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A lack of motivation to change is one of the main barriers to successful treatment for individuals involved in the criminal justice and forensic mental health systems. A two-month group therapy program helped patients in a forensic mental health hospital feel more motivated and ready for treatment. While such preparation programs have been studied in other settings, a recent study is the first in forensic mental health.
The study by Heather M. Moulden, Samuel A. Matthew, and Gary Chaimowitz included 60 men and women in a forensic hospital in Canada who were found not criminally responsible due to a mental disorder. Their research showed that the motivational preparatory program helped the study participants make changes.
This study did not cover the treatment that followed, but other studies have found that participants who completed preparatory programs had improved outcomes. They may be more engaged in treatment, may get early conditional release from prison, or may have a lower risk of repeating criminal behaviour.
This is a plain language summary of:
Moulden, H. M., Matthew, S. A., & Chaimowitz, G. (2026). Enhancing pre-treatment motivation improves forensic mental health outcomes. International Journal of Offender Therapy and Comparative Criminology, 70(2-3), 150–166. https://doi.org/10.1177/0306624X241228229
Brief Motivational Preparatory Program
The aim of the program was to help patients feel motivated to change and hopeful about treatment prospects. The program also helped patients feel they could meaningfully engage in treatment and complete it.
The program is based on two approaches. The first is hope theory, which says treatment is most effective when therapists help clients develop future goals that the clients believe they can achieve. The second is motivational interviewing, which is a style of therapy originally developed to help people with addictions. It is a collaborative, goal-oriented style of communication designed to strengthen a person’s motivation and commitment to reaching a goal. The therapist asks about the person’s reasons for change in a compassionate atmosphere. It is particularly helpful for people involved in the justice system who may have barriers to engaging in treatment, such as distrust, stigma, and misinformation.
The program consisted of twice-weekly, 90-minute group therapy sessions. Patients learn about the forensic psychiatry system, behaviour change, and risk assessment and management. They assess their own risk factors and recovery. They also discuss readiness for change, values, and hope. Hope includes setting goals, as well as carrying out, evaluating, and changing their plans. By actively participating, patients become more aware of problem areas in their lives and begin to make positive changes to recover and manage their own risk.
Changes in Motivation But Not Hope
The researchers compared study participants’ motivation to change and feelings of hope before and after the program. These were measured with standard questionnaires that provide a score for each participant. The researchers also compared participants to a control group who were on a waiting list for the program.
One way of looking at participants’ readiness for treatment was their stage of change. This standard approach to understanding personal change includes the four stages:
- precontemplation (person has not thought about it),
- contemplation (person has thought about it),
- action, and
- maintenance.
The researchers found that most participants were in the contemplation stage before taking the program but reached the action stage afterward. This result was highly significant and was not found in the control group that did not take the preparatory program.
However, the questionnaires before and after the program did not show any change in hope.
Changes in Aggression and Participation
The researchers also found small decreases in aggression in participants following the program. This was measured with scores on the Aggressive Incidents Scale. But this result was not statistically significant.
The researchers also looked at how many treatment programs each participant was enrolled in or was waiting to start. Participants who had participated in the preparatory program later doubled their participation in other rehabilitation programs. Participants in the control group showed no change in participation. This difference was statistically significant.
These findings showed that the program influenced participants’ behaviour. The participants said they felt more ready to change, and their behaviour reflected this. The researchers concluded that helping patients become more motivated to change is likely to have positive results.
Written by Carolyn Brown and approved by Dr. Heather Moulden.
