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Tony Ward’s commentary on our case study of pedophilia and the application of empirical science to this challenging case begins by noting the empirical and theory-driven approach taken in the treatment of John Smith. Ward makes three observations upon which we would like to comment. First, John has been in treatment for a long time, as was necessitated by the multitude of his mental health and other needs, requiring intervention prior to placement in a less restrictive treatment environment. That he was in treatment for a lengthy duration and made only modest progress does not always imply treatment failure, but could be a reflection of the complexity of his psychiatric, social support, interpersonal, medical, risk management, and sex offender treatment needs.
Second, Ward correctly notes that John’s comorbid psychological problems, including mood and personality psychopathology, complicate treatment intervention. Many individuals with paraphilias also experience mood and personality disorders (e.g., Becker, Stinson, Tromp, & Messer, 2003; Stinson & Becker, 2011), many of which are additionally identified as dynamic predictors of risk (e.g., Hanson, Harris, Scott, & Helmus, 2007). When treatment providers fail to address these issues—particularly psychiatric comorbidity, which may imply deficits in self-regulatory functioning—the client remains at risk for future sexual recidivism and other related problems.
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