Therapy with the High-Functioning Sociopath

We all have some fascination with psychopaths and sociopaths. We are disturbed and intrigued by the way these people think. Think about the last time you watched an episode of Dexter, or Criminal Minds, or even Dateline. Although the behaviors of the criminals sometimes range from mild deception and manipulation, all the way to the murderous end of the spectrum, we are still fascinated. That’s why there are so many TV crime dramas, and real-life crime documentaries...we keep coming back for more.

I must admit that I’m just as intrigued as the next person when I learn of a case where the individual is able to carry out some deceptive, diabolical plot and get away with it, at least temporarily. The primary reason I became a therapist was because of my interest in the intricacies of the human mind, cognition, and behavior. I like to know what makes people tick.

Of all the populations I’ve worked with, my “favorite” population is working with high functioning sociopaths. No, I’ve never worked with a serial killer...I don’t believe I have anyway. A high-functioning sociopath would never divulge that information. So what is a high functioning sociopath?

In this article, I use the term sociopath, versus psychopath. Often the terms are used interchangeably, and in this context, sociopath suits best. A high functioning sociopath does not generally commit crimes. Perhaps I should say that they just don’t get caught, or they have constructed their lives around their sociopathy so that they appear as ordinary people. These individuals are generally very charming and socially capable. They’re quite likeable. Most are successful in their careers. Most do not have criminal records. They maintain all types of healthy relationships. Despite all of this, a high functioning sociopath does not have/feel guilt, shame, remorse, empathy, or fear like the average person. They are experts at compartmentalization. In fact, these people are generally able to carry out the duties involved in their careers more effectively because they are not as emotionally enmeshed. They can essentially turn off emotion and get the job done. Think about all of the occupations where a professional has to be at least somewhat emotionally detached in order to do the job...some of these careers involve one’s need to face human suffering on a regular basis. Sometimes the job involves deception and manipulation. Sometimes the person might even have to take a human life.

When working with high functioning sociopaths, it is not usually about some criminal behavior. We are usually addressing 1) how another negative behavior is impacting someone in an intimate relationship; 2) how to recognize when there is a lack of balance; and 3) what is needed to restore feelings of control and balance. Many times the client merely needs to vent, or have a professional who is capable of hearing disturbing things.

One of the assignments that I give to these clients is relatively insight-oriented and self-reflective. I ask them to do some research on high functioning sociopaths, then I ask them to think about how they have constructed a successful life around the sociopathy. Here is a hypothetical example:

Kevin has already accepted that he is a high functioning sociopath. He sometimes shares some of his antisocial behaviors from childhood and adolescence. Since then, Kevin has had a very successful career in the military and in law enforcement. He has also been able to maintain healthy friendships, but some of his intimate relationships suffer because of his lack of empathy. Although Kevin knows that it is morally wrong to cheat, he still does not feel guilt for doing so; the only remorse he feels is about how being discovered can impact his career. Kevin views extramarital affairs as simply having his needs met.

How would I work with Kevin? First, I make it clear that I will not judge him about anything he says, but I won’t just say what he wants to hear. I assure him that whatever he says is confidential unless he is not safe to leave my office. He understands that the sessions with me will be a place for him to be open and honest. Sometimes Kevin just wants to vent frustrations. However, most of the work is designed to restore the cracks so he can become high functioning again. Every once in a while, couples counseling is recommended if the person has invested in a relationship.