This paper takes Betty Joseph's concept of ‘addiction to near death’, which describes a clinical situation in which sadism and masochism dominate the relationships of a particular group of patients, and applies it specifically to the case material of a girl in adolescent psychotherapy treatment. A link is made between the patient's retreat from mature genital sexuality as she approaches adulthood and the use of sadism and masochism towards this aim. The paper concludes with a discussion on the increase in strength and potency of sadism and masochism in adolescence as contributing to the high risk of destructive and self-destructive behaviour present in this age group.