Practitioners often experience confusion and helplessness when trying to work with an adult survivor of child sexual abuse. However, they can use the emotions they feel for survivors as their own personal guide to helping these victimized adults. One of the most important gifts a therapist can offer an incest survivor is an attitude of genuineness. The therapist should also be knowledgeable about the statistics, dynamics, and symptoms of child sexual abuse. The therapist should also have extensive experience, because novice therapists are inappropriate for working with adults molested as children. Therapeutic skills include listening, empathy, validation, self-disclosure, and honesty. At least half the work with incest survivors should focus on one-to-one relationship skills. The therapist also needs to educate victims about their rights and provide knowledge about legal issues, confidentiality, the possibility of changing therapists if dissatisfied, the therapy process, and the therapist's experience in working with incest survivors. The therapist also needs to be prepared for the victim's common reactions of fear, pain, shock, anger, and grief. The four major hurdles to confront during recovery are crisis, denial, fragmentation, and choice. Therapists also need to address their own professional issues, including burnout, heightened awareness, therapist transference, and taking home the pain.