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Kerry Kelly Novick and Jack Novick present their view of sadomasochism as a relational phenomenon with multiple determinants, importantly including painful experiences in early attachment relationships. They discuss their research on beating fantasies and the significance of such fantasies in individuals who develop a sadomasochistic way of functioning. They consider the challenges of working clinically with these problems and introduce their dual track model of development, which enables the clinician to conceptualise the aim of treating such patients as moving them from a closed system way of functioning to an open system way of functioning.