This article will illustrate sadomasochistic dynamics as they arise within the consulting room and highlight the main function of perversions. Although the term “perversion” can be considered outdated, or worse, pejorative, if used in its original meaning, it remains the most appropriate term to describe the plight of certain patients who suffer from a specific sexualised form of acting out. One aim of the perversion is to attempt to reverse an earlier trauma by turning that passive experience, often not consciously remembered, into an active one. The patient suffering from a perversion replaces unwanted or unbearable historical affects with current actions that are sadomasochistic, sexually exciting, and highly gratifying, albeit temporarily, thereby keeping the patient's mind far away from the desolation of the initial trauma. At times, the actions patients are driven to for survival are paradoxically life-threatening. I will briefly refer to the difficulties of the countertransference in working with perverse patients.