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New research highlights role of shame in treating antisocial personality disorder
A new study published in the Journal of Clinical Psychology, January 2026, edition offers fresh insights into the treatment of antisocial personality disorder (ASPD), focusing on the central role that shame plays in both the condition itself and its therapeutic management.
The paper, authored by Dr Stephen Blumenthal and Dr Jessica Yakeley of the Tavistock and Portman NHS Foundation Trust, examined how mentalisation-based treatment (MBT) can be used in group therapy settings for men with ASPD. Mentalisation-based treatment (MBT) is a psychological therapy grounded in attachment theory. It focuses on improving ‘mentalising’ – the ability to understand and reflect on one’s own and others’ thoughts, feelings, and intentions.
Understanding the problem
Antisocial personality disorder has long been considered one of the most difficult conditions to treat, particularly in outpatient settings. People with ASPD often struggle with impulsive behaviour, paranoia, and have histories of serious violence. The authors argue that chronic, pathological shame, rooted in early experiences of abuse and neglect, sits at the heart of many of these difficulties.
The research explains how shame operates differently from other emotions. Rather than being something a person can readily think about and discuss, profound shame is experienced as a bodily state of threat. When someone feels deeply ashamed, their capacity to understand their own mental states and those of others, what clinicians call ‘mentalisation’, temporarily collapses. This collapse can trigger paranoid thinking and violent responses.
A pioneering treatment programme
The paper in the Journal of Clinical Psychology describes a long-term group therapy programme that the Portman Clinic has been running for fifteen years. Unlike time-limited interventions, this programme offers open-ended, voluntary treatment to men who have typically been excluded from other services due to their challenging presentations.
The paper sets out how group members gradually developed the capacity to recognise and discuss their shame rather than acting it out through violence. One participant exemplified the journey many members undertook, from profound isolation and paranoid distress towards connection with others.
Key therapeutic insights
The therapeutic principle that emerged from this work is surprisingly straightforward: secure attachment relationships are the antidote to shame. The group setting allowed members to experience being held in mind by others, often for the first time in their lives.
The authors noted that treatment required significant adaptations. Traditional therapeutic techniques that emphasise interpretation can inadvertently increase shame and drive patients away. Instead, therapists sometimes need to offer concrete gestures of connection, such as walking alongside a distressed patient rather than maintaining a formal distance.
Over time, the group has evolved from a collection of isolated, suspicious individuals into what one member described as “the family we never had”. Participants reported that the group kept them out of prison, and there were no convictions for serious violence among members during their involvement in the programme.
Broader implications
This research builds on a recent randomised controlled trial demonstrating that MBT can effectively reduce aggressive antisocial behaviour in forensic populations. The present paper extends these findings by showing how addressing shame within long-term group treatment can support recovery in individuals previously considered untreatable.
For clinicians working with this challenging population, the message is clear: beneath the aggressive exterior of many people with ASPD lies profound shame requiring careful, patient attention rather than confrontation.
The Portman Clinic, part of the Tavistock and Portman NHS Foundation Trust, provides psychotherapy for people troubled by violent or sexually harmful behaviours, as well as those affected by such behaviours in others.
Drawing on decades of forensic and trauma-informed expertise, the clinic offers specialist assessments and long-term therapy for people often excluded from mainstream services. The Portman’s commitment to understanding the psychological roots of violence, and to reaching those who may be hardest to engage, makes it an international thought leader centre in criminology and forensic psychotherapy.
The full Journal of Clinical Psychology article is available online at: https://doi.org/10.1002/jclp.70087
The Lancet article: ‘Mentalisation-based treatment for antisocial personality disorder in males convicted of an offence on community probation in England and Wales (Mentalization for Offending Adult Males, MOAM): a multicentre, assessor-blinded, randomised controlled trial’ is available online at DOI: 10.1016/S2215-0366(24)00445-0
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