychopathy as a variant of normal personality). Hare also critiques Cooke and Michie's (2001) three-factor model of psychopathy - in which core personality traits are afforded more weight than antisocial behaviors - as consistent with "an academic view that is at odds with clinical tradition." However, this complex conceptual debate is unlikely to be resolved anytime soon. Clarity- Perhaps in spite of its "technical" label, the manual is lucidly written, with an abundance of helpful tables. Clinical Interview- Questions in the Interview Guide are modified somewhat from the previous form, and more space is provided to record responses. As with the 1991 version, there remain several shortcomings of the PCL-R, including its average length of time to administer and score (three hours or more), its requirement of detailed file information, the small percentage of Hispanic-American individuals in the normative samples (2.6%), and its susceptibility to faking good (see p.32 of the manual). In some cases, these weaknesses may warrant use of the Psychopathic Personality Inventory (Lilienfeld & Andrews, 1996), a promising self-report measure of psychopathy that continues to garner research support. Of particular relevance to the reader, some useful and perhaps surprising data on sexual abusers is documented in the new PCL-R manual. Note that only about 20% of the PCL-R's normative sample of 1384 sex offenders were scored using the standard procedure. The remainder were scored based solely on file review, which reduces the total scores by about seven points (Hare, 2003). Therefore, Hare recommends using the norms for all male offenders when interpreting scores for sex offenders. About 33% of the 162 rapists and 66% of the individuals who committed both rape and child molest (mixed group) scored equal to or greater than 30, Hare's (1991) recommended cut score for a diagnosis of psychopathy. The standard procedure yielded mean scores of 25.5 for rapists, 20.9 for child molesters, and 29.0 for the mixed group. Based on 11 studies of the PCL-R's use with adult sex offenders published between 1995 and 2003, several general conclusions can be drawn. The PCL-R is less strongly related to sexual recidivism (correlations typically range from .20 to .30) than it is to violent recidivism (correlations often equal .30 or higher) for sex offenders. Using a cut score of 25 on the PCL-R, the percentage of psychopathic sex offenders who commit a new violent offense is about twice that of non-psychopathic sex offenders. The mean PCL-R score of sex offenders who reoffend sexually is generally over 21, whereas the mean for non-recidivists is typically under 18. Finally, several recent studies have confirmed that sex offenders rated high on the PCL-R (using cut scores of 25, 26, and 30) who also show evidence of deviant sexual interests have sexual recidivism rates of 60% to 70%, about twice the rate of non-psychopathic, non-deviant comparison groups. Like its predecessor, the 2nd Edition of the PCL-R is a utilitarian instrument with an impressive base of empirical support. For clinicians who are both trained in the use of the PCL-R (for information: www.hare.org) and who assess and treat sexual aggression on a regular basis, the PCL-R is an indispensable tool. Psychological test available to qualified users from Multi-Health Systems www.mhs.com |
| back / next |
|
||
|
||
|
||
|
Top of Page |
Front Page |
Contact Us ©2003 ATSA. All rights reserved. |
||
|
||