"Conversations with a Killer: The John Wayne Gacy Tapes" explores several themes, including:

Between 1972 and 1978, Gacy murdered at least 33 young men and boys, many of whom were struggling with addiction or were runaways. He would typically lure his victims to his home, where he would rape and murder them. The bodies of 29 of his victims were found buried in the crawl space under Gacy's home, while the remains of four others were disposed of in the Des Plaines River.