Psychoanalytic psychotherapists increasingly find themselves treating patients who present with problems of compulsive sexual behaviour or sexual perversions. Drawing from clinical examples and theoretical perspectives, the author delineates six key themes which encapsulate her own learning when commencing work with perverse patients. The first is the heterogeneity of this group of patients, both in terms of symptoms and presentation, but also in terms of the depth and developmental implications of the pathology. Further themes are the patient's fear of the object and the inability to bear separation. The author explores the significance of negative countertransference which may be experienced in relation to perverse patients, as well as the risks of being drawn into exhibitionistic or voyeuristic dynamics. Finally, the nature of the superego in perverse patients and the impact of this on the transference are discussed drawing on O'Shaughnessy's notion of the abnormal superego.