This book delves into the mysteries of sadomasochism in the clinical domain where transference and countertransference are at play. Four cases present the unfolding analytic interchange when life and death forces collide. Psychoanalysts provide commentaries from different points of view to unravel the threads binding the complex and puzzling phenomena that often become the underpinnings of lifelong perversions and narcissistic difficulties. Discussions highlight psychoanalytic thinking about conflict, instinctual life, object relations, trauma, narcissistic vulnerability, primitive states, and perversion. This is a clinically centered book in which psychoanalytic therapists will find maps for guiding their own work with sadomasochistic processes.