Does Psychotherapy Make Criminals Worse?

Those familiar with The Sopranos, an 86-episode series about Tony Soprano, know that for seven years, Dr. Jennifer Melfi, a psychiatrist, provided the mob boss psychotherapy. Tony’s involvement and attendance at therapy sessions are erratic, as this tough guy remains ambivalent when it comes to confiding in his female therapist. At times, he sees her as a refuge and as offering an opportunity to do what he almost never does – sit quietly and sustain a conversation with one person. On other occasions, Tony regards Dr. Melfi as another female to conquer. He wants to know about her private life which she resists sharing. He flirts, intimidates, and threatens. Moreover, he appears completely mystified as to what the purpose of his sessions with her is. He complains that he is deriving no benefit but he continues engaging in the process. At times, he spews contempt for the whole enterprise and for Dr. Melfi personally, but even when he angrily walks out, he returns.

Toward the end of the series, Dr. Melfi learns about a book that gives her, as she puts it, “food for thought” about the worthwhileness of her work with Tony Soprano. Even before encountering the book, Dr. Melfi’s supervisor questioned the wisdom and safety of what she was doing with her mobster patient. Tony Soprano made it clear that certain areas of his life were off limits, not ever to be discussed. During sessions, he curses, yells, and sometimes frightens her. Yet, Dr. Melfi persists in believing that she should try to help Tony and continues to believe that she can.

Dr. Melfi encounters a book that refers to therapy as “one more criminal operation” for a patient who actually is a criminal. The psychiatrist's doubts that have plagued her throughout her work with Tony rise to the surface. The authors of the volume provide what Dr. Melfi regards as “food for thought” as they assert that criminals “sharpen their skills as conmen on their therapists.” Moreover, Dr. Melfi is disturbed to read that recidivism is higher among offenders who have therapy versus those who don’t. The authors seem to say that while criminals “glibly engage on issues like family,” they do not look at themselves and change in any meaningful way.

The book that Dr. Melfi read is one written by me, author of this blog, and Dr. Samuel Yochelson, his late colleague. The authors are named, but not the book’s actual title which is “The Criminal Personality.”

Shortly after reading what Yochelson and Samenow have to say, Dr. Melfi fires her patient. After seven years, Tony Soprano is abruptly shown the door in an abrupt and what seems a highly unprofessional fashion. There was no process of “termination” or even a single termination session. Dr. Melfi informs Tony that she is through. A stunned Tony Soprano leaves.

Neither Dr. Yochelson nor I stated that therapy makes criminals worse. Criminals can and will misuse just about anything for their own purpose, therapy included. Many enter therapy for ulterior motives. They offer endless excuses for their behavior, and the therapist may supply even more. They do not want to change but seek to convert the therapist to their point of view. They do exactly what Dr. Melfi finally, and somewhat abruptly, concluded that Tony Soprano had been doing; turn her therapy into a criminal enterprise.

On the other hand, there are circumstances in which a criminal may be amenable to considering living a different way of life because the way he has been living has resulted in consequences disastrous to himself and to others whom he cares about.

At what turns out to be their last session, a shocked Tony declares to Dr. Melfi, “I’m a good guy basically. I love my family.” (Tony had included his wife in several psychotherapy sessions.) In his way, Tony does love his family. The final scene of the series shows Tony Soprano seated in a restaurant with the three people who continue to matter most – his wife Carmela, his daughter Meadow, and his son A.J. Nothing is going well in his life, including his criminal operations. His reign as mob boss is crumbling. Nearly dying from being shot motivated him to question what life is all about. Of course, viewers have interpreted the final scene in different ways. Might it have been that, finally, Tony Soprano had reached a point of being receptive to what Dr. Melfi or a different therapist might have had to offer? Change is always possible.