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Hypnotherapy is a versatile therapy which can be used to support and generate change for those with antisocial personality disorder.
This blog explores what antisocial personality disorder (ASPD or APD) is, treatment options and how hypnotherapy and self-hypnosis can help.
Before you read further, if you are new to hypnotherapy and want to become a professional hypnotherapist or, if you are already qualified and looking to upskill, we recommend you check out our award-winning HypnoTC Hypnotherapy Diploma course.
Antisocial personality disorder
According to the Mayo Clinic, antisocial personality disorder isn’t about someone who is just a bit of a loner, or is a socially isolated in some way.
Antisocial personality disorder is a recognised condition and comes within the broader category of personality disorders and is recognised within the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association 2013).
Interestingly, whilst ICD-10 (International Classification of Diseases and Related Health Problems, World Health Organisation 2016) had a code (F60.2b Dissocial personality disorder) for antisocial personality disorder, the newer ICD-11 (2022) doesn’t use separate labels. Rather it classifies personality disorders according to levels of impairment severity.
Signs of antisocial personality disorder
Those with antisocial personality disorder can initially appear charming (although this can seem superficial), and the perception of charisma and personal confidence may be used to engage in numerous sexual interactions, with relationships likely to be short-lived due to their callous or duplicitous behaviour.
It can be difficult to determine whether they are being truthful or lying, due to their manipulative tendencies. Those individuals engaged in more harmful or dangerous behavioural patterns can sometimes be called sociopaths or psychopaths.
Adults with antisocial personality disorder can have certain traits relating to an ongoing pervasive and inflexible pattern of behaviour that is relative stable over time and deviates from the norms of the person’s culture.
- Arrogance / cocky manner
- Cynical view of the world
- Has a sense of superiority over others
- Sense of importance of own opinion
- Consideration or respect for others
- Guilt when harm others
- Regret or remorse for their conduct
- Right or wrong
- Physical and emotional rights of others (and can violate those rights)
- Acting in a manner perceived as aggressive, hostile, violent or threatening to others
- Deceitful behaviours and telling lies to get what they want from others
- Engaging in actions to deliberately anger or upset others
- Interact harshly or with cruel indifference
- Irresponsible and difficulty or failing to consistently meet work, family or other responsibilities
- Problematic drug or alcohol use
- Use of deliberate charm, wit or persona to manipulate others for personal gain/ pleasure.
Childhood development and conduct disorders
Whilst antisocial personality disorder traits can emerge at any time, personality is recognised as forming during childhood. For adults with antisocial personality disorder, there is often a link to a past diagnosis of ‘conduct disorder’ (pre age 15). This coming from behaviours such as being dishonest and lying, aggressive and destructive behaviour and significant disregard or deliberate violations of rules.
Whether childhood ‘nature’ or ‘nurture’ is most influential here is debatable. Genes can predispose someone towards antisocial personality disorder. In the same way, a dysfunctional family upbringing, (such as abuse, violence and neglect, or family members with personality disorders) can lead to changes in the way the brain functions during brain development, potentially triggering the emergence of antisocial personality traits.
A doctor or other healthcare provider may conduct a thorough mental health examination, which can include medical and family history, presenting thoughts and emotions, how they interact in significant relationships, their behaviours and potentially even seeking information for family and friends. During the diagnosis process, other personality disorders and psychiatric conditions (such as narcissistic personality disorder, schizophrenia or bipolar disorder) will be considered and ruled out before antisocial personality disorder is given as a diagnosis.
General treatment of antisocial personality disorder
In the first instance, people with antisocial personality disorder may not spontaneously engage in therapy; they can consider they don’t need nor would benefit from help.
For treatment to be effective, the individual will need to be willing to engage in therapeutic treatment. Where there are co-morbid conditions talk therapy and/or medications may be recommended.
Where an individual is already engaging in some form of therapy or treatment, a range of complementary and supportive options may be explored. In addition, clients may come to hypnotherapy after needing medical or psychological assistance with other symptoms, such as anger, depression or alcohol/drug misuse.
Hypnotherapy and treatment of antisocial personality disorder
Hypnotherapy can offer help to those with antisocial personality disorder symptoms, and to friends and families of those who have antisocial personality disorders. Whilst not likely a task for a newly-qualified hypnotherapist, a well-qualified and suitably experienced hypnotherapist, who participates in therapy supervision, can work alongside the individual’s primary care provider, any interprofessional teams or psychological or psychiatric support.
When working as part of a care team, good communication is essential for the hypnotherapist to be able to work effectively within the overall treatment plan. Working as an isolated therapist, without sufficient knowledge or experience could exacerbate rather than help the client. In all such situations, working within the scope and breadth of competence is important, together with referral for issues that the therapist is unable to work with.
In the first instance, the therapist will consider a risk assessment, both for the risks posed by the client, and the potential for counter transference (the therapist reaction to the client). Where the risks can be adequately controlled, these will influence the treatment plan. Such a plan is likely to follow the concepts of STM,
- Stabilisation – preparing the client for change
- Treatment – active change work
- Maintenance – integrating the change and helping the client take ownership
As previously mentioned, clients with antisocial personality disorder may not, at least initially, be fully committed to change. Here it is important, throughout the therapy process to work to establish a more balanced Locus of Control.
The change process will often start with techniques from behavioural hypnotherapy. These can help the client identify unhelpful habitual responses and actions, and form new more helpful behaviours. A particular advantage with hypnotherapy is the use of mental rehearsal and future pacing to practice the new ways of responding. Not only is this a good ecology check (will it work in the real world?), but it also helps the client practice in a safe environment. By the time they come to actually do it in their daily life, it can already seem familiar.
Cognitive hypnotherapy builds on the gains of behavioural therapy and can work with cognitive distortions and unhealthy beliefs. Even more helpful is that clients can learn useful questioning strategies to apply to any future unhelpful thoughts. Specific cognitive-based methods, such as rational emotive behaviour therapy (REBT), acceptance and commitment therapy (ACT) and mindfulness can all provide helpful strategies for coping with challenging thoughts, feelings and emotions.
Behavioural and cognitive hypnotherapy work well together to enable the client to learn beneficial coping strategies. In the same way, those who interact with someone with antisocial personality disorder (e.g., friends, family, colleagues) can learn how to establish effective boundaries and learn how to best communicate with someone with non-standard ways of responding to situations.
Other hypnotherapy models can also be therapeutically beneficial. Firstly, analytical hypnotherapy is ideal, where a client wants to know ‘why’ and to get subconscious insight on a deeper level. Beyond this is regression hypnotherapy. This can be highly helpful in understanding and gaining a new perspective of past events. However, even more useful is the access to past resources, which the client can the employ going forward.
Hypnotherapy self-care activities to support the session work
Within any hypnotherapy treatment process, the added benefits gained from the client learning self-care techniques can be recognised. Here, self-care tasks can be lifestyle-related and out of hypnosis, or undertaken in self-hypnosis. These tasks would be discussed and agreed with the client and it can be useful for the hypnotherapist to follow up with a note about them in an email after the session. This avoids any confusion.
To reinforce new behaviours, a client might be asked to undertake a ‘contract for action’ and engage in activities where they will have an opportunity to practice their new responses in the ‘real world’. This may be supported by mental rehearsal, whether informal (imagine) or formal self-hypnosis (future pacing).
Where ongoing insight would be helpful, an analytical approach could be used, such as journaling, or directed journaling (topics to consider). This could then be used for self-actioned insight, or the journal entries could be discussed at the next therapy session.
Working with clients who have antisocial personality disorders may not be something ideally undertaken by students or the newly qualified. However, a hypnotherapist with some experience will have an understanding of how best to identify areas for change, plan appropriate hypnotherapy approaches and promote engagement.
Locus of Control blog: https://hypnotc.com/locus-of-control-scale-hypnotherapy/
Finally, if you would like to find out more about using hypnotherapy with clients, do visit our Diploma page and have a browse through the information about our world-class, award-winning training.
– written by Dr Kate Beaven-Marks