ABSTRACT
This chapter explores clinical material in the light of the patient's history from an extended assessment and subsequent treatment, to highlight some of the dynamics involved in paedophilic activities. It suggests that what the paedophile hopes to achieve in his offending is primarily the elimination of anxiety emanating from the dreaded emotional experience of exclusion, isolation, emptiness, and non-existence. During the initial assessment he did not deny his offending, although he wanted to insist that his paedophilic activities had always been non-penetrative and fixed at fondling boys to erection in their boxer shorts. It was quite clear that Alex's increasingly demanding behaviour on the ward was symptomatic and linked to his paedophilic psychopathology. Alex had made it abundantly clear to be that if he were released from the secure hospital he would re-offend within twenty-four hours, emphasising that his own paedophilic functioning could not be trusted.
