The debate regarding mental illness in the recent tragedies suffered by American communities has a unique aspect for me, as a psychologist and therapist. I’ve treated mentally ill people who had killed in the past, and I’ve treated people who later went on to kill. I recently learned of a former patient who was arrested for murder. Sadly, this isn’t a new experience for me. No fewer than four former patients have gone to jail for murder and similar charges. These are just the events of which I’ve become aware, as events and media coverage have forced their way into my life.

Treating patients who have killed is its own challenge, which many forensic psychologists have dealt with for years. It is not a glamorous thing, and I long ago stopped watching films or television about serial killers and murderers, because of the way they turn such people and their acts into excitement for the screen.

But when former patients are charged with murder, a psychotherapist struggles with complex, wracking questions of guilt, competence, and 20/20 hindsight. I once read a book called Tales From A Traveling Couch

Mental illness is a struggle, for all those involved

, by a psychologist named Akeret. In it, the author tracked down several former patients to find out how they were doing, and what impact therapy had on their lives. The author was struggling with his own questions as he followed this exploration, questions not dissimilar from my own.

What value does psychotherapy hold? What value do the psychotherapists themselves hold? Is that value based upon the outcomes of their work, and the successes or failures of their patients?

For years, in several states, I’ve worked mainly with men and teen boys, many involved in the justice system. The overwhelming majority of these services have been publicly funded, through state or Federal dollars, as my patients were almost universally from poor and impoverished backgrounds.

Many things have recently been written and argued about the role of mental illness in violent crime. Poverty and drug use are far stronger predictors of violence, than are mental health diagnoses. Were mental health treatment more widely available to those who need it, many people would benefit. But, sadly, murders and tragedies would still occur. And therapists would still be wondering, worried that there might have been something they should have done, clues that they missed, techniques that they didn’t know.

The men involved in the recent tragedies in Colorado, Arizona, and Connecticut had seen therapists and mental health providers in their lives. Those providers did all they could, with the resources they had available. Those professionals are surely dealing with their own pain and fears now, asking questions which can’t be answered, if there was anything that they could have done.

Several years ago, I was trained as an advanced instructor in suicide prevention and assessment. I sought out the training because of the losses experienced by several therapists I supervised. I saw those therapists struggling, and wanted to give them hope, and to help other therapists avoid that pain. I have since trained thousands of therapists, teachers, students, and family members. Therapists who lose patients to suicide struggle with similar questions and feelings, worrying that perhaps they did something wrong, missed something they should have seen. Perhaps they shouldn’t even be practicing, they often wonder, struggling with pain and fear. In my trainings, I teach that try as they may, sometimes, a therapist might not be able to prevent a suicide. There are many reasons for suicide, and while untreated mental illness is a significant reason, it is only one.

Across their careers, therapists will treat and help many hundreds, or thousands of people. Their value is in that work, in that career, in that commitment. The value of a psychotherapist is in those efforts, as they work to ease pain and improve functioning. Their efforts and values multiply as the people they treat touch and improve the lives of others.

So, I find that this same message applies, as I contemplate the names and memories of patients who have committed tragedies, and taken innocent life. Mental health treatment is just one ingredient in our society’s efforts to cure ills, improve lives, and ease pain. Sometimes, therapists can be that one critical missing ingredient, and turn the tide in someone’s lives. Other times, the work of psychotherapy is like seeds strewn on rocky ground, because there are too many missing components and the change of therapy cannot take root. The value of psychotherapy, and the psychotherapist, is in all of the seeds that are sown in the garden,and in the love and commitment of the gardener who tends those fields.

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