This meta-synthesis explores individuals' experiences of engaging in psychotherapeutic interventions for sexual offending. The findings of ten qualitative studies were integrated and five over-arching concepts emerged: (1) incentives and inhibitions: to engage or not to engage?; (2) help or hindrance: the impact of others in therapy; (3) the abused and the abuser: perspectives for transformation; (4) struggling and striving: dealing with distress and difficulties and (5) what works: inside and outside. A line of argument derived from these concepts is proposed as a framework for understanding sex offenders' experiences of therapy and highlights aspects of treatment programmes that need further exploration or emphasis. Using qualitative accounts can improve the responsiveness of treatment programmes, but such research is currently limited. Future qualitative studies and reviews could help further improve the effectiveness of treatment programmes, and thereby reduce the rate of sexual reoffending.