[00:00:00] Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.
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[00:01:00] All right, everybody. Welcome back. Thanks for being here.
Hey, today is an interesting episode. Interesting for me in particular, because I am interviewing two guys who wrote a book in an area that I have no knowledge in, and it was fascinating. So today, I have Dr. Jason Smith and Dr. Ted Cunliffe talking all about their book, which is called Understanding Female Offenders. As you can tell from the title, this is a book that really delves into so many aspects of female offenders and female psychopathy. The book is linked in the show notes if you would like to check it out.
Let me tell you a little bit about them and about what we talked about today.
During the episode, we touch on a number[00:02:00] of things related to female psychopathy. We talk about psychopathy in general, what it is and where it came from as a construct. We talk about the differences between male and female-presenting psychopathy. We talk about differences in assessment with women suspected to have some psychopathy. We also just generally talk about the assessment process and their favorite measures and ways that they approach the clinical interview with women.
There’s a lot to take away from this episode as always, but for me, this was particularly rich simply because I don’t know much about this area. And we truly only scratched the surface. So, if you want more information, certainly check out their book which is linked in the show notes.
Dr. Ted Cunliffe is a Clinical and Forensic Psychologist.[00:03:00] He, over the past six years, has been in full-time private practice and provides expert witness services in various [00:03:00] jurisdictions and courts within Florida and beyond. He’s provided assessment services and worked with forensic populations in a wide variety of settings including juvenile detention centers, adult prisons, juvenile probation, and outreach programs in the community for over 30 years. Specifically, he has served as a staff psychologist and mental health director at a wide number of correctional facilities in Florida, California, and Canada.
Jason Smith is a licensed Clinical Psychologist and currently the Chief Psychologist for a female correctional facility where he’s continued treating, assessing, and managing incarcerated women. With the coauthors of the book, he has published on female offenders, psychopathy, as well as theoretical Rorschach articles.
He has received[00:04:00] board certification from the ABPP in Clinical psych0l0gy, and he’s presented research and workshops on assessing and treating female offenders both nationally and internationally. He was also awarded the APA Division 18 Criminal Justice Section Outstanding Dissertation Award (2014) and the SPA John E. Exner Scholar Award.
So, these guys are super knowledgeable on a fascinating topic. Without further ado, I’ll transition to my conversation with Dr. Jason Smith and Dr. Ted Cunliffe.
Jason, Ted, welcome to the podcast.
Dr. Jason: Thank you for having us.
Dr. Ted: Thank you very much. We appreciate that, Jeremy.
[00:05:00] Dr. Sharp: I am really excited to be talking with you guys because this is one of those interviews where I truly do not know anything about this area. And so all of the questions that I might ask are born out of my own curiosity and what I think other folks might be interested in. And I know there are a lot of folks out there who do work in this area and are going to get a lot out of it as well. So, I’m just grateful that you are willing to come on and have this chat with me.
Dr. Ted: Thank you.
Dr. Sharp: Well, I always start with this question of why this work is important to you. Out of all the things that you could’ve done in the field or might do in the future, why this? Jason will start.
Dr. Jason: Yeah, I’ll start. So in grad school, Ted was my main professor. He presented a lot on[00:06:00] female offenders, female psychopathy that really didn’t have much research behind it. So through grad school and then after I graduated, I looked specifically for female offender prisons to work at.
And I find the work to be fascinating and really important because, especially our research in our book, the male offender is much different in presentation than the female offender. So, that was part of why I was doing the research. Why we wrote the book was that it was completely different presentation-wise. And we felt like it was a good avenue that needed to be studied and needed to be presented and written about. So, that was why for me, at least, and I’ll let Ted say it as well.
Dr. Ted: Well, I can actually think of several [00:07:00] reasons. I think one from a public safety point of view. That’s how I ended up getting involved in psychology really because I was a juvenile correctional officer for a number of years. And so the public safety aspect, but also the treatment aspect and the assessment aspect. And as science, just practitioners being psychologists, that’s extremely important that our treatment and assessment should be guided by research. And I think that’s important. And as Jason mentioned, there’s very little known about this population and that’s how I got into it.
I was working with Carl Gacono. Our other author is not here. This is a three-generational situation. And he was writing a lot about male psychopaths[00:08:00] and I was working at a female prison, and I was looking around going, man, these women don’t look like what you’re talking about psychopathy being like. And so I think it’s important for that reason. I think women have been left out of forensic treatment and assessment for a long time and presented an enigma for a lot of people. I think it’s important for that reason to try to shed some light on guide treatment and assessment.
Dr. Jason: And to help clinicians too because if they have their conceptualization wrong, they’re going to miss some things. And just to only help the clinicians and then, as Ted said, to give them appropriate assessment and treatment as well.
Dr. Sharp: Sure. I think I was half-joking when I was talking with y’all before, and I think I said something like, “Are female psychopaths even a thing?” And I know it’s kind of a myth for sure, but[00:09:00] it really is an interesting idea. When you think of the “stereotypical psychopath” it’s certainly not a woman at least in my mind. And I will guess other clinicians probably feel the same. So, shedding light on this area feels crucial.
Dr. Ted: Right. When you think about your prototypical psychopath, you probably wouldn’t think about a woman.
Dr. Sharp: Sure. Now, this may be too personal of a question for either of you and feel free to just shut me down if that’s the case, but I think about how a lot of us get into the field and work in areas that are personally relevant for one reason or another. Was there anything like that for either of y’all that drives you specifically to work with female offenders or was it truly just wanting to expand knowledge in the field and curiosity and that sort of thing?
Dr. Jason: Yeah,[00:10:00] for me, there wasn’t anything necessarily personal. It was interesting. It was a place that needed some research and things like that. And I felt that as my niche kind of thing. So nothing specifically personal that get me into that work.
Dr. Ted: Yeah. I wouldn’t say personal in terms of female offenders and psychopaths, but definitely personal in terms of psychopaths because I had an older brother that was a psychopath. I think I read my first Hervey Cleckley book, The Mask of Sanity. I think I probably read that when I was about 18 years, just a real thirst to try to understand because he really created a lot of damage to our sanity. I think everyone was really struggling with that.
Then in terms of the females, that’s how[00:11:00] I got into psychopathy, but females are very intriguing. It’s a fascinating population. And I think when we think about male psychopaths as we’ll hopefully get into, we’re looking at narcissism and antisocial personality disorder, but women don’t really have. I mean, some women are narcissistic but in very low numbers. And that’s not really the driving force behind female psychopathy. It’s more borderline and has history on it.
Dr. Sharp: I see. Yeah, there’s so much to get into here. I’m just holding back all the questions, but I appreciate you diving into that a little bit. Like I said, definitely I’m not the only psychologist to pursue some of these areas out of our own experience.
So I wanted to ask just right off the bat as we start to[00:12:00] get into some of the content for the book. And then we talked about this in our pre podcast chat, but I’m guessing people are probably curious like how do three men write a book called Understanding Female Offenders? What’s that process like? How do you understand?
Dr. Jason: Well, I think it goes back that we just all have clinical experience in working in this population. So nothing necessarily has to do with our gender. It’s just that we were there, we were able to study them, we were able to assess them appropriately, and we had the data, we had the clinical experience, so that’s why it all came out in the book and it just happened to be that we were three males doing it and not three females.
Dr. Sharp: That’s fair.[00:13:00] As y’all discussed your experience, I can’t even count the number of years combined that you all have working in these settings. And I think that’s just important to highlight that.
Dr. Ted: For me, it wasn’t actually the reason I went into psychology. It just happened that I happened to be at a female prison. Taking a look around, and then I got interested that way. Life’s like that sometimes.
Dr. Sharp: It really is. Yeah, that intersection of opportunity and interest or curiosity that falls on your lap sometimes.
Dr. Jason: And I’ll have to back that up too. It was the right place at right time. I went to a graduate school that Ted was teaching in. He did all the female offender research. He introduced me to Carl and just for the past, probably about 10 or 11 years, we’ve been pretty much focusing on female offenders. So yeah, right place, right time.[00:14:00] life works crazy like that sometimes.
Dr. Sharp: It sure does, right. And here you are, you’ve written a book. How did I end up here?
Well, let’s dig into it a little bit. I am so excited to talk through this topic. I thought we might start just with an overview of psychopathy in general. Can you all talk through that? What do we even mean? What is this concept of being a psychopath or psychopathy as we provide this discussion here?
Dr. Jason: Ted, did you want to grab that one?
Dr. Ted: Okay, sure. Well, I think an important point to point out is that this is an extremely old concept. Antisocial behavior, rule-breaking behavior, and things of that nature[00:15:00] have been an issue since human societies first were formed. And when you look at the history of psychology, the history of mental health treatment, a lot of it comes out of the Greek philosophers. And probably, I would consider Theophrastus, who was a student of Aristotle, the first personality psychologist. And he developed a number of typology and psychopathy was one of the things that he was talking about. So psychopathy is an extremely old concept.
There have been some forks in the road along the way. One of the things that people often get confused about and we wrote in the book was the difference[00:16:00] between psychopathy, sociopathy, and anti-social. People get confused often. I remember Jason and I years ago working on a paper and we never actually did publish, but what’s in the name was one of the titles we were throwing around. And Jason was coming up with some amazing stuff just from the general culture, television shows, where they would be referring to a person as a psychopath one minute and then two episodes later a sociopath. And it just goes around and around.
I don’t want to speak for Carl and Jason, but for myself, anytime I hear that S-word, I’m like, no, because that’s where all the data is [00:17:00] in psychopathy not in sociopathy.
Sociopathy is a term that was coined by Birnbaum in 1909 and was really influenced by the age of enlightenment. It’s not a hard-wired personality dimension here that’s causing this behavior. It’s the situation the person is in. So if you grow up in the Corleone family, then your chances of being a psychopath are a lot better. And from that, I sort of refer to it as the social deviance model and it was actually in the DSM, the first edition in 1952. Meanwhile, all the psychopathy research is continuing on looking at different aspects.
And then[00:18:00] they had a lot of problems measuring it. So then that morphed into an antisocial personality disorder, which is really focused on the behavioral aspects and not so much the personality aspects. And there’ve been a lot of arguments over the years about this issue. Reid Meloy and other people involved here, and all kinds of people have chimed in about this. And I liked what Reid said because he said that they had sacrificed validity on the altar of reliability. But basically what you’re talking about with psychopathy is it’s a multi-dimensional construct that you’re looking at behavioral aspects, you can have effective aspects, interpersonal aspects.
And we’ve seen this over the years. Things really exploded after the mid-70s,[00:19:01] the early 80s with Robert Hare developing the psychopathy checklist, which we talk a lot about in your book. But that really, in terms of psychopathy, opened things up in terms of getting a clear idea of what psychopathy is and allowing us to measure it.
And a lot of the data since then has really clarified these kinds of issues that when you look at psychopaths versus non-psychopaths, their brains function differently. Interpersonally, they’re much different, and trying to get a handle on that. So, I think from a personality aspect the male psychopath is basically antisocial personality disorder and narcissistic personality disorder, and in some cases, paranoid personality to start or tendency to figure into it quite highly.
But when you’re looking at [00:20:00] females, that doesn’t really cover it. They don’t do that kind of thing. They’re not boastful and arrogant like the male psychopaths are. However, they’re no less lacking in empathy.
All of these different things that we think about with psychopaths still exist. And looking back to what Jason just referred to a little while ago, that if your lens is a male presentation and you’re dealing with women and you’re assessing women, you’re going to miss a lot of stuff.
And I think this is true of anything really. I mean that when you look at the psychology of women, there’s giant literature in terms of neuropsychological findings, functional MRI findings, personality[00:21:00] measures. When we look at the PAI, the MMPI alone, gender’s a big part of that assessment in terms of how you’re going to look at those scores. So, I think it’s important for that reason.
Dr. Sharp: Absolutely. I have two questions just right off the bat. One is off-script and you may not know this and that’s totally fine. When you talk about psychopathy being around since humans were humans, it makes me wonder, I feel like there’s so much out there about the evolutionary benefits of collaboration, but what, if any, evolutionary benefits are there to psychopathic behavior?
Dr. Jason: I know Milan talked a lot about with his evolutionary model off the top of my head. I can’t think of it. Ted may have some. But one thing that [00:22:00] was interesting to find is that anti-social males were evolutionarily attractive to histrionic females, like this hypersexuality feminine kind of characteristics.
So Milan was talking about that, which I think defines possibly why the two split? So the anti-social with the males and then we’re talking about the histrionic female. Again, the character chores, like the extremeness of the two that they have some attraction to each other. So that was one thing that we found in researching the book. Milan talked a lot about the evolutionary stuff, and I can see that as the reproductive mating and their characteristics and things like that.
Dr. Ted: I think what I would add to that is that[00:23:00] clinically speaking and from an assessment point of view, you know, we’re doing an assessment, we’re trying to relate the assessment findings to the person that we see in front of them, whether it’s for the court or whatever.
I mean, it’s a matter of looking at test scores and trying to give people a sense of what to expect and what difficulties somebody might have. And so dimensionality is the core concept here that it isn’t a matter of if the person is a psychopath or not, the issue is how psychopathic are they?
So when you look at the prototype, the extremely psychopathic person, they’ve got a lot of problems. They have a lot of difficulties. I mean, we focus on the damage that they do in society, but [00:24:00] I wouldn’t want to be like that. I thought about it before, like, working in corrections and you look at these guys or women and it’s just like, “Man, I wouldn’t want to be like them.” They have a lot of problems functioning, adapting.
It’s an interesting point that you raised in terms of, are there any good things? Well, he talked about this idea of positive psychology. Positive psychopathy, he referred to it as. And yeah, there are some aspects of being a psychopath that are actually good.
Dr. Sharp: That’s fair. Are there any that you can think of off the top of your head? We don’t have to spend a ton of time on this.
Dr. Ted: Having a lot of energy and being industrious. I have a good friend of mine who is a salesman [00:25:00] of pharmaceuticals. He goes off to the training sessions for a week in The Bahamas, that kind of stuff. And I always joke with him. It’s like, they’re training you guys how to be a psychopath, right? Because that’s an aspect of it. Like selling yourself.
People, when they’re victimized by a psychopath, one of the things is that they feel so embarrassed about it. It’s just like, “Oh my God, like, how could I fall for this guy?” Like, how come you didn’t see all these red lights? What’s going on?
And so there’s that manipulativeness in it. Thinking of the pathological range and manipulativeness but sometimes manipulativeness a little bit will be good. The same thing with narcissist women, all of these other things.[00:26:00] It’s not like you don’t want any of it. I think getting back to what Jason was talking about, and then I’ll shut up is this idea of when things become maladaptive. In the DSM, there’s a lot of discussion around these personality disorders. For instance, being maladaptive. And that’s the core issue.
The point that you’re bringing up is more people that maybe aren’t primary psychopaths, they’re not people that are prototypical psychopaths, people that definitely maybe have some traits but they’re not going to be people that are committing the kinds of offenses that psychopaths tend to commit.
Dr. Sharp: Did you have other thoughts, Jason? I saw you.
Dr. Jason: The only other one that I had was one of the items on the PCL-R and obviously what it measures is promiscuous sexual behavior. So they have[00:27:00] a higher chance that their genes are going to get passed off into the next generation. So, that’s probably why it continues.
Dr. Sharp: Oh, well, yeah, that’s important to highlight. That is true. Thanks for rolling with a curveball question. It got me thinking.
So we talked a little bit about the different presentations between men and women with psychopathy. It seems like personality traits are a big part of that. Are there other differences that y’all would like to highlight between men and women in terms of how psychopathy presents?
Dr. Jason: Yeah, so obviously the personality, as Ted was talking about. So the males were more narcissistic, the females more borderline and histrionic personality. But if we go and look at different domains, so a couple of domains effectively, interpersonally, and then how their self-concept is.[00:28:00]
So interpersonally, females and males differ in that. We talk about it like the pseudo dependency in females. They are more interested in others. Males tend to be more like lacking attachment. However, the issue with the females in terms of their interpersonal actions is that though they want to interact with others, there’s some gain. So some attention-seeking interactions. Needing other people to kind of mirror how they’re feeling increases their self-esteem. So they need people to help boost themselves up. So that is a big aspect in the…
All the Rorshach male data that Carl collected that we examined in the book is they have very few texture responses. So some lack of attachment. [00:29:00] But for the females, their Rorschach, not only do we even have 1, they would have 2 and then they would also have a higher score on the Rorschach oral dependency scale- another measure of dependency. So interpersonal, that’s a big difference between the two.
The other one, self-concept. So as Ted was talking about, males are very boastful, narcissistic, grandiose. The females, though they have this self-focus like they want to talk about themselves as Carl and Ted have talked about, the female psychopath will look in the mirror, but not like what she sees. The male psychopath will look in the mirror and then enjoy what he sees. So we found a lot of that in our data in terms of Rorschach and then PAI as well. So the self-concept, females tend to view themselves more as damaged and broken. [00:30:00] The males not necessarily.
And then the last other domain that we have was effective. On the Rorschach, females, I think would probably go back to like their high borderline traits, higher liability in terms of their emotion, more pure see on the Rorschach, differences in terms of how they handle the emotions. So more liability was a big difference between the males and the females in terms of how they handle their emotions.
So yeah, not only the personality traits but within the domains of things, we can even see some of the differences between those two.
Dr. Sharp: I see. Are there any differences in how these characteristics are externalized in terms of actions, the crimes[00:31:00] committed? These are very naive, but how does all this get externalized between men and women? Are there differences there?
Dr. Jason: So, go ahead, Ted.
Dr. Ted: Okay. I guess what I was going to say just to add to what Jason was talking about is that pseudo dependency is extremely important. And we see this in the offenses they commit. The involvement of other people.
Female psychopaths don’t commit stranger offenses like a male psychopath, a rogue alone. You think about some prototypical psychopaths, Ted Bundy stalking women. There are no other people involved. Whereas when you look at women, there’s always that there are people involved. Sometimes it’ll be maybe a stronger[00:32:00] female or a male. And they tend to offend against people within their social […]. And dovetailing on what Jason was talking about, this idea that there’s a lot of self-criticism in these women and that they use other people as a means to shore up that sagging self-esteem.
They use the idea of the mirror where the other person becomes the mirror. And you really see this when you interview them, especially women. If there’s another woman in the room, if it’s a female psychologist evaluating the person, they’re extremely concerned about how they’re being seen. [00:33:00] It’s a lot of heightened worry and anxiety about how they’re being perceived and whether they’re being accepted, especially by other women.
But that’s not to be confused with empathy or any kind of deep emotional feelings that they have a great deal of shallow at that just like the men do and a lack of genuineness, just like the men do. But it presents in a different way because they’re women based on cultural factors, evolutionary factors, all kinds of things.
Dr. Sharp: Since you bring that up, it makes me think about the idea that women are not a monolith, right?[00:34:00] I don’t know how much we can dig into any data you might have in terms of like when we’re talking about female offenders, are there major differences that y’all found between racial or ethnic groups or SES, or even, I don’t know if you got into trans women versus ciswomen, all of that?
Dr. Ted: I would add some things to your list.
Dr. Sharp: Please do. Yes.
Dr. Ted: Security level. If you talk about ciswomen, that’s a big variable. CS is another big variable. IQ is another one. The offense category is another big issue. We’ll see that over and over the data and the male data too. But when you look at people that commit property offenses or financial offenses is much different [00:35:00] than people that are committing murders.
Dr. Sharp: I see what you mean. Are there any demographic variables off the top of your head that you know lead to some of the bigger or contributes to some of the bigger differences among women?
Dr. Jason: Demographically, not necessarily. Definitely in the book, we talked about specific female sex offenders. And then when we talked about female psychopaths, we didn’t necessarily group them out by category or race or anything like that. So there probably were two females that identified as males or transgender, but it wasn’t enough to separate everything. So yeah, nothing in particular for that. But the sample was rather large. We had about 337[00:36:00] females in the data set. So, there wasn’t anything. The only thing that we did really make sure it was IQ, like low IQ. Anything less, especially 80 for the Rorschach isn’t appropriate. So we threw that out as a big thing for our data, at least in terms of that.
Dr. Sharp: I see. Thanks for diving into that. I just have so many questions here.
I know we talked a little bit about myths about female offenders. I’m curious what y’all might say about that? What are some of those myths that you run into?
Dr. Jason: Well, the first one especially because working on the female sex offender chapter was that females don’t commit sex offenses. That’s a huge myth. But[00:37:00] I think within the media now, with teachers and students and things like that, some of that stuff is getting brought a little bit more mainstream. But also the data in terms of female sex offenders is not great either. So that’s why we were really interested to kind of delve into that topic. So one of the myths that we definitely came across is that females don’t commit sex offenses, which is totally a myth.
Dr. Sharp: Are there any differences in the quality of sex offenses between men and women, if that question makes sense/if you get what I’m asking, like the characteristics of sex offenses in terms of assault versus coercion? I don’t know. I’m not even sure.
Dr. Jason: Yeah, it goes back to what Ted was talking about. Most of the sex offenders that we had were[00:38:00] with other males or another female. So it was that dependency aspect of things. And it’s more relational as Ted was talking about family victims. Very few strangers in terms of that. So yeah, in our data, it was more violent offenses against not necessarily violent, I should say sexual offenses against minors was mainly our category. And they were mainly people that they had some relationship with, which is completely different than some of the other sex offenders because, for the males, you can have stranger victims and things like that. That’s definitely a big difference that we found.
Dr. Sharp: Right. Any other myths about female offenders that we should chat about?
Dr. Jason: Ted wrote those. So I’ll [00:39:00] let him take the floor.
Dr. Ted: There are quite a few I think. It’s an interesting discussion because when you think about bias and we wrote a chapter on that, one of the things that when we think about society is that there is a lot of gender bias in society in general, without a doubt. One of our observations has just been that when we look at the justice system and the prison system, the bias tends to almost work in the opposite direction from what it does in society.[00:40:00]
So one of the myths that we looked at in the literature was this idea that women are more harshly punished than men are, which there’s very little data to support that assertion and it certainly hasn’t been my own personal experience doing cases. I mean, I’ve got a case right now, a very young girl that was looking at attempted murder of her parents. And there’s a great deal of concern that she gets treatment. And I completely agree with that, but I think if she had been a male, I’m not so sure that would happen.[00:41:00] And there’s an interesting thing that goes on with that is that the entry to the juvenile justice system or the justice system, women and girls are treated much lighter by the justice system.
A lot of the data that we looked at, however, once they’re in the system, they tend to be looked upon with more scorn, especially by other women. One of the things you’ll hear all the time is that clinicians not wanting to work at female correctional facilities.
Dr. Sharp: Why is that?
Dr. Ted: Well, for the women, I remember back when I was collecting my piece of the data and I had a female co-researcher[00:42:00] many months in England and we were doing research together. So we used to do the PCL-R interviews together. And the reason we were doing that was just for inter-rater reliability, that kind of thing.
And it was much different when she would do the interview, versus when I would do the interview. How they would react to her, how they would react to me. There was very much sisterhood presentation and a lot of cajoling and almost trying to talking into thinking that there are good people. Like they would say stuff like this all the time. Like, oh, I’m not a bad person. Whereas with me it was more sexualized in terms of this is how some of these women interact with men. That already should get what they need. [00:43:00] So that’s one myth.
I think another one has to do with the media. This idea that women are left out and left behind, nobody cares about them and that the media were so hard on them. Well, we found a lot of data to suggest that actually the opposite of that. And if you go online, you’ll find all books written about how women are just victimized by the culture and female offenders being victimized by justice systems and the media and things of that nature. But when you actually look at the research, like the media research we were looking at in this case, [00:44:00] and what you find is that there was a lot more almost like gentle wanting to provide some kind of explanation for why they were in the trouble they were in, that kind of thing. And that’s not something that I think the general public would necessarily think.
And when we think about the media, they tend to think that they’re hard done by the media, but we found very little support for that. Most media presentation was actually saying that they’re more likely to be looking for excuses for letting them off the hook. The most harshly treated in the justice system, [00:45:00] the group that seems to have the highest probability of being incarcerated and being incarcerated for an extremely long time, are African-American men, overwhelmingly. African-American women, not so much.
And so that’s a pretty significant myth. I think we also talked about this idea that female psychopaths don’t exist. There are people saying that literally. Oh, well, this is just completely ridiculous. Female psychopaths don’t exist. That they’ve got some other problem. That they’re traumatized and they’re being interpreted [00:46:00] differently. But most of our dataset were not traumatized. So how do you explain that?
Dr. Sharp: That is fascinating. Especially now, I think we’re in a time where there’s a helpful recognizance of trauma and its role in mental health concerns. And that’s actually surprising to me that y’all, didn’t see as much trauma.
Dr. Ted: Trauma is something that I always assess for. I think that the men are traumatized, not as much as females or women, but a lot of the guys that I’ve seen over the years, a lot of them had trauma histories. That’s not something that’s really discussed when it comes to men. [00:47:00] It’s discussed a great deal when it comes to women. When you look at programs, and Jason can speak to these programs in the correctional environment, trauma programs they almost always start out with the women.
Dr. Sharp: Sure. Do you have thoughts or data, of course, on the ideology of female psychopathy? I mean, what are some of those environmental factors that may contribute,/ or risk factors, things like that?
Let’s take a quick break to hear from our featured partner.
The SPECTRA Indices of Psychopathology provide a hierarchical-dimensional look at adult psychopathology. Decades of research into psychiatric disorders have shown that most diagnoses can be integrated into a few broad dimensions. The SPECTRA measures 12 clinically important constructs of depression, anxiety, social anxiety, post-traumatic stress, alcohol problems, [00:48:00] severe aggression, antisocial behavior, drug problems, psychosis, paranoid ideation, maniac activation, and grandiose ideation, and organizes them into the three higher-order psychopathological spectra of Internalizing, Externalizing and Reality-Impairing.
These scores provide a quick assessment of the overall burden of an individual psychiatric illness, also known as the P factor. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect-The PAR’s online assessment platform. Learn more at parinc.com\spectra.
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All right, let’s get back to the podcast.
Dr. Ted: Do you want to take that Jason?
Dr. Jason: So obviously, anything early on, genetics I think obviously plays a big role in that, kind of going back to what I was talking about with the Milan stuff. Environmental factors, yeah. They could possibly grow up where there’s trauma or abuse or things like that. It is totally possible that it shapes the personality of the female psychopath. We’re not saying that all these female psychopaths don’t have trauma. But actually, when we looked at the data and the ones that did it, all the female offenders at times had [00:50:00] different trauma indices.
So then not all of them were psychopaths or not all of them engaged in these different kinds of things. So I think genetics plays a role. I think environmental factors, this kind of coming together. We find with the data, especially early behavioral stuff, that’s more like the males. The females have it, but it’s just not there. Their violence might be different. It might be relational or ostracizing or gossiping and things like that. All of those things probably play a role in whatever it may be. And then it just continues and continues and then comes out as they advance in age.
But yeah, there weren’t any particular things like, Oh, these three things lead to psychopathy. I think it’s just a mixture of everything. [00:51:00] Definitely, the ones that are higher in psychopathy seem to have a long range. You can see different markers of violence or things like that, or even early on. So yeah, nothing in particular that I would say. I don’t know if Ted wants to add anything to that, but I think it’s a combination of genetics and the environment as well.
Dr. Sharp: Like everything, right?
Dr. Jason: Yeah. Unfortunately.
Dr. Ted: It’s a very heritable condition. And I think that you really can’t ignore that sometimes there are very few environmental factors at play. Sometimes it’s just pure genetics and sometimes say can come from [00:52:00] very loving parents. I’ve seen it myself where the parents are pulling their hair out because they just don’t know what to do. Their daughter is trying to submerge their 3-year-old son in the bathtub.
Dr. Sharp: Sure.
Dr. Ted: 10-year-old daughter. Oh my, what do we do? What have we done wrong? In some of these severe cases, maybe they haven’t done anything wrong. Sometimes it’s pure genetics. Other times there are definitely environmental things that happen as Jason mentioned, trauma.
I think one of the things you always have to be careful about in these discussions is not getting into an all-or-nothing thinking process.[00:53:00] Like, Oh, it’s this. That’s the reason or this, and that’s the reason. Well, substance abuse, the neighborhood you grew up in, who your parents are, early experiences, genetics, all play a role. And getting back to your earlier point in terms of the individual, well, it’s different for different people.
Dr. Sharp: Yes. As someone who works with kids primarily, I have a pediatric focus. I think a lot of the audience does as well. Are there any signs that y’all know of that you can speak to that might emerge in childhood that really we should be paying attention to that might influence later psychopathy?
Dr. Jason: Nothing that I can think of. Well obviously,[00:54:00] you always have early behavioral problems like stealing or lying or things like that. I know they always try to say animal abuse, things like that. You don’t really see much of that for the females in terms of like this callousness and lack of empathy. I kind of see it as the adults. But bullying, ostracizing maybe might be one. Relational aggression in the females, probably, maybe an indicator but obviously any overt aggression or things like that would be a possible sign. I haven’t done much, I know Ted’s done more with the juvenile, so he might be able to speak a little bit more with that.
Dr. Ted: I think one of the key aspects is the lack of empathy when you look at these things. That’s[00:55:00] one of the core dimensions of psychopathy, no matter what, whether you’re talking male psychopaths, female psychopaths, juveniles. And that when you’re in the presence of someone that really has no empathy for other people, it can be a very unnerving experience.
Dr. Sharp: Absolutely.
Dr. Ted: Yeah. And when you think about our child-rearing practices and talking about a pediatric process, parenting is all based on empathy. Share and don’t do that because that makes so-and-so feel terrible. How would you like it if somebody did that to you? Basic empathy kinds of stuff. And so that would probably be [00:56:00] the earliest marker that people will be able to identify. And it’s usually the one that people comment the most about.
Dr. Sharp: I see.
Dr. Ted: I’ve done evaluations court and interviewed the family, they’ll say stuff like that. Like, Oh yeah. I remember, I was 4years and my sister was 7years and she tried to put my hand down a […] and just this real lack of empathy, a lack of understanding of another person’s emotional experience. So I would say that that would probably be key.
What Jason was talking about is that women are much more relational than men[00:57:00] that other people have written extensively about these terms. And so when you think about that in terms of psychopathy, the things that Jason was mentioning just now, like vicious cyberbullying would be a marker.
We’re all guys sitting here. We don’t have a sense of that. Like what girls can be like to other girls and how important that is. Being a part of the group is much more a part for girls than it is for boys. Boys are much more comfortable doing stuff on their own. And guys[00:58:00] that are being jerks, just like that we got going over here. Women getting back to this relational aspect. So those would be things I think that would be key markers. The lack of empathy in these relational deficits that Jason was talking about, kind of vindictiveness.
Dr. Sharp: I see. Thanks for talking through that. There’s so much, but I want to make sure and talk about some of the assessment practices that you all discussed. This is The Testing Psychologist podcast. So yeah. I’m curious about the assessment process. I wonder if we might just say or talk generally about the instruments, the measures that you might use to assess psychopathy, [00:59:00] and then how the process is different or what you might do to tweak the assessment process specifically for women?
Dr. Jason: I think we’re all on board, Ted, Carl, and myself is that in order to assess psychopathy, the PCL-R in our minds is the only valid measure of it. Though there are self-reports on psychopathy when we’re talking about a disorder that has talked about manipulation and lying. We feel that PCL-R is the best way to assess psychopathy and we are all on board.
It’s an interview. So you have a record review, and we always advocate that you do the record review first prior to the interview because one of the things [01:00:00] and Ted probably will talk about is that when you’re interviewing them, you want to see how they react or if their story matches up. And if you do the interview and don’t look at the record review till after, you’re going to lose a lot of clinical data. You’re going to miss a lot of different things. So we advocate record review of as many files as you can get, secondary sources, sometimes even Google searches to be honest, newspaper articles, clipping to see if the judges or victims have said anything about them.
As for the females, one of the big things is impression management. So they’re not going to necessarily always go into the depth of different things. So if you just take their word for it, you’re going to miss a lot of stuff. So psychopathy in terms of not necessarily a diet, but assessing psychopathy that’s the measure that we use.
[01:01:00] I’ll let Ted speak a little bit too about some of his stuff, and then we can go a little bit more in-depth into how we differentiate a female PCL-R interview then a male interview. But anything else, Ted, that you…
Dr. Ted: I was just going to add Jason, what you were talking about in terms of the record review that this is something we can’t emphasize enough. That you’re dealing with a disorder in which the key aspect is lying and manipulation, which is precisely why Robert Hare did the structured interview format and not self-report.
What’s the difference if you want to assess a construct like lying? Well, if you say to the person, [01:02:00] do you lie? Well, somebody who’s honest is going to say yes, but somebody full of lies is not. Behavioral control is one of the items on the PCL-R. And I think this is what Jason was alluding to that the way that I always do this, and I don’t know if it would necessarily be a recommended practice in all situations depending on how violent, dangerous, and large the person is I think.
One of the things that I always do with that is having the record review there to confront them on their lies and then pretend like I’m upset and confront them. And I always do this at the end of the interview. So I would confront them and pretend like I’m very upset and[01:03:00] raise my voice. How can you come in here and lie to me like this when I can’t believe this and this kind of thing. Somebody that’s low in that would be apologetic, like, Oh, sorry, jeez and try to diffuse the situation. Somebody that’s high is going to be flipping you the burden saying, you are. Giving it back to you? There’s your behavioral sample.
So this is important. I think there’s something wrong all of us know as being clinical psychologists that any kind of behavioral assessment is always good. If that would be the thing that I would add to it, I think that a lot of times people don’t do that. They ask the person, Oh, do you ever have problems [01:04:00] with getting upset and that kind of thing? And then they say no, and then they go, okay, well that’s a zero, which isn’t necessarily the best practice.
Dr. Sharp: I have a question. Just going back a little bit. When you’re talking about record review, well, one, this is very important. So you mentioned a few examples of Googling and newspaper articles and so forth, but just to spell it out a bit, what records do you consider most important in these assessments? Like what are you really trying to get your hands on before you do these interviews?
Dr. Jason: Well, I’ll speak to it. Again, most of my assessments are done with people that are incarcerated. So prior to their sentencing and going to prison, they have something called a pre-sentencing record. So it is very important to review any clinical notes from maybe medical [01:05:00] or other psychologists, maybe at other prisons that have been transferred. We also have access to their emails or phone calls. That’s really good clinical data I really enjoy.
So when they go to prison, every lunch, they have something called a mainline. So they come and you get to observe them as they’re eating. So you get to see who they’re hanging out with, how they’re functioning, so you can determine to see, Oh wow, this person’s coming into me and saying, they’re severely depressed, they can’t get out of bed, yet they’re laughing and joking. And they’re walking the room and in the dining hall. It’s a really good behavioral observation.
So really anything that I can get a handle on, but definitely like if I don’t have a pre-sentence investigation that one sets up the stage and then everything else. It’s great if you can get a newspaper article from them[01:06:00] from their trial, or maybe look at some videos, but any other records. And then I just always ask other staff members that have interacted with them. So that will just give me more. Are they consistent? Are they trying to split things like that? So any really collateral information. We don’t really get much family, but sometimes with phone calls or things like that if you can get some of those things. And so that’s mine because I’m working in the prison.
Ted’s will probably be a little different since his role is different, but maybe he’s had some other records that he looks at.
Dr. Ted: Well, I think school records, I would add to that. I think teachers, previous teachers. I used to do this when I was in the correctional system too. If I could get a hold of a teacher that will remember them, that was always very [01:07:00] valuable. Interviews with family are always very helpful. I’m doing forensic assessments. So that’s something that we routinely do is do collateral interviews with families. But the type of record is almost a difficult question to answer. Almost anything and everything.
Dr. Sharp: Everything. Yeah, sure.
Dr. Jason: Anything you can get your hands on to be honest is good. And again, some of those reports and stuff like that, it depends how well the person wrote it or how many records they had and things like that. So yeah, anything that we can get our hands on.
Dr. Ted: There’s been so much concern about body cams with the police. That is golden stuff.[01:08:00]
Dr. Sharp: Oh, I’m sure.
Dr. Ted: You see how they are at the time of the events, how they’re behaving, what their interactions like with the police, things like that are very valuable. I had a case, well, I don’t know, 25 years ago now, where one of the family members suggested, “Hey, why don’t you call this guy here?” He was a guy that worked with my sister. And so I said, “Okay.” So I called and this guy had all kinds of videos of her. I got office parties. It was unusually good, but almost anything and everything that’ll give you some insight.
Dr. Sharp: Fair enough. [01:09:00] What about the role? It sounds like there’s a lot of emphasis on record review, and then the PCL-R which just for anyone who may not know, what is the PCL-R?
Dr. Jason: The Psychopathy Checklist-Revised. So it’s a 20 item semi-structured interview created by Hare. Most recent ones in 2003.
Dr. Sharp: Okay. What’s the role of any other measure in this process? You mentioned the Rorschach a few times. What about that? What about others?
Dr. Jason: Yeah, so that one helps us identify independence. So that was an identified group. So non-psychopaths or psychopaths. So the PCL-R goes from 0 to 40, so 30 or higher, we include in the psychopathic group, 24 or less. So then we use the other measures, the Rorschach. We use that one and the PAI to [01:10:00] look at differences, look at how they’re dealing with it interpersonally.
The other domains that I talked about are self-perception effective modules. So we’ve used more of the PAI and the Rorschach because we feel like the Rorschach is the performance measure to see how they handle the ambiguous situation, which is always fun for the females. And then the PAI we also use in our assessment to see if there are any differences between the two. I’ve used the trauma symptom inventory too just to get a look at some of the trauma symptoms. And I know Ted’s pretty big on the policy deception scale too, to get a little measure of how they’re perceiving things as well.
So in our book, and then some of the data we have the[01:11:00] policy deception scale. But the main three is PCL-R to identify where they fall on the psychopathy continuum, and then PAI and the Rorschach to help look at differences really between the two is kind of our dependent measures.
Dr. Sharp: Right. And then what might be a dumb question, but I ask those sometimes. What do you do with these results? What happens with the assessment results? I know a lot of this was for research, of course, but I’m curious on the real-world side of things, what happens with the results of these assessments especially if someone’s already in prison or headed that direction. It’s like, “Oh, we already knew this stuff.” So what do you do with it?
Dr. Jason: So a lot of the assessments that I do is to see if they qualify for a treatment program, like a trauma treatment program [01:12:00] or something like that. Any assessment that I do clinically, I bring the inmate in, we go over what some of their findings are, see if they can relate to it like a treatment plan.
So especially clinically, we’ll sit them down, and then they tend to be pretty astonished how well the assessment actually understands them. They think that I have some magic eight ball, especially when I give them the Rorschach and I give them the results and they’re like, “Wow, you got that from that test?” And I’m just like, “Yeah.” And they’re like, “Oh, I thought you were just pulling my leg or something like that.”
Normally, I’d call them over and give them their results in a group. So, they’ll go back and there’ll be like, “I can’t believe it.” And then they’ll all be like, “What is going on? I can’t believe all of them. How do you know so much about me? Yeah, the test. Oh my God.” So that actually, to be honest, [01:13:00] actually helps them a lot. It helps them understand themselves and then helps me pair the treatment that we’re doing with them so that they’re not like I’m just doing this test for no reason.
No, there’s a reason behind it. And it’s always focusing on the treatment. And it will help me also identify, especially if certain people in certain groups may have some difficulties. Maybe I need to rework the groups or things like that. So it’s also informative for me so that I can get a good mesh of people where it’s not an issue, things like that.
Dr. Sharp: Great. As we start to wrap up here, I know we’ve covered a wide range of ideas and topics. I’m just curious, anything that y’all would like to touch on that we haven’t talked about or maybe want to talk more about here before we wrap up or any just takeaways [01:14:00] for folks who are working with female offenders or are thinking about getting into that?
Dr. Jason: It is definitely a difficult population, but it can be pretty rewarding again because that many people have probably come before you. So if you’re interested in it, I would definitely recommend it.
Just a couple of takeaways. We talked about the PCL-R, there are definitely some items that look different for the males versus the females. So I would just be mindful. We mentioned it in a little bit, but parasitic lifestyle looks a little different maybe for the females. Assessing the grandiose, self-focus probably will look a little different and just going into broad topics. But to also understand female psychopathy, you need to know some of these things [01:15:00] because you’re going to miss them when you assess certain items. So there are different questions that me, Ted and Carl have come up with that we use to assess female offenders with the PCL-R.
And then the other takeaway is males and females, especially in psychopathy are different. And our book that we’re plugging here, but there’s a reason. We’re not just putting out. These are not just theories. This is data-driven, all our stuff. We have over 300 in our sample. So it’s a pretty big sample where we’re making some of the suggestions and claims that we’re talking about. It’s data-driven. And we’re all scientists practitioners. So we all are clinicians, but we also do research as well.
Dr. Sharp: Of course. Ted, any parting words here?
Dr. Ted: I agree with what Jason’s talking about there. I think [01:16:00] the reason that the population is a challenge for some clinicians is because of the lack of familiarity. And the approach is different. We didn’t actually dive deep into a lot of these assessment practices, but the way you would interview a woman is much different from how you would interview a man talking about these kinds of things.
And so there are certain things that you need to be aware of that you can’t take the facts approach to be like, Oh no, I don’t want to hear about that. Just answer my bloody question, that kind of thing. I mean, you can’t be doing that. [01:17:00] There’s almost like a… In order to get the information, you have to be very supportive.
Dr. Sharp: That’s interesting. Yeah. Can you say, I know we just have two minutes, but I’m curious, what practices would you say are really top of mind that are different?
Dr. Ted: Perhaps it’s more of a reflective listening approach.
Dr. Jason: Supportive.
Dr. Ted: That’s right. I think that when you’re talking with them, one of the aspects about psychopathy, and this would be a good takeaway, is that one of the core features we’ve discussed is lying, manipulative behavior, things of that nature. And so some of these women, these psychopathic women[01:18:00] will be using a lot of cultural beliefs to their advantage. It is true that domestic violence exists and things of that nature, that women are definitely victimized by men at much higher base rates than the reverse. That very unusual for men to be beaten unconscious by a woman.
However, because they tell you that that’s the case, that doesn’t mean it’s so. And that’s always something to be very cognizant of. And getting back to what we’ve been talking about all along, like the pseudo dependency,[01:19:00] the sense of self-criticism, seeing themselves as damaged, you’re not getting the arrogant elite narcissist here. You’re getting the borderline who feels inadequate and empty. This doesn’t mean that they also don’t have a lack of empathy and things of that nature. So when you’re talking to them, that supportive style is extremely important because you’re going to get nowhere otherwise. Jason can definitely attest.
Dr. Jason: Yeah, nonjudgmental, supportive, mirroring their emotions.
Dr. Ted: The men, you might have the guy come in and you’re like, “Hey, Frank, come here. Okay. Sit down.” Guy sits down and you ask the questions and go, okay. Well, if you do that with women,[01:20:00] you’re not going to get it, right?
Dr. Sharp: I see.
Dr. Ted: You have to be like, Hey, how are you doing? Is everything okay? That kind of thing.
Dr. Sharp: Right. More relational. That sounds like that.
Dr. Ted: So that would be the important takeaway. And I think also Jason talked about this too, is just how important it is to fully assess your people in whatever you’re doing and designing your treatment appropriately based on science.
And from a forensic standpoint, you’re looking at different things. It’s a different role entirely. We’re helping the court understand what’s going on with this person and helping them make their decision about what they’re going to do. [01:21:00] So all of this information is very important for them to know about. And sometimes it’s a matter of helping attorneys work with our clients. And these interviewing techniques and how to connect with them so that they can work with them, it’s much different for women than it is for men.
Dr. Sharp: Yeah, that much is clear. I’ve really taken away quite a bit from this conversation even not doing much work in this realm. It’s really got my wheels spinning around these differences that we need to be aware of. I appreciate everything that you all shared and the work that you put into the book, which of course will be linked in the show notes. And I always ask if folks have questions or might want to get in contact with you, what is the best way to do that?
[01:22:00] Dr. Jason: Email is probably the best way.
Dr. Sharp: I can include those in the show notes.
Dr. Jason: Yeah, that’s fine.
Dr. Sharp: Great. Well, thanks a lot, guys. This was fun. It was entertaining. Like I said, it’s got me thinking. And again, I just appreciate your time.
Dr. Jason: Yeah, thank you very much for having us.
Dr. Ted: Yeah, we enjoyed it. Thank you.
Dr. Sharp: All right, everyone. Thank you as always for listening. I really appreciate it. Glad you tuned in for this one. And I hope that you took a lot away from this episode. Lots of resources and links in the show notes, and you can go there to access anything that you might’ve heard about during this episode.
If you’re an advanced practice owner who is looking for accountability and support as you grow your practice in 2021, The Testing Psychologist, Advanced Practice Mastermind, which I facilitate, is starting [01:23:00] in early June. This is a small group coaching experience where you’ll join other psychologists who are working on taking their practices to the next level. We provide support and accountability, and it has just been awesome to see the current cohort and what everyone in that group is doing. So you can get more information at thetestingpsychologists.com/advanced and schedule a pre-group call to see if it’s a good fit.
Okay. I will be back with you on Thursday with a business episode. Stay tuned and take care until next time.
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