In forensic psychotherapy there may be competing goals and agendas, influenced respectively by concerns about mental health and well-being, risk reduction and psychodynamically-significant change. There has, to date, been no published study of the goals and concerns of forensic patients undergoing therapy. Semi-structured interviews with ten patients considered by their therapists as having gained from forensic psychotherapy were analysed thematically. Results indicate the importance to patients of trust and acceptance in the therapeutic relationship, and changes in the domains of perception of self and interpersonal functioning as well as changes in problematic behaviours. These findings have implications for the choice of measures in systematic outcome research.