This study explores the impact of inclusion of victim empathy-based content in offender treatment. It presents first a systematic review of 20 papers, before proceeding to consider a qualitative interviews with therapists (n= 7), and forensic patients (n= 5), who had completed a long-term violence therapy (Life Minus Violence – Enhanced, LMV-E©). The research explored perceptions of forensic patients and treatment facilitators when completing victim empathy work, and explored any negative effects this may have. Findings from the systematic review indicated five themes: (1) Interventions incorporating victim empathy can be effective; (2) There are positive risk-understanding consequences from completing victim empathy work; (3) Offenders perceive victim empathy positively; (4) The emotional impact of victim empathy work on offenders’ is poorly explored and, (5) Completing victim empathy in treatment groups receives mixed evaluations from offenders. The systematic review was used to inform the interview themes for the resulting qualitative study with facilitators and forensic patients. This study indicated six themes: (1) Victim empathy content facilitates change; (2) Victim empathy content can be difficult for patients; (3) Victim empathy content can lead to an emotional response; (4) Victim empathy content can be beneficial, with the process important; (5) Victim empathy content can help understand risk, and (6) Patients’ experience of treatment begins before attending sessions. The results are discussed with attention to similarity in perceptions and experiences between staff and patients, with suggestions made for clinical implications and future research.