APPENDIX 1.2
CLINICAL CASE EXAMPLE

This case is a composite of a number of men whom I assessed while they were serving prison sentences for sexual offenses against children. Details have been changed or merged to protect confidentiality.

Mr. Smith was a 27-year-old man attending a sex offender treatment program while he was in prison serving a sentence for sexually offending against a boy. At the age of 26, Mr. Smith befriended a 13-year-old boy’s mother. Mr. Smith volunteered to help when the boy expressed an interest in working in the fast-food delivery business. He made arrangements to take the boy on his delivery rounds from 8:00 p.m. to 4:00 a.m. and asked for and received permission from the boy’s mother to have the boy sleep over at his place afterward in order not to disturb the mother after they were finished making deliveries. On returning to his apartment, Mr. Smith gave a mixed alcoholic drink to the boy, telling him it was only a soda. When the boy fell asleep on the couch, Mr. Smith performed fellatio on the boy. The boy regained consciousness while this was happening and ran out of the apartment. He notified a neighbor, and police were called. Mr. Smith was convicted of a sexual offense for the first time.

On entering treatment, Mr. Smith denied that he had ever committed a sexual offense, claiming that his conviction was a result of a misunderstanding. He was assessed in a phallometric laboratory (see chap. 2 , this volume) and was found to have strong sexual arousal to depictions of young boys and little sexual arousal to adult men or women. During his treatment, Mr. Smith admitted to a long history of sexual interactions with children, beginning in his own childhood after he was sexually abused by older boys. He estimated that he had had sexual contacts with dozens of boys over the years. Mr. Smith said he had committed these sexual offenses in public places such as parks or malls over many years without ever being caught or detected. On the basis of his sexual history and phallometric test results, Mr. Smith was diagnosed as having pedophilia.