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This book examines the forces of sadomasochism in the clinical domain where transference and countertransference reside. Psychoanalysts write in depth about cases where sadomasochism is present for both analysand and analyst. Four cases present the unfolding analytic exchange where life and death forces collide. Each case is accompanied by three discussions illuminating the complex phenomena that often include lifelong perversions and painful narcissistic difficulties. Through the case presentations and discussions, psychoanalytic therapists will find maps for guiding their own work with sadomasochistic processes. Treatments where sadomasochism is prominent abound with dramas containing control and denigration, domination, and submission. Often there is a history of over stimulation and under stimulation from infancy and childhood influencing the formation of object relations and unconscious fantasy.Since Freud first introduced the concepts of component instincts and psychosexual development, psychoanalysts have been exploring sadomasochism in its various forms. The belief that togetherness involves tormenting pain creates a sense of life and death struggle that is imbued with powerful instinctual gratification. Unconscious sexualized scenes of both dyadic and triadic forms carry humiliation and conquest. These analysands employ a variety of defenses, especially disavowal. The analyst's affective responses to the negation and attacks provide an opportunity to recognize conflicts and repetitions, and to move them into a symbolizing process. Contributions to the book come from a variety of psychoanalytic perspectives. Understanding of these sadomasochistic phenomena highlight psychoanalytic thinking about conflict, instinctual life, object relations, trauma, narcissistic vulnerability, primitive states, and perversion.