In contrast to obligatory or frank perverse sexuality, the term perverse defenses refers to certain modes of warding off intolerable affects, inner conflicts, external reality, and the experience of psychological “deadness.” Perverse defenses may involve seeking excited or altered states, taking risks, and engaging in sadomasochistic behavior, and they serve to avoid deeply felt commitment in a valued relationship. These defenses can markedly impede analytic process and may lead to treatment stalemate. Although patients with perverse defenses can profoundly challenge the treatment process and cause discouragement in the analyst, eventually they can achieve substantial analytic gain.