This case study describes psychotherapeutic work with a patient engaged in sadomasochistic and fetishistic practices. These practices are understood as defensive attempts in dealing with internal humiliation. Due to shame and humiliation, the theme of transvestism did not appear until later in the treatment. During the therapeutic encounter the perverse manifestations emerged as an inability to experience any affect. The control of the patient's psychic structure is traced through sexualization and development of an excited, erotized transference. The paper explores the source of titillation in the patient that created excitement in the therapist. The importance of containing the transference through a structural intervention is discussed.