Traditional measures of the therapeutic alliance do not capture the dual roles inherent in relationships with involuntary clients. Providers not only care for, but also have control over, involuntary clients. In 2 studies of probationers mandated to psychiatric treatment (n=90; n=322), the authors developed and validated the revised Dual-Role Relationships Inventory (DRI-R). The authors found that (a) relationship quality in mandated treatment involves caring and fairness, trust, and an authoritative (not authoritarian) style, (b) the DRI-R assesses these domains of relationship quality, is internally consistent, and relates in a theoretically coherent pattern with ratings of within-session behavior and with measures of the therapeutic alliance, relationship satisfaction, symptoms, and treatment motivation, and (c) the quality of dual-role relationships predicts future compliance with the rules, as assessed by probation violations and revocation. The DRI-R covaries with multiple domains more strongly than a leading measure of the therapeutic alliance, suggesting that it better captures the nature and effect of relationship quality in mandated treatment.

The utility of psychopathy measures in predicting violence is largely explained by their assessment of social deviance (e.g., antisocial behavior; disinhibition). A key question is whether social deviance interacts with the core interpersonal-affective traits of psychopathy to predict violence. Do core psychopathic traits multiply the (already high) risk of violence among disinhibited individuals with a dense history of misbehavior? This meta-analysis of 32 effect sizes (N = 10,555) tested whether an interaction between the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 2003) Interpersonal-Affective and Social Deviance scales predicted violence beyond the simple additive effects of each scale. Results indicate that Social Deviance is more uniquely predictive of violence (d = .40) than Interpersonal-Affective traits (d = .11), and these two scales do not interact (d = .00) to increase power in predicting violence. In fact, Social Deviance alone would predict better than the Interpersonal-Affective scale and any interaction in 81% and 96% of studies, respectively. These findings have fundamental practical implications for risk assessment and theoretical implications for some conceptualizations of psychopathy.

Although considerable research on psychopathy has been conducted over the past 30 years, relatively few studies have examined key issues related to potential ethnic differences in this constellation of socially maladaptive personality traits. Given recent sociopolitical and scientific developments, an issue of considerable debate is whether Black individuals possess "more" traits of psychopathy than do Whites. To address this issue, a meta-analysis of differences between these groups' scores on the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) was performed, using 21 studies (N = 8,890) of correctional, substance abuse, and psychiatric samples. Blacks exceeded Whites by an average of less than 1 point on the PCL-R total score. Effect sizes for core interpersonal and affective traits of psychopathy (Factor 1) were sufficiently homogeneous to clearly interpret, although other features manifested statistically significant heterogeneity. Our finding that Blacks and Whites do not meaningfully differ in their levels of core psychopathic traits is consistent with community-based findings for self-report measures of psychopathy and clinical diagnoses of antisocial personality disorder.

Objective The Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003) is often used to assess risk of violence, perhaps based on the assumption that it captures emotionally detached individuals who are driven to prey upon others. This study is designed to assess the relation between (a) core interpersonal and affective traits of psychopathy and impulsive antisociality on the one hand, and (b) the risk of future violence, and patterns of motivation for past violence, on the other. Method A research team reliably assessed a sample of 158 male offenders for psychopathy, using both the interview-based PCL-R and the self-report Psychopathic Personality Inventory (PPI: Lilienfeld & Andrews, 1996). Then, a second, independent research team assessed offenders' lifetime patterns of violence and its motivation. After these baseline assessments, offenders were followed in prison and/or the community for up to one year to assess their involvement in three different forms of violence. Baseline and follow-up assessments included both interviews and reviews of official records. Results First, the PPI manifested incremental validity in predicting future violence over the PCL-R (but not vice versa) – and most of its predictive power derived solely from impulsive antisociality. Second, impulsive antisociality – not interpersonal and affective traits specific to psychopathy – were uniquely associated with instrumental lifetime patterns of past violence. The latter psychopathic traits are narrowly associated with deficits in motivation for violence (e.g., lack of fear; lack of provocation). Conclusion These findings and their consistency with some past research advise against broad generalizations about the relation between psychopathy and violence.

Long-term and high-level exposure to endotoxin, compared with no exposure, appears to be associated with a reduced risk of lung cancer in this cohort.