The Impact of Psychopathy and Therapeutic Alliance on Treatment Outcome in a Dutch Forensic Treatment Sample

Jacomina Gerbrandij, Fordham University


Psychopathy is a clinical disorder characterized by difficulties and deficiencies in affective, interpersonal, and behavioral domains. Boldness, Meanness, and Disinhibition are three distinct but interrelated phenotypes that together constitute psychopathy as conceptualized by the Triarchic model of psychopathy. Psychopathy seems to be associated with several negative outcomes such as recidivism, violence, and treatment non-completion, the latter of which is also related to increased rates of recidivism in forensic populations. There was early skepticism relating to the treatment of individuals exhibiting psychopathic traits, but more optimism exists today. Therapeutic alliance tends to be an important factor that influences treatment completion rates. The current study examined the relationship between psychopathy and therapeutic alliance and their relationship with violence and treatment completion, in a sample of 100 forensic psychiatric patients diagnosed with personality disorders (antisocial, borderline, narcissistic, paranoid), participating in a randomized clinical trial (RCT) in the Netherlands. The RCT consisted of a 3-year treatment program evaluating the effectiveness of Schema Therapy compared to treatment as usual. Psychopathy and therapeutic alliance were rated by patients and clinicians, using the Working Alliance Inventory (WAI) to measure therapeutic alliance and Triarchic psychopathy scales derived from an abbreviated version of the Schedule for Nonadaptive and Adaptive Personality that was adapted for use with forensic populations in the Netherlands: the SNAP-F. It was hypothesized that psychopathy and therapeutic alliance would be significantly negatively related. Psychopathy was expected to show a significant positive relationship with violence and a significant negative relationship with treatment completion. Therapeutic alliance was expected to be significantly negatively associated with violence and positively with treatment completion. Psychopathy and therapeutic alliance were not significantly related. Results indicated that there was a significant relationship between self-reported psychopathy and violence while participating in the 3-year treatment program, while clinician-rated psychopathy did not significantly predict violence. Clinician-rated psychopathy did, however, significantly predict treatment completion, while self-reported psychopathy did not. Therapeutic alliance did not significantly predict violence or treatment completion. Clinical and theoretical implications of the findings are discussed, as well as suggestions for future research.

Subject Area

Clinical psychology|Therapy|Forensic anthropology|Personality psychology|Mental health

Recommended Citation

Gerbrandij, Jacomina, "The Impact of Psychopathy and Therapeutic Alliance on Treatment Outcome in a Dutch Forensic Treatment Sample" (2022). ETD Collection for Fordham University. AAI29326347.