Psychotherapists have been dealing with the concept of sexual sadism and masochism for decades. In his early writings, Freud (1924) described sadomasochistic (SM) practice as a means of obtaining pleasure through the administration or obtaining of pain. He recognized that SM behavior contradicted his theories of human instincts and the pleasure principle, and ultimately attributed the behavior to the interaction of imperfect aggressive instincts, unconscious Oedipal guilt, and the enigmatic death drive. His initial perspectives on SM behavior ultimately informed our field's current perspectives on SM as a form of psychopathology. To date, some researchers study SM sexual practices through a psychopathological framework that characterizes SM identity as a type of abnormal sexuality. Meanwhile other psychotherapists see the practice as linked to complicated object relations, narcissism, affect regulation and various neurotic responses (The Clinical Problem of Masochism, 2012). Recently, researchers have pushed for a non-pathological understanding of MS behaviors. Lawrence and Love-Crowell (2008) state that researchers and clinicians should adopt an informed, non-judgmental stance when undertaking work with MS populations. Others propose that researchers form broad, neutral, or positive definitions of SM practice (Powls & Davies, 2012). Unfortunately this initiative is hampered by society's continued view of SM as deviant or abnormal. Furthermore, SM culture and practice are not often discussed in psychology training programs. This article will highlight empirical work describing the history of diagnoses of sadism and masochism, while acknowledging the limitations of studies in this area. Works detailing the culture... middle of paper... for use with incarcerated individuals and it is not yet known whether they would be appropriate for use in other contexts. More work should be done to develop interventions that can be used with SMs who adhere to the safe, healthy, consensual mantra characteristic of the SM scene. Furthermore, studies should be developed that represent the voices of SM women as well as SM participants in terms of gender, sex and ethnicity. A more complete understanding of the diverse communities within the MS culture may lead to the development of more effective treatment methodologies. Finally, psychologists should take note of the growing interest in healing or “therapeutic” narratives presented in SM websites, literature, and popular media (Barker, Gupta, & Iantaffi, 2007) as these findings have been linked to psychological growth and to the increase in sexual self-efficacy (Bader, 1993).