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The author reviews her 40-year professional career in forensic psychotherapy. She describes her formation at medical school in Argentina, the Menninger School of Psychiatry in Topeka, Kansas, and the Henderson Hospital in Surrey. She reflects on her work, for 30 years, at the Portman Clinic. ‘Dancing with death’ is a metaphor for seeking serious danger, and she offers an extensive clinical vignette from her early career to illustrate the complexities involved in the assessment and treatment of perversion, reviewing the case in the light of her more recent thinking. Perversion is seen as a manic defence against the dreaded black hole of depression but, as well as being associated with the death instinct, perversion secures survival. Both features have to be born in mind in therapeutic work, and she considers both technical and transference/countertransference aspects of treatment, emphasizing the particular advantages of group-analytic psychotherapy. The context in which Mother, Madonna, Whore was written is reprised. Lastly, she surveys the work of the International Association for Forensic Psychotherapy and our developing understanding of severe female psychopathology.