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Although there is an extensive psychoanalytic literature on perversion, and numerous articles about creativity, few authors have explored relations between creativity and perversion. In particular, the role of childhood trauma and its impact on object relations has not been examined in patients with perversions whose creativity is blocked. In association with preoedipal anxieties and fantasies, childhood trauma can not only contribute to the development of perversion, but can also inhibit or distort the creative process by establishing an inner world characterized by the presence of a threatening internal bad object and the elusiveness of an internal good object. Though it is essential to help these patients establish an identification with the phallic father, an internal good maternal object, in the form of a muse, needs to be retrieved to bring inspiration and reduce the anxieties generated by an internal bad object, thereby facilitating the pursuit of authentic creative work. A detailed case report illustrates how this theoretical perspective guided the treatment approach to a male patient with macrophilia who was struggling to realize his creative potential.