Forensic Therapy

Practitioners of forensic therapy may employ a diverse array of psychotherapeutic techniques and diagnostic tools in their practice. These methods can include:

• Cognitive-behavioral therapy (CBT)
• Cognitive processing therapy (CPT)¹
• Mindfulness-based interventions including meditation
• Dialectical behavior therapy (DBT)
• Trauma-focused therapy²
• Interpersonal psychotherapy (IPT)³
• Gender-responsive treatment (GRT)
• Art⁴ and/or music⁵ therapy

Forensic psychotherapy can take place in many types of settings, such as:

• Courts
• Local jails
• State and federal penitentiaries
• Forensic mental health facilities
• Hospitals
• Halfway houses
• Parole offices

Practitioners generally take a nonjudgmental stance when assessing and treating individuals involved with the legal system. The process of forensic therapy often involves an attempt to understand the factors in a person’s life experiences, medical history, and personality that led to their actions. During treatment, a forensic counselor may attempt to help an offender gain insight into their own behavior, take responsibility for their actions, and identify motivational and behavioral strategies to avoid future offenses. 

There remains substantial debate over whether forensic therapy can reduce recidivism, with some studies indicating that the data do not show a significant, consistent benefit. However, some meta-analytic research shows moderate evidence for the ability of cognitive-behavioral and mindfulness-based therapies to improve mental health in incarcerated individuals.

Because forensic therapy is such a broad field, the experience of evaluation and treatment may vary considerably between individuals. For some people, contact with a forensic counselor may consist primarily of short interviews and assessments intended to determine their mental health status for trial or sentencing purposes. Others may receive continual psychotherapeutic treatment over several years to address mental health symptoms and antisocial behavior.

Forensic psychotherapy generally begins with an evaluation from a treatment provider to determine the individual’s mental health status. According to the American Psychological Association’s professional guidelines, a forensic psychology specialist may employ any appropriate and evidence-based assessment tools. These can include conversations with the patient as well as behavioral observation, written or computerized tests, and other research-backed methods for evaluating mental health.

During treatment, the therapist may encourage the client to share their thoughts, feelings, and life history. They may also suggest techniques to improve self-awareness and emotional regulation. 

Therapy often involves a particular focus on the offenses that resulted in the person’s incarceration. Clients may be encouraged to consider their motivations for their actions, as well as how the offenses could have been avoided. While forensic therapists typically encourage individuals to reflect on the negative consequences of their actions (both for themselves and for others), they also usually strive to remain objective and nonjudgmental. The primary focus of treatment tends to be helping the client achieve clarity, psychological well-being, and positive changes in behavior.

Any individuals involved with the criminal justice system and experiencing mental illness may benefit from forensic psychotherapy. However, care practices can vary widely between different settings and regions, making it difficult to draw broad conclusions about the effectiveness of treatment. Evidence from large-scale reviews is limited but suggests that forensic therapy may be more effective at relieving symptoms of mental illness than at reducing the risk of future criminal behavior.

Research on individuals in forensic psychiatric units suggests that the following factors may lead to poorer outcomes and longer length of stay:

• Convictions for violent offenses
• Convictions for sexual offenses
• Psychotic symptoms
• Substance use disorders
• Cluster B personality disorders
• Lack of social support
• Prior criminal history
• Lower age at first criminal offense
• Beliefs, attitudes, and worldviews that support criminal behavior

While these factors may present difficulty for some people, therapy may lead to symptom relief and progress in several areas of life, including anger management, substance use, and impulse control. Forensic therapy may help people of all ages who have been involved in the criminal justice system.

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

For those experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Researchers and clinicians continue to explore ways to improve the effectiveness of forensic mental health treatment. One novel approach, reported in Frontiers in Psychiatry, involves strengthening the level of social support available to clients in outpatient care. Trained volunteers provided individuals with coaching and informal, friendly, supportive social interactions. The researchers found that participants receiving this additional intervention were significantly less likely to commit additional crimes or require further hospitalization.

Another therapeutic approach that has demonstrated potential effectiveness in recent studies is acceptance and commitment therapy (ACT). This method combines elements of cognitive-behavioral treatment and mindfulness, aiming to help participants accept negative emotions without reacting to them reflexively. A 2019 research review reported results from randomized controlled trials indicating that ACT may reduce aggression and dialectical behavioral therapy (DBT) may reduce recidivism in forensic therapy patients.

Seeking treatment while incarcerated or admitted to a forensic hospital can be difficult, and inmates or patients may have little influence on the kind of care they receive. It may be possible to submit requests for mental health treatment through corrections officers. Also, attorneys, family members, healthcare providers, and nonprofit groups dedicated to justice reform may be able to help incarcerated individuals advocate for care. However, the type and quality of mental health treatment available may vary substantially between facilities.

Individuals involved with the justice system but not confined to detention or treatment facilities often have many more options for finding therapy. Primary care providers may be able to offer referrals to mental health specialists, and insurance providers may offer ways to search for qualified counselors. Local clergy members or representatives of other community organizations can often help as well.

Nonprofit or governmental organizations focusing on mental health may also be able to help people seek treatment following involvement in the legal system. Notable examples include:

• National Alliance on Mental Illness (NAMI)
• Mental Health America (MHA)
• Anxiety and Depression Association of America (ADAA)
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• Health Resources and Services Administration (HRSA)

Some people may find it easier to seek therapy online for mental health challenges related to criminal or legal system involvement. Formerly incarcerated individuals with limited access to transportation may find remote treatment more convenient, and online therapy may seem more comfortable than in-office treatment. Many research studies have found that online therapy is as effective as in-office care. Regardless of whether you prefer in-person or online therapy, help is available for a wide variety of challenges related to forensic psychology.