The stress model takes into account the many factors involved including the victim's age, the frequency of the sexual abuse, the degree of associated aggression, the relationship of the participants, the total family dynamics and object relations before and after the abuse, subcultural customs, and environmental responses. The stress model recognizes that child sexual abuse is seldom the only stressor faced by the child victim; consequently, apparent effects of the abuse must be ascribed to factors in a complex situation. A developmental perspective is a key aspect of the stress model, since the nature or meaning of the abusive situation must be viewed in relation to the developmental status of the child. That status is a key element of the child's ability to protect the self from or deal with the abuse. Under the stress model, therapists must explore the range of stressors that clients have faced. A significant assessment issue is the determination of the centrality of sexual abuse to the client's self-concept. The assessment may conclude that child sexual abuse is not the primary issue to be addressed by intervention and treatment. Treatment evaluation must assess achievement in terms of the client's developmental trajectory and the apparent effect of particular interventions in altering it. Tables match the initial and long-term effects of child sexual abuse with the studies that have identified the effects. 165 references