The following is in interview between Terrence Shulman, JD, LMSW, ACSW, CAAC, CPC, founder of the Shulman Center for Compulsive Theft, Spending, and Hoarding in Michigan, and Elizabeth Corsale, MA, MFT, co-founder of the Pathways Institute for Impulse Control. The interview was featured in Schulman's book "Cluttered Lives, Empty Souls;" in it, Corsale discusses kleptomania, shoplifting addiction, and stealing:
T. Shulman: Could you tell me your background (education and professional)?
E. Corsale: I am a licensed marriage and family therapist. I have worked since 1995 with shoplifters and their families, and have treated a variety of impulsive/addictive disorders such as sexual addiction. I founded and directed the Shoplifters Recovery Treatment Program (SRT) - now a part of Pathways Institute for Impulse Control - one of the few nationally recognized treatment programs for compulsive stealing. I am a member of the California Association of Marriage and Family and I've offered comprehensive education, training, outreach and consultation to clinical professionals and to criminal justice institutions. I also have a private treatment practice in San Francisco.
T. Shulman: When and how did you become interested in the study and treatment of kleptomania/ shoplifting addiction?
E. Corsale: I was an intern working with a forensic psychologist and he and I began talking about how frequently he would get referrals from the court to evaluate or treat individuals with significant shoplifting/stealing histories but no other criminal profile. He asked me to do a little research and see if I could find a program, book or literature on the subject. My research turned up very little, and from there we began working on developing a treatment model based on successful alcohol and drug treatment programs. Over the years - primarily through experience and better available research of impulse disorders - the program I now direct has grown and evolved.
T. Shulman: What is the difference between someone who is a plain thief or just dishonest and someone who has kleptomania/theft disorder? Also, define them both a bit.
E. Corsale: Well, this is a challenging question. As I see the question, you are asking about psychological assessment and treatment. I don't think in terms of "plain old thieves" or "plain old dishonesty." If someone is stealing or shoplifting the person has some kind of problem; and it is my job to comprehensively assess them using the best research measures and clinical interviewing evaluations available. To evaluate someone's stealing behavior, I ask questions such as: Is this impulsive and compulsive behavior? Does their behavior fit the criteria for Kleptomania or Impulse Disorder NOS? How often do they steal? How much is stolen? Is the stealing ego syntonic (the stealing is in harmony with one's self image) or ego dystonic (the stealing is not in harmony with their self-image and they are conflicted about their behaviors)? Do they have a co-morbid mood disorder, eating disorder, or substance abuse history? Does this person have an Axis II personality disorder diagnosis and if so, is it directly related to the stealing behavior? These are some of the questions that help me to formulate a complete picture of what the stealing behavior is about.
Another way to answer this: there's a real distinction between someone with a criminal profile - for example someone who is a "booster" and sells stolen merchandise for profit or works with a gang of people who steal and who has a long history of such behavior and lives a criminal lifestyle - vs. people with kleptomania and impulsive theft have much more unevenness in their lives; in other words, the rest of their lives are typically upstanding and orderly. When you see this unevenness, you have to ask: okay, what's going on with this person?
T. Shulman: Does your research and/or clinical experience lead you to believe that shoplifting addiction/kleptomania is on the rise and, if so, why?
E. Corsale: It is a significant problem and before we can understand if it is on the rise we would need a large scale prevalence study and to my knowledge no one has done this yet.
T. Shulman: What are the primary reasons people steal?
E. Corsale: If we are speaking about impulsive and compulsive stealing then we need to think about the etiology of impulse disorders, the neurobiology of the patient, dopamine feedback loops and the psychological, emotional and developmental context of the patient. We know that impulse disorders are made worse if there is an increase of stress in an individual's life. If you do not suffer from an impulse disorder and you turn the knob up to high stress you are likely to be more impulsive while the stress is high, although unlike a person with impulse disorders you won't keep repeating the impulsive cycle once the stress has lessened. It has been my experience that people who suffer from impulsive and compulsive stealing have had to deal with overwhelming stressors. These stressors maybe internal or external and can occur at any stage of life. They often have co-morbid mood disorders which can create enormous stress. Many of these patients had early childhood attachment loss or trauma and often stressful dysfunction family systems which resulted in compensatory behaviors of which stealing is often only one of the significant cluster of unhealthy behaviors and thoughts they use to cope.
T. Shulman: What treatments have you found work best for these disorders?
E. Corsale: I believe people need long-term, ongoing treatment, including cognitive-behavioral therapy, dialectical-behavioral therapy, psychodynamic treatment, medication, group and individual therapy, and supportive 12-step programs if they are applicable and available.
T. Shulman: What would people in general be most surprised to know about shoplifters/ kleptomaniacs? What do you think of the term "thief"?
E. Corsale: They often don't know why they are doing what they are doing and they can't just "stop" without support. Treatment takes a long time; there are no quick fixes. Also, as I stated earlier, people with kleptomania and impulsive theft disorders are typically completely upstanding and honest in all other areas of their lives: they usually hold good jobs, go to church or are religious, and are well-respected in their communities. Also, people often think just because someone shoplifts from stores that they are going to steal from anyone, anyplace, at anytime; and that's rarely the case.
T. Shulman: How do you see the relationship between shoplifting and stealing behaviors and other addictive-compulsive behaviors?
E. Corsale: We definitely see patients with co-occurring hoarding, eating disorders, sexual addictions, and a lot of codependency. I've always been interested in and treated a variety of impulse control disorders and addictions and I believe that increasingly we are seeing more and more people with a cluster of addictions. The longer I work, the more unusual it is to find somebody who is just an alcoholic or even just a shoplifter. Again, we see a lot of codependency, so we see a lot of people who steal things for other people because they are trying to manage the impression of how others see them. This is manipulative but that's part of codependency-being seen as nice, generous, and financially affluent. People struggling with codependency often fear feeling out of control if they were to be fully honest with others or assert their needs, thoughts and feelings. So, in treatment, we have to identify and work with this all the time.
T. Shulman: What do you think about the recent TV programs on shoplifting addiction/ kleptomania?
E. Corsale: I haven't seen any recent programs so I can't comment. There is a tremendous amount of stealing going on in our culture. Some of the people stealing are Kleptomaniacs by criteria others are not. But that shouldn't be the focus of the issue. If someone is stealing then there is a serious problem to address. We in the mental health field, and media need to bring awareness and a spirit of sincere non-judgmental inquiry in order for us to understand impulsive and compulsive stealing. I have worked with hundreds of people who have stolen and each person has been unique and has value.
T. Shulman: How do you measure success in your treatment?
E. Corsale: If the person can reduce the harm they are causing themselves and others, get to abstinence, and work a solid program so they don't relapse and return to stealing. That is the first part of the equation. Once they are on their way to living a life "sober" from stealing, can they get back on track developmentally, psychologically and emotionally? Can they begin to have meaningful relationship and meaningful work? Are they making their unique contribution to those around them and the greater community at large? Are they now able to become fully themselves free from the burden and early trauma of an out of control impulse disorder?
T. Shulman: Do you have any comments on the Lindsay Lohan shoplifting case, Bernie Madoff, or the banking, mortgage, and investment house frauds?
E. Corsale: No comment.
T. Shulman: Where do you see the future of this area of treatment going?
E. Corsale: I believe the future of treatment will be combination therapies & medication. Hopefully, we will learn much more about the brain and the neurotransmitters - dopamine specifically - and understand how to better regulate it through technological innovations and neuro-scientific discoveries. However, it is likely that psychotherapeutic treatment will continue to be necessary. We humans create a psychology of meaning as it relates to the context of our life and our unique differences that make us who we are and this has to be included in the treatment particularly treatment that involves relapse prevention. Treatment can't ever be one size fits all. Our psychology can only be as healthy as the context and our variability allows. Psychotherapy is necessary in order to get the support, understanding and help you need to work through the issues and problems that self-destructive impulses create in one's life.
If you have a problem with compulsive stealing or a stealing addiction, Elizabeth Corsale, MA, MFT, supervises a skilled staff at the Pathways Institute for Impulse Control: www.pathwaysinstitute.net or 415.267.6916