The authors report their main findings on the psychological characteristics of Mafia members studied in the past 10 years. Clinical data were collected, such as psychotherapy reports of therapists who treated patients belonging to the Mafia and clinical interviews of important Italian Mafia informers. The psychological profile of a Mafia member and his relatives is described. The importance of the process of identity construction that a mafioso must learn in order to join the Cosa Nostra organization is outlined. The psychological distress mafiosi suffer and the type of psychotherapy they require are reported, including brief excerpts from clinical sessions. Therapists and analysts always feel troubled working with these patients, and supervision is often required. Italian clinical work differs greatly from that represented in American movies, and specific theoretical and clinical training is necessary to treat the particular characteristics of these patients.