The most devastating aspect for the victim of childhood sexual abuse, and the one most usually dissociated or denied by him/her is the fact of the victim's own active participation and responsiveness in these relationships. The individual's coming to terms with his/her own participation in these relationships constitutes one of the pivotal issues in treatment. Clinical data is presented to illustrate these points and to focus on some of the technical issues that arise in treating these patients, such as the unraveling of the intricate interweaving of fact and fantasy and the definition of the limits of responsibility. Also discussed was the inability to trust others, simultaneous wishes and fears about dominating and being dominated, and lack of responsiveness, sexually and otherwise. 22 references.