Change process in psychotherapy for criminal offenders: a comprehensive review with content analysis

The aim of this study is to systematically identify and synthesise the therapeutic components that facilitate recovery in criminal offenders undergoing psychotherapy or psychosocial interventions. A systematic review was conducted covering 163 studies published between 2000 and 2024, focusing on interventions such as cognitive-behavioral therapy, schema therapy, mentalisation-based treatment, and attachment-based approaches. A content analysis of these studies resulted in 7 core themes and 32 sub-components representing therapeutic components frequently emphasised in the literature. Structured and directive therapy approaches, cognitive restructuring, and social skills training were the most frequently emphasised, while relational factors such as empathy, warmth, unconditional respect, and therapeutic alliance were less represented. Trauma-focused and cultural or gender-sensitive adaptations were minimal. The findings highlight the predominance of technical, protocol-driven approaches in offender rehabilitation and underscore the need to integrate structured interventions with relational, motivational, and individualised adaptations. Overall, this review provides a comprehensive synthesis of psychological mechanisms discussed in the literature as relevant to offender recovery, emphasising the importance of balanced, multi-component, and individualised therapeutic approaches that address both technical and relational factors.