This chapter deals with intergovernmental relations in Italy. The perspective is theoretical, historical, and constitutional. After recalling the origins of political autonomy in the medieval experience of the municipalities, the author analyses the birth of the Italian State and its transformations in the Liberal Era, during Fascism, and in the years of the Constituent Assembly. The Italian Constitution established a “Regional State,” whose characteristics have been outlined superficially. The relationships between the State, the Regions, and Local Authorities have been influenced by many factors, which are analysed in detail. Even reforms have failed to stabilise intergovernmental relations. The new Republic of Territorial Autonomies, created due to the 2001 constitutional revision, has achieved positive and negative results. The essay also highlights the new problems arising from the process of European Integration and the international crises (social, economic, and military) of the third Millennium. The result is that, alongside the written Constitution, a living Constitution has been created, primarily determined by social contexts, politics, and the jurisprudence of the Constitutional Court. Intergovernmental relations depend on many variables, so the Italian case is fascinating from a comparative perspective.