Working with patients with ASPD

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Big5Club

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I have a patient with ASPD who admits to lying to get what they want (from people in their lives, court, medical providers). This has been very effective for them and it’s not something they want to change. I haven’t worked with this kind of presentation before. Is this something to target? And if so, do you have any suggestions given they see it as an asset? And if not, do you have some suggestions for how to approach it when they bring it up? I don’t want to feel complicit or like I am condoning their behavior, but I don’t know if it would be effective to target it.

I’m thinking of approaching it by sharing how it makes me feel uncomfortable to hear it and makes me question the trust in our relationship. Would love your thoughts.

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I have a patient with ASPD who admits to lying to get what they want (from people in their lives, court, medical providers). This has been very effective for them and it’s not something they want to change. I haven’t worked with this kind of presentation before. Is this something to target? And if so, do you have any suggestions given they see it as an asset? And if not, do you have some suggestions for how to approach it when they bring it up? I don’t want to feel complicit or like I am condoning their behavior, but I don’t know if it would be effective to target it.

I’m thinking of approaching it by sharing how it makes me feel uncomfortable to hear it and makes me question the trust in our relationship. Would love your thoughts.

You cant treat something that a person doesn't want to change? Why are you seeing this person?
 
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Hare wrote a treatment guideline book, published by MHS. The book suggests that you avoid treating the personality characteristics. Instead, it suggests that you attempt to help the individual focus their efforts on prosocial endeavors (e.g., exploit people as a car salesman instead of a mugger).
 
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Hare wrote a treatment guideline book, published by MHS. The book suggests that you avoid treating the personality characteristics. Instead, it suggests that you attempt to help the individual focus their efforts on prosocial endeavors (e.g., exploit people as a car salesman instead of a mugger).
This is very interesting. I think my strategy has been to kind of reflect back the effects of their behavior, and how it moves them away from their overall goals with some success. I have been trying to focus treatment on moving them towards their goals in an adaptive way. I am definitely going to check out the Hare book. Thanks for the suggestion.
 
I’m thinking of approaching it by sharing how it makes me feel uncomfortable to hear it and makes me question the trust in our relationship. Would love your thoughts.
Virtually zero experience with ASPD but I think you might be able to answer your own question as you gain more understanding of ASPD and how that shapes a person's worldview, how they respond to inputs/outputs, what they are motivated by, etc.

My analogy would be with BPD and DBT. A decent clinician should be able to diagnose BPD and can pick up a Linehan book and 'deliver' DBT since the skills are super basic.

But I think the average clinician is not likely to be super successful because they haven't spent the time to really understand the interaction between high emotional sensitivity and a history of invalidation in order to then selectively use the right validation techniques as the grease to effectively teach BPD skills.
 
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Hare wrote a treatment guideline book, published by MHS. The book suggests that you avoid treating the personality characteristics. Instead, it suggests that you attempt to help the individual focus their efforts on prosocial endeavors (e.g., exploit people as a car salesman instead of a mugger).

I'm sorry, this is not useful, but I am finding the "exploit people as a car salesman" thing hilarious for some reason.
 
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For other reasons I’d rather not share on a public forum.

This is cryptic and could be construed as concerning in and of itself. In terms of a question of "why are you treating this person," the only real answer is that they presented at your office/clinic for treatment. If there is some ulterior motive for treating anyone, that's something to examine with a supervisor or consultant in some way.
 
This is cryptic and could be construed as concerning in and of itself. In terms of a question of "why are you treating this person," the only real answer is that they presented at your office/clinic for treatment. If there is some ulterior motive for treating anyone, that's something to examine with a supervisor or consultant in some way.
I think you are reading too much into it. It’s court mandated. And I work for an agency where I can’t refuse patients. I’m just weary of sharing too much information online.
 
Virtually zero experience with ASPD but I think you might be able to answer your own question as you gain more understanding of ASPD and how that shapes a person's worldview, how they respond to inputs/outputs, what they are motivated by, etc.

My analogy would be with BPD and DBT. A decent clinician should be able to diagnose BPD and can pick up a Linehan book and 'deliver' DBT since the skills are super basic.

But I think the average clinician is not likely to be super successful because they haven't spent the time to really understand the interaction between high emotional sensitivity and a history of invalidation in order to then selectively use the right validation techniques as the grease to effectively teach BPD skills.
Right. I actually do DBT, so completely get what you’re saying. I think that’s what is tough here because the presentation is so unfamiliar to me. And most of what I read is that there isn’t too much you can do to change behavior. There is such a deeper understanding of BPD and the rationale for DBT that I am just not finding for ASPD.
 
I think you are reading too much into it. It’s court mandated. And I work for an agency where I can’t refuse patients. I’m just weary of sharing too much information online.

Ah, why not just say that, then? That's a fairly common thing that gives away nothing.
 
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I tend to run a little anxious. 🥴

No worries, tends to run in the field. :) Probably better to be more careful than the other way around in disclosing possible PHI, but yeah, this is fairly regular, especially in certain settings. The only thing it really gives away is that you're not in private practice.
 
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I'm sorry, this is not useful, but I am finding the "exploit people as a car salesman" thing hilarious for some reason.
Or they could just go to Hollywood Upstairs Medical College and be able to prescribe anything they want!

To the OP, there's been some limited research on very intensive behavioral interventions (literal ABA) for children with Conduct Disorder with callous traits, but even the positive results they report are iffy at best. Honestly, the internal aversive of guilt and related feelings seems to be fundamental in reducing antisocial behavior in humans.
 
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