Masochism appears as a multi-layered puzzle: First, there is the relatively easy-to-answer question of why someone can derive satisfaction and even sexual pleasure from pain, humiliation, and shame, and therefore voluntarily places themselves in situations of suffering. The second question is already more challenging: How can pain addicts respect themselves? The core of the puzzle, finally, primarily addresses therapists: How can one help such pain addicts? It is extremely difficult to address and change the masochistic character, symptom, and sexual issues. Treatment requires a great deal of patience from all parties involved, and each success is regularly followed by setbacks. Léon Wurmser demonstrates that the solution to the puzzle lies in a better understanding of the dynamics underlying masochistic behavior, illustrated through detailed case studies.