Treatment interventions are increasingly needed for patients with violent behavior, who make up a growing proportion of the population in public mental hospitals. The literature suggests that these patients repeatedly use violent behavior to obtain their goals because it has worked successfully for them in the past. They also tend to have an image of themselves as persons to be feared and to have limited patterns of imagination and fantasy that inhibit alternative responses. The authors describe a treatment approach that combines cognitive, behavioral, and expressive therapy concepts and incorporates creative therapies such as art and music. The goal of therapy is to alter the self-image of violent patients and help them develop alternative response patterns.