Seventy percent of the 300,000 runaways on the streets today are running from sexual assault. This is one of the facts presented to relate the severity of the problem of child sexual abuse. Two basic dynamics which occur in child sexual abuse are power and sexualization of nonsexual needs. The five phases of this abuse are engagement, where there is access to the child; sexual interaction, where there is a progression of sexual activity; secrecy, where there are promises made or threats of physical harm; disclosure, either accidental or purposeful; and suppression, where there is denial. The perpetrator is usually emotionally immature, overinvested in his family, and unable to meet his need for closeness and affection in a nonsexual way. In treatment there must be a break through the denial and a change in family, family structure. The mother may be dissatisfied with her role in the family, sexually dysfunctional, or physically absent. Treatment for the mother includes helping her deal with environmental change, inability to trust, denial, and anger. Some impact areas and treatment issues for the victim are damaged goods syndrome, guilt, fear, depression, and impaired ability to trust. In an incestuous family, the relationships among the three primary members mother, father, and child, are drastically altered from those that exist in a well-functioning family. The intent of the work with family members is to change these relationships. The child must be moved from the powerful linkage with the father; the husband and wife must rebuild and strengthen their relationship; and a strong relationship between mother and child must be built. The physical, emotional, behavioral, and interpersonal symptoms of child sexual abuse are listed. 11 references, appendixes, and bibliography.