“When Your Child is a Psychopath” /The Atlantic
For me, this article raises the question of what you can reasonably define/expect of treatment both as a parent/clinician which can be a difficult topic. Parents also may not be open to hearing the answer to this question at the beginning of a first session so it also may be something to think about in terms of how to manage in communicating as you define treatment and the relationship?
“Callous” children will inevitably be given a very heavy burden of diagnosis, with extremely difficult options that we see in the article here. From the narratives, these young children spend half of their lives away from their own parents in residential programs, and hope that their “cognitive morality” will be reshaped. They are still growing… their brains won’t be finished cooking until 25!
As clinicians… How do you manage expectations with parents to ensure what is reasonable in treatment? In the DSM-5, disorders are delineated by functional impairments, but this article delves into the many gray tones of relationships and morality in psychopathy. For individuals of this psychiatric disorder, can we ever expect “normal” relationships (eg Carl)? Can positive behavioral therapy really reshape cognition to this level when it starts this early? Carl’s example seems to be a realistic example of someone, 10 years out of residential treatment, happy with his own success, and still in-contact with the treatment center. The center considered Carl to be a “success” as he was not in jail (!) and not aggressive, though he was committing adultery and not functional in his relationships and clearly still manipulating situations.
People like Carl and Samantha are going to struggle with relationships all throughout their life. The actual disorder will never go away, but how can they reasonably navigate the microsystems around them in a safe, legal, and healthy way, that hopefully provides connection to them in a way they are able to process.