What Works and What Doesn’t? Responsivity from the Perspective of Incarcerated Individuals with a History of Sexual Recidivism

Abstract

The risk-need-responsivity (RNR) principles of correctional intervention provide guidelines for preventing future offenses, including sexual offenses. Although recidivism rates for sexual offending are generally low, some individuals do reoffend after release from prison. These individuals, often referred to as “sexual recidivists,” typically pose a statistically higher recidivism risk and often have complex criminogenic needs. However, despite their extensive experience with the correctional system, little is known about what they believe makes therapeutic interventions motivating, engaging, and effective. The current study qualitatively examined the lived responsivity experiences of 23 incarcerated men in Norway who have recidivated sexually, focusing on their preferences and beliefs about therapeutic interventions. The findings revealed that valuable interventions are characterized by what I summarize as predictability and entirety, delivered by professional facilitators. Overall, the stigma of sexual offending, along with these men’s repeated failures to desist, can create responsivity challenges, indicating the need for tailored efforts to support their desistance processes.

Plain Language Summary

How people with repeated sexual convictions can be supported in their processes toward positive change

This paper explores how professionals within the correctional system can better support individuals who have sexually reoffended as they try to change their lives. I interviewed 23 incarcerated men with repeated sexual convictions to learn which kinds of programs, therapy, and support they find motivating and helpful. The participants said they need predictability and long-term commitment from staff. They want help that addresses their whole lives, allowing them to be seen as more than their offending, and they value professionals who help them gain insight and “connect the dots” about why they offended. The stigma associated with sexual offending can make it harder to trust services and professionals, creating barriers to receiving and responding to support. The findings suggest that understanding the unique situations of those who have sexually reoffended is crucial and may necessitate extra efforts from professionals. By attending to these individuals’ needs and preferences, professionals can be more effective in guiding them toward living crime-free lives.

Introduction

According to official statistics, individuals convicted of sexual offenses rarely recidivate, but those who do typically pose a statistically elevated risk of sexual recidivism (Hanson & Morton-Bourgon, 2005; Lussier et al., 2024). While incarcerated, they are therefore often rightly targeted for therapeutic interventions aimed at preventing recidivism. To this end, the risk-need-responsivity (RNR) model of correctional interventions provides the most well-known, evidence-supported guidelines (Andrews, Zinger et al., 1990; Dowden & Andrews, 2000; Hanson et al., 2009; Olver, 2017; Smid et al., 2016).

The RNR model essentially revolves around the three overarching principles of risk, need, and responsivity. Among these, responsivity is the least studied and arguably the most misunderstood principle, making it essential to understand how to improve adherence in practice (Parker, 2022; Wormith & Zidenberg, 2018). In essence, responsivity is about improving the likelihood of successful rehabilitation by ensuring that therapeutic approaches are individualized. Particularly, what is known as specific responsivity (as opposed to general responsivity, see Andrews, Bonta, & Hoge, 1990) serves as a crucial reminder that “one size does not fit all” (Wormith & Zidenberg, 2018, p. 16). While a particular intervention may work for some “types” of individuals, it may be less successful with others. Although this is often apparent to professionals in the correctional system, it does not necessarily translate easily into practice. The numerous definitions and interpretations of responsivity are inconsistent and lack clear coherence, and—due to the complexity of the matter—adherence to this principle often proves difficult. Moreover, certain types or sub-populations of incarcerated individuals have been largely overlooked regarding responsivity, despite previous unsuccessful attempts to support their transition to a crime-free life. One such population is individuals who have been repeatedly convicted of sexual crimes—a group that is often considered difficult to motivate and engage in therapeutic interventions (Laws & Ward, 2011).

As responsivity pertains to the personalized aspects of therapeutic interventions, encompassing individuals’ subjective experiences regarding their capacity to engage with and derive benefits from these interventions, responsivity is particularly suited for qualitative exploration. However, within the RNR tradition, the majority of studies and evaluations have been quantitative, emphasizing measurable outcomes. As a result, lived experience has been sidelined. Only a few studies have shed light on responsivity among individuals convicted of sexual offenses from a service user’s perspective (e.g., Blagden, 2022; Hudson, 2005; Lindegren, 2025b; McCartan et al., 2021). These studies highlight some specific challenges these individuals face in accessing and engaging with support and interventions, such as stigma. However, studies reflecting the service user perspective often focus on individuals convicted of sexual offenses in general, specific therapeutic interventions, or particular sites. The current study represents a notable exception to this, by focusing on a diverse sample of incarcerated individuals who had sexually recidivated. Previous findings from this project found that a majority of the sample attributed their reoffending, at least in part, to the system’s failure to provide effective interventions in the past (Sandbukt, 2025a). Yet, little is known about what could mitigate this experience. This has served as an impetus for further investigation into the specific requirements of this population to improve the effectiveness of correctional interventions.

This article addresses a gap in the literature by adopting an open and exploratory approach to investigating what I refer to as “the lived responsivity experience” of currently incarcerated individuals with a history of sexual recidivism (IHSR). Having served multiple convictions for sexual offenses—whether their second, third, fourth, or fifth—IHSRs possess extensive long-term experiences with the correctional system, which provide them with valuable insights into past and current interventions. Although they have not yet successfully desisted, they are actively engaged in the process, even if they are still in the initial stages. As “sexual recidivists,” they may encounter unique challenges affecting their response to therapeutic interventions and intervention offerings. Consequently, their perspectives can generate valuable insight into responsivity in this particular population. As such, the study aims to contribute to the ongoing discussion on “what works” in therapeutic correctional settings, with a particular focus on “what works for whom.”

Literature Review and Theoretical Framework

Internationally, the development of prison programs and therapeutic interventions has been heavily influenced by the “what works” tradition and the risk-need-responsivity (RNR) model (Andrews, Zinger et al., 1990). This includes Norway, where the current research was conducted, and interventions for individuals convicted of sexual offenses are no exception (Friestad, 2005). The RNR model’s history is extensive (see Wormith & Zidenberg, 2018 for a thorough review), encompassing a broader set of principles for effective rehabilitation (Andrews, 2001). Nevertheless, the RNR model essentially revolves around the three overarching principles of risk, need, and responsivity. In brief, the risk principle asserts that interventions are most effective in reducing reoffending when they focus on individuals who are at a higher risk of reoffending (Andrews & Bonta, 2010). This principle highlights who should receive the most intensive interventions. The need principle emphasizes that interventions should address individuals’ criminogenic needs or dynamic risk factors, which, when influenced, can impact the likelihood of recidivism. As such, this principle serves as a reminder to professionals about what to focus on during interventions (Andrews & Bonta, 2010). Finally, the responsivity principle generally states that interventions should be delivered in a style and mode that is consistent with the ability and learning style of the individual to whom the intervention is being offered (Andrews & Bonta, 2010). To achieve this, professionals must match services not only to criminogenic needs but also to individual attributes and circumstances “that render cases likely to profit from that particular type of service” (Andrews, Bonta, & Hoge, 1990, p. 20). This principle thus concerns the how of interventions. Adherence to responsivity means offering interventions in ways that are likely to foster change in the individual concerned.

The Responsivity Principle

Responsivity, according to the RNR model, entails two components: general and specific. General responsivity emphasizes that certain types of interventions are consistently regarded as superior to others for effecting change, regardless of the specific “problem” (Andrews & Bonta, 2010; Wormith & Zidenberg, 2018). These interventions typically include cognitive-behavioral and social learning approaches, and it is also widely accepted that strength-based approaches, delivered by warm, empathetic, and respectful professionals, are more effective than punitive ones (Fortune et al., 2012; Kewley, 2017; L. E. Marshall, 2019; W. L. Marshall et al., 2017; Sowden & Olver, 2017). However, a wide variety of therapeutic intervention frameworks may be employed. For instance, the good lives model (GLM) has recently gained significant attention from professionals within corrections due to its dual focus on risk reduction and enhancing well-being (Prescott & Willis, 2022; Ward & Stewart, 2003). Consideration of the situation and the unique characteristics of the individual to whom the intervention is being offered lies at the core of this model. These considerations constitute the specific responsivity principle of RNR, where “general cognitive-behavioral techniques” are adapted to “specific offender characteristics” (Andrews & Bonta, 2010, p. 310). Specific responsivity factors typically include individual characteristics, such as gender, learning disabilities, personality, motivation, and mental health issues (Andrews, Bonta, & Hoge, 1990; Andrews & Bonta, 2010; Jung, 2022). However, specific responsivity can be subdivided further into internal and external responsivity (Andrews, 2001; Dowden & Andrews, 2000). While the former concerns individual attributes such as personality and cognitive maturity (Ward & Maruna, 2007), the latter is concerned “with environmental factors, including institutional culture, and the skills, approaches, and characteristics of individual change agents” (Ricciardelli & Perry, 2016, p. 404). Despite increased acknowledgment among scholars that the context surrounding therapeutic interventions constitutes an important responsivity aspect, especially for highly stigmatized individuals such as those convicted of sexual offenses, internal factors remain the more typical examples of specific responsivity in the literature (Blagden, 2022; Blagden et al., 2016).

Specific Responsivity, Motivation, and Readiness

Among all specific responsivity factors, motivation has arguably received the most attention, particularly regarding those convicted of sexual offenses. This is because in most contexts and settings, incarcerated individuals have the right to refuse to cooperate with any particular intervention (Hanson, 2014). In Norway, for instance, treatment and other types of therapeutic interventions are voluntary, also for those with a history of sexual offending. Furthermore, research suggests that individuals convicted of sexual offenses who decline therapy or drop out prior to completion have increased probability of recidivism (Seager et al., 2004). Consequently, several considerations regarding responsivity revolve around motivation and factors that may threaten engagement in interventions. It is widely recognized that those delivering the intervention must possess the skills to initiate, enhance, and sustain motivation, ensuring that individuals in need enter and remain in therapy or programs (Andrews et al., 2011; Olver et al., 2011; Ward et al., 2004). A good working alliance—or therapeutic alliance—is deemed essential in this process, placing the primary responsibility for fostering responsivity on those delivering the intervention (Bélanger & Higgs, 2024; Blagden et al., 2016; W. L. Marshall et al., 2003; Ward et al., 2006). However, motivation is a complex concept, and although it is typically viewed as an internal responsivity factor, it often relies heavily on external responsivity factors. Motivation to participate in a correctional intervention does not necessarily indicate preparedness to change; many incarcerated individuals recognize the potential benefits of being perceived as compliant or eager to change and, therefore, may accept or even seek out therapeutic intervention options (Hudson, 2005; Lindegren, 2025b; Serin & Kennedy, 1997). Conversely, it cannot be assumed that those currently unwilling to engage in interventions lack a desire, or the motivation, to stop offending (Ware & Blagden, 2017). For individuals to effectively make changes, they must believe that change is achievable, and experience support throughout the process (Blagden et al., 2016). These aspects are part of what is called readiness, a concept that encompasses the preparedness for change among all parties involved and represents a significant consideration for responsivity (Frost, 2017). Several researchers highlight the importance of aligning interventions with an individual’s level of readiness (Serin & Kennedy, 1997; Ward et al., 2004; Williamson et al., 2003).

Responsivity, motivation, and readiness are clearly related concepts. Following Howells and Day (2003), Ward et al. (2004) define readiness as “the presence of characteristics (states or dispositions) within either the client or the therapeutic situation, which are likely to promote engagement in therapy and that, thereby, are likely to enhance therapeutic change” (p. 647). These authors further contend that treatment readiness implies that the individual is motivated, can respond appropriately, finds the process relevant and meaningful, and possesses the capacity to successfully enter the program or treatment. Hence, readiness is a comprehensive construct related to context and process, encompassing the user, the service, and various factors that influence preparation and predisposition, including the element of timeliness (Frost, 2017). These readiness frameworks are based on the transtheoretical stages of change (SOC) model, which conceptualizes the structure of change underlying the modification of addictive and other problematic behaviors while accounting for incidents of relapse (Prochaska et al., 1992). The SOC model involves a dynamic continuum along which an individual can progress or regress through five stages: pre-contemplation, contemplation, preparation, action, and maintenance (Olver & Wong, 2017; Prochaska et al., 1992). Some level of motivation can exist at any of these stages; as Prochaska et al. (1992) point out, “even precontemplators can wish to change” (p. 1103). Within the SOC model, change is recognized as a dynamic process, and the authors argue that professionals’ knowledge of an individual’s position in this process can help them tailor interventions accordingly: “A person’s stage of change provides proscriptive as well as prescriptive information on treatments of choice” (Prochaska et al., 1992, p. 1106).

Ward et al. (2004) argue that typically, when an individual is deemed not ready for change (e.g., does not want to engage in therapy), the suggested solution would be to modify either the individual client, the intervention, or the setting. These authors also contend that motivation and (specific) responsivity are narrower in scope than readiness, which they consider the more inclusive construct; however, this view is not entirely agreed-upon nor clear. It could be argued that Ward et al.’s (2004) suggestions for modifying “low readiness” represent true responsivity adherence, depending on how broadly one defines responsivity. For instance, Blagden (2022) argued that motivation and readiness are crucial elements of responsivity in rehabilitative interventions, and that these components can be heavily impacted by the wider context. Andrews, Bonta, and Hoge (1990) have emphasized matching services “to those attributes and circumstances of cases that render cases likely to profit from that particular type of service” (p. 20, my italics). The literature on external (specific) responsivity mentioned above reinforces this perspective. Nonetheless, frameworks that prioritize readiness serve to emphasize the dynamic interactions among the individual, the intervention, and contextual factors in how individuals respond to interventions and offerings (Ward et al., 2004). This more nuanced understanding of how individuals are enabled to respond to and utilize therapeutic interventions might be crucial for comprehending responsivity among IHSRs.

Responsivity and Individuals Convicted of Sexual Offenses

Recent studies support the assertion that certain sub-groups of individuals within the correctional system may need specific responsivity efforts to benefit from therapeutic interventions (see e.g., Lockwood, 2022), and individuals convicted of sexual offenses seem to constitute one such group. They are frequently viewed by both the public and, at times, professionals as being distinct from other incarcerated individuals, challenging to work with, and difficult to treat and reintegrate into society (McCartan et al., 2021). While being largely based on misperceptions, such beliefs place individuals with sexual offense convictions in a stigmatized position. Stigma, or even the threat of stigma, may lead to self-isolation, avoidance of therapeutic programs and social activities, or the adoption of a negative self-view that obstructs cognitive transformation processes related to desistance (Hudson, 2005; Laws & Ward, 2011; Sandbukt, 2023; Ware & Galouzis, 2019). Mann et al. (2013) explored the reasons why some individuals convicted of sexual offenses decline to participate in therapeutic interventions. They identified several common factors, including ineffective communication between staff and prisoners, insufficient information regarding the purpose, content, and effectiveness of the interventions, and feelings of unsafety within the prison environment. Each of these external elements influenced motivation to engage in treatment. In this regard, Blagden et al. (2016) examined the experiences and perspectives of both prisoners and staff at a therapeutically oriented prison for individuals convicted of sexual offenses, focusing on the prison climate. They identified “experienced safety” as a potentially vital responsivity factor for those incarcerated, as it allowed them “the headspace to deal with their problems, engage in treatment programmes and also grow and develop in personally meaningful ways” (p. 389). In a recent Swedish study, Lindegren (2025b) found that internal prisoner hierarchies, where people convicted of sexual offenses are often placed at the bottom, created a readiness barrier for men convicted of such crimes.

IHSRs represent a sub-population among individuals serving sexual offense convictions. They typically have extensive experience with therapeutic interventions and several failed attempts at going straight. This experience and their current situation of “being a recidivist” may intensify stigma-awareness (Sandbukt, 2025b) and pose additional responsivity obstacles. Given the severe consequences of sexual recidivism, it is important to understand how the overall unique situation of IHSRs affects the ways in which they feel enabled to respond to therapeutic interventions.

The Present Study

The present study builds on the idea that certain sub-populations may share specific responsivity factors or issues that professionals need to consider. There is a significant gap in our knowledge regarding how to effectively implement the responsivity principle when working with certain sub-populations that are in particular need of effective interventions. This study therefore utilizes an open and exploratory approach to examine “the lived responsivity experience” of individuals with a history of sexual recidivism (IHSRs). The goal is to amplify the voices of IHSRs and gain insights from their unique, long-term experiences with the justice system. The research question guiding this study was: What do IHSRs believe makes correctional interventions motivating, engaging, and effective, and what does not?

Methods

Background and Context

This study is part of a larger qualitative research project that examines various aspects of sexual recidivism through the narratives of individuals who have experienced it. Conducted in Norway, one of several Nordic countries collectively labeled “exceptional” in terms of penal policy and practice (Crewe et al., 2023; Pratt, 2007), the results must be understood within this context. In Norway, all therapeutic interventions provided within prisons are voluntary and subject to availability. Historically, there has been a lack of systematic approaches to identify who receives therapeutic interventions, the types of interventions offered, and when they are provided. Systematic risk screening for individuals convicted of sexual offenses has only recently been implemented, to link higher-risk groups to specialized psychological treatment services while they are incarcerated. Such treatment is most often conducted individually. While several prison units provide group-based programs, their availability and their focus on sexual offending differ across units. In summary, the types of therapeutic interventions available to IHSRs depend on the specific services offered by each prison unit as well as the motivation and eligibility of the individual to participate.

Recruitment and Participants

To be included in the present study, participants had to be serving a prison sentence for at least a second sexual offense conviction. This means they must have previously completed a prison sentence for a sexual offense, been charged in relation to a subsequent sexual offense, and then convicted and returned to prison for that reason. Recruitment was dependent on and facilitated by dedicated correctional staff contacts in prisons across Norway. Knowing that IHSRs serving sentences in Norwegian prisons are few (about 80 individuals met the inclusion criteria when the recruitment began), I requested that all eligible individuals be encouraged to participate. Prison contacts approached each potential participant, providing them with an information sheet that explained the study’s purpose and what participating would entail. Participation was voluntary and without financial compensation. After providing informed consent, each participant was scheduled for their first interview. Recruitment concluded after approximately one year when inquiries from prison contacts ceased, indicating a lack of new eligible individuals.

The final dataset consisted of 46 interviews conducted with 23 men. All information available about the men, beyond their history of sexual recidivism, was self-reported, with the following information gathered through interviews. The men’s mean age was 49.5 years (range: 28–84). A small number had been convicted of adult rape, while the majority were convicted of child sexual offending. Seventeen were sentenced to forvaring (a form of preventive detention; see Appleton et al., 2025), while the rest served fixed sentences ranging from 3.5 to 12 years. The men had one to four prior sex offense convictions and one to three prior releases from sexual offense sentences. About one-third had one or more prior non-sexual convictions. While most had some form of treatment or program experience from prison or the community, the intensity, format, and duration varied. Most of the men were attending therapy and/or treatment programs at the time of the interviews. The few who were not either did not want to participate or did not meet inclusion criteria for available interventions.

Procedure

Ethical Approval and Considerations

The study was approved by the data protection officer at Oslo University Hospital and the relevant correctional agencies. Confidentiality was strictly maintained throughout the process. During transcription and anonymization, I removed names of treatment providers, prison officers, and others. Given the vulnerability of IHSRs, less critical details are also occasionally removed from the quotes or slightly altered in the dissemination of the results to prevent participant identification. Pseudonyms are used throughout this article.

Data Collection

The interviews were conducted between 2021 and 2022 at 11 sites in Norway, ranging from high-security prisons and forvaring (preventive detention) units to transition prisons. Each participant was interviewed twice in prison. The interviews were audio-recorded, lasted about 2 hours on average, and were transcribed verbatim without unnecessary delay. Follow-up interviews were conducted between 1.5 and 5 months after the initial interview.

The interviews followed a semi-structured guide allowing for an open and inductive approach, and were largely participant-driven. The aim was to gain insight into what the participant rendered important in terms of recidivism, prevention, and risk reduction. Since the overall research project adopts a narrative perspective, the life story interview (LSI; McAdams, 2008) served as a foundation for the interviews. The topics covered important life events (e.g., high point, low point, turning point, and life challenges) as well as perspectives on the past, present, and future. The LSI was supplemented by questions about the men’s experiences from prior periods of imprisonment, release, re-entry, and therapy, as well as post-release supervision. When the participants described a therapeutic intervention as “good” or helpful, I probed further to encourage reflection (e.g., “Can you explain what you liked?” or “What did the professional do or say to help you?”). Conversely, for interventions deemed less helpful or effective, follow-up questions explored what could have improved the overall experience (e.g., “What was it that you disliked?” or “What could have been a helpful approach in that situation?”). For those with limited experience in therapy and programs, open-ended questions were used to investigate what they believed could have prevented reoffending (e.g., “What could have been said or done to help you back then?” or “what sort of support do you think you need to stay crime-free in the future?”).

Analysis

The data analysis process followed the steps of reflexive thematic analysis (Braun & Clarke, 2022). Initially, familiarization was an exploratory process in which I read and re-read the interview transcripts, searching for anything the participants described as helpful, motivating, or meaningful in the therapeutic interventions. The data was inductively coded in NVivo. The concept of “interventions” was approached broadly, encompassing any therapeutic or rehabilitative efforts from professionals, including prison staff. I organized these excerpts under an overarching code titled “what works,” which was later analyzed and divided into topics such as time, scope, relationships/dynamics, and readiness. Additional codes were created to include perspectives on what had not worked, allowing for the exploration of potential past responsivity issues. From the recurring topics and patterns across interviews, I developed themes based on shared meaning.

Methodological Reflections

A key issue to address is the uncertainty surrounding whether the men interviewed in this study are accurately reporting what works, given that they are still incarcerated. It is debatable to what extent individuals can objectively evaluate their own change and the relevance of such personal evaluations (Olver & Wong, 2017). From a narrative standpoint, accounts given are interesting regardless of an objective “truth” (Presser & Sandberg, 2015), as they provide insights into how experiences are understood. Thus far, the user voice has been more or less absent from the RNR research literature. This omission is regrettable, as responsivity emphasizes the importance of individuals’ subjective experiences regarding their ability to engage with and benefit from interventions. Ultimately, it is the users who are meant to respond, so it is essential that we hear from them. In light of the existing gaps in the responsivity literature, I argue that the men’s current positions and their extensive intervention experiences, including those from less effective interventions, render their perspectives worthy of scientific attention.

Positionality and Reflexivity

Describing and reflecting upon the ways in which one’s persona has influenced the collection and analysis of data is deemed an important part of qualitative research (Damsa & Ugelvik, 2017; Phillips & Earle, 2010). As the single interviewer, coder, and author of this study, these aspects become particularly important. In terms of positionality, I have worked in the field of sexual offending for almost a decade—a fact that I shared with the interviewees. This openness may have affected the stories they shared with me, though it is unclear to what extent. The power relations between the men in this study and myself are undoubtedly skewed, perhaps most clearly demonstrated by the fact that they themselves are not in a position (neither physically, because they are in prison, nor morally, because their stories may be assumed to be illegitimate) to speak to and be heard by a larger audience. At the same time, the fact that the men viewed me as somewhat of an “insider”—due to my experience from the field—likely helped create a safe environment for them to share their experiences, which contributed to the generation of rich data.

In the analytical process, I engaged in discussions of findings and potential interpretations with supervisors and experienced colleagues in the field of sexual offending. Before beginning data collection, I also established a research journal that I regularly updated to document the methodological and practical steps involved in gathering my data. After each interview, I wrote a brief memo to capture my immediate thoughts about the experience, including aspects such as the setting, atmosphere, and flow of the conversation. These memos frequently included observations on interactions during interview breaks, along with initial analytical reflections and questions. I revisited these notes later to critically review and confirm my interpretations during the data analysis phase.

Results

The questions that guided the analysis were what IHSRs believe makes correctional interventions motivating, engaging, and effective, and what does not. The results presented here reflect the themes that manifested from a combination of the participants’ current experiences and their prior intervention experiences recounted with hindsight.

Predictability

The first theme revolves around the men’s appreciation for therapeutic interventions that attended to their need for predictability, both within the framework of the intervention and regarding their future prospects. Essential elements in fostering a sense of predictability included trust, time, and post-release follow-up.

Trust

Most men agreed that building trust takes time, describing stability, routine, and long-term commitment as important. Many emphasized that they “have problems with trusting new people,” and therefore, unstable conditions and short-term attempts to “treat” them are not viable. As Mikael articulated,

[A] psychologist isn’t something you just swap easily. It’s about relationship and trust, and I struggle with trusting other people. I don’t have any problems talking to you because, in a way, these are things that I’ve been through so god damn many times [he laughs] and it’s kind of repetitive for me. But if I’m going to change to a new psychologist, for example, it won’t be done in a day. You know, I’ve spent a year to be able to open up to the one I’m seeing now. One year, right, and I’ve been going weekly – an hour and a half every week.

Many emphasized their appreciation for the opportunity to engage with the same professional(s) over a longer period (see also Hudson, 2005). For instance, William expressed satisfaction with his weekly individual therapy, referring to it as “a brilliant program,” with the best part being “that you can continue with the same psychologist and get good follow-up after serving time as well.” However, during our conversations, I sensed that although William appreciated the formal structure of this intervention, it did not fully meet his expectations in practice. He said,

I can add that I changed therapist six months ago and, in three months, [the new therapist] will be out on parental leave. So it’s not. . . I’m not saying that there’s anything wrong with [this intervention], but there’s also kind of a little problem there, that you don’t get sufficient continuity, and continuity is important. . . . [B]y all means, I think it’s going to go very well. But that’s something I hope [this intervention] will eventually focus more on, that they will practice long-termism and predictability.

Several men shared stories of “getting a new psychologist,” expressing disappointment and frustration over canceled appointments, instability, and unpredictability. Still, although they might have wished to see the same psychologist for years, this is rarely achievable in practice. Moreover, changes in therapists were sometimes welcomed, provided the men were prepared and perceived the change as an improvement. For instance, Kristian felt quite satisfied despite a recent therapist change, because the new one offered more stability:

That was actually a good swap. Yeah, because it was so unstable. And I think the previous one was just as good to talk to, but he was away more than this new one. . . . So the one that has taken over, he’s been very stable, he’s been here every time.

Time

Some men also emphasized the importance of time spent in therapeutic interventions: particularly those currently attending individual therapy shared thoughts about treatment intensity. While some opted for more frequent sessions, others favored longer ones, and a few felt they had little to discuss and wanted fewer sessions. Nonetheless, the majority expressed a desire for a higher intervention dosage than they had received. As an example, Lukas expressed frustration that he was only entitled to 45 minutes per week:

What I kind of experience as very frustrating in the therapy I’m attending now is the amount of time . . . they spend on us. . . . I always leave with a bad feeling, because I never feel done with what we’re doing. We never get to finish the things we’re doing in a good way. And I’m very aware of that.

Later, Lukas mentioned that he had tried to communicate his feelings to his therapist(s), suggesting that if 45 minutes a week was the norm, he would prefer one and a half hours every other week instead of weekly sessions. However, they could not find a solution that met his needs, and he questioned the reason behind it:

They say it can’t be solved. At first, they blamed the prison, but then I solved it with the prison, but then it wasn’t only about that anymore. It was about their time. So I don’t know, I haven’t gotten any good answers other than that it’s about resources. . . . [I] think for treatment in general, at least in an initial phase and at least for me, it would be important to have much more frequent and much longer conversations. Because I have a lot on my mind.

Post-Release Follow-Up

Another common concern was that prior interventions were too short or terminated too early. Simon had seen a psychologist during his last imprisonment, without much gain from it: “Y’know, six months is a short time.” Mikael wished he could have stayed longer at an open facility before reentering society and stressed the importance of “gradual release,” along with some level of control and accountability upon his next release. He said, “I think I will be able to function out in the community at some point, in a while, I don’t doubt that. But I need follow-up, I do. And I need regular follow-up.” Fredrik articulated a worst-case future scenario involving reoffending, and when asked whether this might happen, he replied,

If I’m not well prepared and don’t have a help and support system around me, then of course it can happen. I could of course sit here with my arms crossed and say “no-no, that’s never gonna happen,” but y’know, I can’t say that.

Even after a reasonable follow-up period, many men sought the assurance of an “emergency option”—someone they could contact if they felt particularly vulnerable to reoffend. Petter was approaching release and had applied for a therapist who could support him temporarily out in the community. He expressed confidence that he would not reoffend, but added, “You can feel certain today, yet uncertain tomorrow.” He therefore communicated his clear desire for post-release support, stating, “I want some form of follow-up, and I also want some form of reassurance that if I feel something [in terms of urges to offend], I can make an emergency phone call.” Several men shared similar sentiments and expressed concern about being left without a support system after their release, fearing that this could lead to new offending behavior over time. Isak, who had experienced two prior releases and the same number of sexual reconvictions, recognized that there were situations he needed to avoid upon release. When asked how to navigate those situations, he mentioned discussing them with his psychologist in therapy. He expressed satisfaction with her response: “[the psychologist] said, ‘Call me’. I liked that. That she said that I can simply call her whenever.” Knowing he had a safety net upon release provided him with much-needed predictability and a sense of security.

Entirety

The second theme, entirety, emphasizes the men’s desire for approaches that encompass the complexity of their histories and situations. They expressed a need for interventions to be holistic, or “all-inclusive,” and capable of helping them resolve the tension between offending and self.

An All-Inclusive Approach

The men opted for holistic and inclusive approaches where no significant aspect is systematically overlooked. While what was deemed most important varied among the men, they agreed that therapeutic interventions needed to address more than just the offense itself to be motivating and effective. This aligns with the literature on strength-based approaches, emphasizing goal achievement and well-being as strategies to prevent future offending (e.g., the GLM; Ward & Stewart, 2003). For example, Simon compared his current individual therapy to some of the prison programs he had attended, expressing a clear preference for the former:

[T]he difference between [current therapy] and some of the programs [this prison] offers is that in [the programs], it’s only narrowed down to crime. They don’t see the person. And I see that I have so much that’s kind of connected and needs to be dealt with, and in that regard, [current therapy] is a lot better because it’s [about] the whole person. . . . In one session, we might talk about that part, and other times, we may need to talk about that, and the third time, it might be something else that we. . . [he laughs a bit] Y’know, you get to address things, things that revolve around me as a person. And then it feels as if you’re actually. . . that I’m being heard, which is not the case in the programs at [prison] at all: there it’s kind of crime, crime, crime, crime, no matter what, and for me, that’s just not. . . well, it doesn’t give me anything.

At the same time, several men expressed regret that they had not been “pushed” or “forced” to discuss the underlying causes of their offending behavior. As IHSRs, they recognized that change processes could have been initiated earlier. For instance, I asked Robert what he thought could have led to a different outcome for him—how he could have stopped offending after a single conviction. He replied,

That I simply had had force met with force back then. And kind of. . . well, maybe been met with some demands and specific questions about why. You’re usually not met with that when you’re serving a regular sentence, y’know. [But] when you’re on forvaring you’re. . . well, you’re asked questions, about why this and why that and what you think you need to change to get out. Many of those things, y’know. And . . . you kind of get picked to pieces and get those merciless risk assessments and conversations and those things that make you either kind of wake up or you keep flying around in the fog.

According to Robert, the “merciless” approach he finally encountered was beneficial—it helped him progress. While several men expressed regrets and complaints regarding the forvaring (preventive detention) regime, many echoed Robert’s sentiment. For example, Sebastian, who was serving his third sex offense sentence, spoke about how he was finally engaged in the process of change and self-reflection due to the requirements of this type of sentencing:

Maybe [I’ve changed] because it is a forvaring sentence and because things are up in my face all the time. Um, and I think that’s good. I’ve gotten a proper confrontation. I can’t just surf through this.

Resolving Tension

In line with prior studies, the need to be seen and heard was evident across the men’s narratives (Lindegren, 2025a). Several men felt that previous attempts to “treat” them had been superficial and did not address what they perceived as the real issues. Although most acknowledged that their crimes needed to be addressed, they were more interested in understanding how these crimes fit into the larger context of their lives. Simon elaborated,

No one has only one problem. . . . It’s all connected somehow, and then it’s about finding out that okay, how is this connected and also how can you. . . y’know, what can you do to . . . avoid situations that are not ideal. But as I’m saying, then you need someone who takes the whole caboodle.

This “whole caboodle” Simon referred to was often likened to a puzzle or a mess of experiences in need of entanglement. Many felt that their childhood and early years were integral to this caboodle. Consistent with prior research, many shared stories of adverse experiences and trauma, including instances of sexual violence, and they wanted to discuss these aspects during interventions (Kahn et al., 2021; Levenson et al., 2016). Samuel served as one example. Although he mostly denied many violent and sexual offenses on his record, he explained that, unlike previous interventions, he enjoyed the therapy he was currently attending. He described how his motivation for both attendance and change had increased, explaining, “They sort of take it piece by piece. They don’t exclude things, like [former therapist] did, right, who didn’t want to talk about my childhood.” Being denied the opportunity to discuss his childhood had seemingly served as a responsivity barrier in the past.

Adam had attended a group-based program in prison but had not yet received individual offense-specific therapy, adding that he was “envious” of those who had. Since he did not remember much of his younger years, he brought his family photo album and a binder full of documents to our first interview, explaining how these served as a testament to his childhood. Adam had revisited all the offenses he had committed over the years and tried to identify common features. It was evident to him that his childhood, filled with adverse experiences, mattered. He hoped to receive help from “professionals” soon to assess whether any of his theories were valid. When asked why it was crucial for him to get to the bottom of this, he simply replied, “Why I’ve become the monster I am?” and laughed. Like many others in this study, Adam had spent considerable time reflecting on why he had ended up with multiple sexual offense sentences in light of his overall life and who he “was” as a person. He seemed desperate for interventions that could help him connect the dots. In fact, resolving the tension between their offending and their identities appeared to be key for many (see also Kruse, 2020; Laursen & Mjåland, 2025). This aligns with prior research that emphasizes investigating and understanding the past in the sense-making process among individuals convicted of sex offenses (Lindegren, 2025a) as well as in the desistance process generally (Maruna, 2001).

The Professional Facilitator

While earlier themes focused on the content and frameworks of interventions, this final theme addresses the delivery style, characteristics, and skills of the professionals involved. Valued professionals were often described as facilitators of a safe environment, insight, and (readiness for) change.

Facilitating a Safe Environment

The men typically approached interventions with skepticism due to their backgrounds and expressed concerns that stigma might deter others with similar histories from accepting help. Some shared experiences of prison staff unintentionally revealing others’ status as individuals convicted of sexual offenses. For instance, Samuel explained how attending treatment could inadvertently expose someone’s status, which could refrain them from attending:

The officers talk about it out loud in the hallway, right. There’s one guy who’s always claimed that he’s in prison for murder. Of course we know that that’s not the case. And then the prison officer stands in the hallway and says that he needs to get ready to go to [name of intervention]. And of course, everyone knows what [this intervention] is.

Due to the stigma surrounding them, the men expressed that they needed assurance that confidentiality was prioritized, both inside and outside the therapy room. Lukas recounted that after being released from a previous sentence, he was referred to a local mental health unit but declined the treatment offer after the first preparatory appointment. He explained, “I wasn’t taken seriously when I was worried about my privacy rights. . . . I didn’t get an answer from them, and then I felt as if I wasn’t being taken seriously, and then I didn’t bother going there.”

The men were also acutely aware of professionals’ reactions to what they said (see also Sandbukt, 2025a), and, as indicated by the first theme, they needed time to establish a sense of trust and safety. Many highlighted the importance of “good chemistry” and a mutually respectful relationship with professionals as key to moving forward. As Morten stated, “You can’t open up to just anyone.” Kristian elaborated, “It’s about chemistry and about me feeling safe. And that I haven’t. . . um, been looked down on, y’know.” When I asked Kristian how he knew he was safe and not being looked down upon by a professional, he replied,

I can tell that they’re interested in me, and kind of what is it that. . . why have things turned out this way? Um, like they’re interested in my story, y’know, it’s not only kind of “oh my god, what have you done?” I’m a bit scared of that [sort of response], right; “you can’t do that.”

Several men said that it was easier to open up to professionals with extensive experience working with individuals convicted of sexual crimes, as they were less likely to be prejudiced. William explained,

If you seek out [services specialized in sexual offending], you know that there’s a psychologist who’s genuinely interested in that field, and who’s not judgmental. Because of course, if you go to see an average doctor, they will also, like everybody else, be prejudiced against pedophiles. By all means, they will probably try to do the best they can to help you, but if you meet with someone who has deliberately chosen to work with sex offenders . . . then you kind of know that you’re in the best possible hands, y’know.

Despite feeling “in the best possible hands,” several men were aware of the methods used by professionals and the language they employed. For instance, Lukas sometimes felt as if he were being categorized during therapy and expressed concerns about assessments and how results were communicated:

Personally, I find it very statistics-driven, and the parameters don’t fit me. It was difficult to see risk factors put into an Excel sheet and scored from 0 to 3. I understand why they need it, but it didn’t feel necessary to categorize me that way. The text explaining it makes sense, but the number doesn’t. I would prefer to just read the text, as I tend to get a little hung up on the numbers.

Such specific responsivity issues were sometimes communicated with frustration. Understanding why professionals gathered information and how they assessed certain areas was presented as a solution to enable the men to trust the process and gain a sense of safety (Mann et al., 2013). For instance, Adrian, who was about to start psychological treatment for the first time, expressed skepticism about the science behind what psychologists do, saying, “I’m thinking that if you had been able to see the inside of what they were doing and the assessments, then maybe that would have made a little more sense.”

Facilitating Insight

Once the men perceived therapeutic interventions as safe spaces, they favored professionals who presented as interested and committed to helping them proceed. For instance, recall Sebastian’s emphasis on the requirements associated with the forvaring regime, and how these elements provided a much-needed “proper confrontation.” Later in the interview, he emphasized that it was, in fact, his current therapist who had ultimately facilitated insight into what changes he needed to make, and how:

[The therapist] asks essentially good questions, she’s good at listening and paying attention. And she pokes into those parts that she finds interesting and wants to hear more about, and what I get out of those conversations is that I, um, I hear myself and I realize things myself, y’know.

Many men valued professionals who knew how to listen, ask the right questions, and provoke new perspectives. Several also expressed appreciation for interventions that were somewhat challenging and went beyond merely scratching the surface, stating that the opposite approach was often ineffective and a waste of time. For instance, William, who had engaged in various therapeutic interventions over the years, noted significant variation in quality and perceived benefit. He commented on one of his experiences,

[T]o criticize [Clinic] and the psychologist I had there, the treatment was not very confrontational, and it was kind of . . . like buying a good conscience. Rather than real help.

Similarly, Lukas expressed his feelings about a past therapeutic intervention, saying, “It gave me nothing. It was like talking to my dad” (see also Sandbukt & Harris, 2025). Now, after yet another sexual offense conviction, Lukas was clear about what he needed from his therapists. “I’ve said to my therapists that ‘I need you to be very hard on me’. Because I’m very good at talking. But I need them to challenge me, y’know.”

Facilitating Readiness for Change

Although several men used terms like “confrontation” positively, this was not necessarily indicative of a desire for traditional “confrontational” intervention styles (see W. L. Marshall et al., 2003). For example, Lukas described how feelings of shame could be triggered and amplified if he was “confronted in negative ways.” Like several others, he highlighted the importance of professionals abstaining from correcting him, allowing for readiness for change to be facilitated through time and reflection:

I need to be able to talk about my experience and the fact that that’s how I experienced it, and then that could be a cognitive distortion or. . . [he laughs a bit], or whatever, and I kind of accept that. But my feelings must also have a place in a conversation like that, no matter how bad it sounds, and then we just have to take it from there. Maybe there are feelings that I have to consider, [feelings] that are mad as hell, but you can’t start at that end. We have to start talking together. [People must] recognize that change takes time. It’s not like flipping a switch, like people think [he laughs]. . . . It’s a process.

The men’s reflections imply a preference for professionals who serve as active facilitators, engaged in their change processes. However, trust was an essential precondition, and, in line with the concept of readiness, timing and framing needed to be considered. In this regard, Petter explained how it took him many years and two sexual offense sentences to move from denial to recognition of his offenses. Although he could not precisely explain how this shift occurred, he credited his contact officer, who patiently paid attention to him and waited until he seemed ready before offering a place in a treatment program. Petter accepted the offer and, in retrospect, described the program as a crucial turning point in his life. He praised the program and its staff, contrasting it with previous treatment programs that merely “removed a bit of gravel from [his] head.” In this case, the professionals “used an excavator inside [his] head,” successfully breaking through the wall he had built over years of denial. In many ways, Petter’s story of personal change aligns with what Lindegren (2025a) referred to as a “micro-turning point”; being seen and offered the program at the right time indeed marked the start of a “crucial chain of events or insights” (Lindegren, 2025a, p. 3).

Concluding Discussion

While it remains unknown whether the men in this study will ultimately stay crime-free or reoffend upon release, I will discuss how their perspectives can potentially enhance professionals’ adherence to the principle of responsivity when working with IHSRs. As indicated by their reconvictions, previous periods of incarceration and therapeutic interventions had not been sufficiently effective in preventing crime. The men’s perspectives often highlighted what could be seen as previously unaddressed responsivity issues. They expressed that previous interventions were not satisfactorily available; professionals had failed to see or understand the real problems, or they had not created an environment that encouraged the men to open up and pursue their own change processes. In the words of William, “to use an old cliché: you can lead a horse to water, but if he doesn’t drink, he doesn’t drink.” However, several men noted that they had experienced significant turning points, with the thematic summary of findings highlighting predictability, entirety, and the role of professional facilitators as highly valued and central aspects. These findings can be interpreted in various ways. One interpretation is that the so-called “sexual recidivists” are not fundamentally different from other incarcerated individuals in terms of their needs from interventions and professionals; they simply have not had those needs met before. Arguably, all the themes raised are likely to improve the experience—and possibly the outcome—of therapeutic interventions for every incarcerated individual, not just those with sexual offense convictions or recidivism experience. Alternatively, the results suggest that having a history of sexual recidivism entails a slightly different set of responsivity issues that professionals should consider. This interpretation indicates the presence of what may be termed “sub-population-specific responsivity” among IHSRs, where the need for environmental safety and relational security lies at the core.

Readiness for and willingness to change is not a given for those who have sexually offended, nor should it be required in the initial stages (Harris, 2017; Ware & Blagden, 2017). The men in this study entered interventions with inherent skepticism, believing they might not be safe. While this applies to individuals convicted of sexual offenses more broadly, these men seemed particularly aware of external responsivity factors, such as professionals’ attitudes and overall styles. It is of course important to keep in mind that the men’s stories about past interventions and release experiences were recounted in retrospect, with the advantage of knowing how events unfolded. However, this experience may itself provide new perspectives that influence how they respond to interventions. Being an IHSR means being someone who has repeatedly failed in the worst possible ways and who is not yet considered a desister. However, for most IHSRs, we must assume that their goal is to become one. The desistance literature recognizes that leaving a criminal identity behind is as much a social process as it is a personal one (Laws & Ward, 2011; McNeill, 2015). The key to change often lies in the ability to “rewrite a shameful past” and envision oneself as a reformed individual in the future, a process that usually requires support and recognition from others (Maruna, 2001). In this context, the men’s repeated offending and (thus far) inability to correct their behavior may have increased their self-awareness and challenged their identities in ways that those convicted for the first time may not experience, at least not to the same degree (Sandbukt, 2025a). Questions such as “Why did I turn out this way?” or “What is wrong with me?” become more pressing, and if left unaddressed, they may impede processes of change and desistance rather than facilitating them. The men’s narratives also demonstrated an awareness that readiness for change fluctuates—an awareness that those who have not repeatedly failed may lack. As such, the need for predictability becomes increasingly pronounced, as illustrated by the men’s explicit desire for follow-up and an “emergency option” after release. Due to their past recidivism experience, they might question both their own capacity to change and the system’s ability to support them in this endeavor. An underlying vulnerability stemming from accumulation of internal responsivity factors, such as adverse childhood experiences (Kahn et al., 2021; Levenson et al., 2016), along with an unpredictable everyday life, may heighten the need for predictability and increase sensitivity to relational instability. In reality, responsivity is about professionals striving to respond to and adapt to such needs, thus finding the best method to increase and uphold readiness for change.

In terms of practical implications, this study demonstrates the extra efforts IHSRs may need from professionals to be ready for, and responsive to, interventions. It highlights the challenges IHSRs face due to lives thus far characterized by instability, adversity, and failure and discuss them in relation to their seemingly increased need for predictability, entirety, and insight-promoting delivery. The men communicated a need for assistance in “connecting the dots” related to their repeated offending, often searching for answers in their childhood, adolescence, and broader life experiences. In this critical endeavor, they expressed a profound need to be seen and heard—not only as complex human beings but also as individuals with intricate histories (see also Blagden et al., 2016). This requires time and continuous affirmation that they are supported throughout their change processes which also involves efforts to reduce stigma within local prison units (Lindegren, 2025a; McCartan et al., 2021; Ware & Galouzis, 2019). Although the need principle of the RNR model reminds us that effective interventions should address criminogenic needs, it is also recognized that addressing non-criminogenic needs may be beneficial for the individual’s overall well-being and motivational purposes (see e.g., Jung, 2022). For IHSRs, this acknowledgment seems key, at least in the initial stages. Confidentiality and a non-judgmental approach are crucial to keeping them motivated for interventions. Moreover, the relationship—or alliance—with professionals may be more critical for IHSRs than for other incarcerated individuals. Upon release, support networks such as Circles of Support and Accountability (CoSA) can provide IHSRs with the predictability they need (Azoulay et al., 2019). Within CoSA, volunteers and professionals play a crucial role in fostering motivation and readiness for change, ultimately ensuring safety to both IHSRs and society. These networks also facilitate opportunities for individuals to engage in discussions about their offenses, allowing them to be held accountable while also being seen beyond their offenses. Future studies are needed to investigate whether the findings from this study translate to other contexts.