Incarcerated older persons’ motivation to engage in criminal court-mandated treatment: Findings from a qualitative study

Background: Motivation to change is a central component of successful psychotherapeutic treatment. It is however unclear how external pressures in court-mandated treatments interfere with a patient's internal motivation. This study sought to investigate service providers' and users' experiences with court-mandated psychotherapeutic treatment and its effects on a patient's motivation. Methods: We conducted a qualitative interview study with 41 older incarcerated persons receiving involuntary treatment and 63 mental health professionals (MHP) from Canada and Switzerland. Interviews were analyzed using thematic analysis. Results: MHP participants referred to the difficulties of using internal motivation as selection criterion for treatment participation but emphasized the advantage of the legal referral as a chance to connect with a person who would otherwise not seek treatment. This coerced participation in psychotherapy allowed the MHPs to build internal motivation throughout the intervention. Further, we delineate certain external and internal factors that influence treatment motivation. For instance, a patient's strategic motivation to engage in treatment to regain freedom; the influence of authorities' decision-making processes on treatment motivation; conveying and understanding of psychotherapy to promote active participation. Conclusions: Our study provides important empirical findings on the effects of the legal referral on a patient's motivation. Findings suggest that the legal referral in itself does not stand in contradiction to internal motivation. In fact, it facilitates the engagement with a person needing treatment. However, a patient's internal motivation is challenged if goals set by external decision-makers are unclear, unpredictable, and vague. To increase the effectiveness of court-mandated treatment, institutions should therefore establish clear goals that are communicated clearly and transparently to the patients. With this clarity, a patient's internal motivation can be enhanced, which ultimately affects outcomes of court-mandated treatment orders.