People who engage in sexual acts that are compulsive or criminal often show marked fluctuations in superego functioning. Alongside a ‘moral’ superego, there may be a harsh and condemning superego, as well as evidence of a more ‘perverse’, sadistic superego. The individual may feel identified with the superego, or at the mercy of it, or it may be projected onto the therapist or others. Therapeutic work often reveals marked underlying depression. Illustrated with clinical vignettes, this chapter explores these different configurations and describes the challenge for the therapist to position themselves constructively in relation to these shifting internal objects.