The long-term effects of these violations of children have been described clinically. This study was initiated to demonstrate differences in emotional distress experienced by childhood victims of sexual abuse when abused by relatives, friends, or strangers. Clinical records of 311 women were reviewed following termination from psychotherapy. Fifteen percent of the women indicated they have been abused by a father, brother, grandfather, stepfather, friend, or stranger. The women identified long-term emotional effects related to their experiences. The most devastating psychological effects appeared in this sample when the victims were abused by a trusted person who was known to them. Family relationship (father, stepfather, brother) did not appear to be the determining factor in creating distress, but rather, the emotional bond the victim felt toward the perpetrator and betrayal of trust were crucial in the development of distress. Clinical implications for marital and family therapists were addressed. (Author abstract) 2 tables and 18 references.