SEXUAL ABUSE OCCURS FREQUENTLY AND FORMS THE BASIS OF A SUBSTANTIAL PORTION OF CHILD AND ADULT PSYCHOTHERAPY. MOST SEXUAL MISUSE OF CHILDREN IS BY TRUSTED ADULTS. PERSONS WHO ENGAGE IN INCEST ARE OFTEN AFRAID AND UNWILLING TO BECOME INVOLVED IN THERAPY, BUT THE PROGNOSIS IS EXCELLENT FOR FAMILIES WITHIN A STRUCTURED SYSTEM OF SOCIAL MANAGEMENT AND TREATMENT. A CASE HISTORY OF CHILD ABUSE AND THE PROVISION OF PSYCHIATRIC CARE SUGGESTS SEVERAL RULES FOR THE PSYCHOTHERAPIST TO FOLLOW IN THE EVALUATION AND MANAGEMENT OF INCESTUOUS CHILD ABUSE: (1) DO NOT RELATE ONLY TO ONE PERSON; (2) DO NOT RUSH CONJOINT THERAPY; (3) DO NOT TRY TO MANAGE ALONE; (4) DO NOT HIDE FROM SOCIETY AND KEEP SECRETS; AND (5) DO NOT JUMP TO PSYCHODYNAMIC CONCLUSIONS. MANY MANAGEMENT GUIDELINES DEVISED BY HELFER AND KEMPE, BRANDT STEELE, PARENTS ANONYMOUS, AND OTHERS CAN BE APPLIED TO SEXUALLY ABUSIVE FAMILIES. A MODEL DEVELOPED BY A CHILD SEXUAL ABUSE TREATMENT PROGRAM IN SANTA CLARA COUNTY, CALIF., COMBINES PROVEN QUALITIES OF OUTREACH, SUPPORT, AND SELF-HELP WITH SPECIFIC STRATEGIES OF INTERVENTION, CHILD ADVOCACY, AND THE ENHANCEMENT OF INTERAGENCY TEAM COORDINATION. THE PROGRAM ACHIEVES A HIGH RATE OF REHABILITATION FOR FAMILIES ONCE THOUGHT TO BE UNMANAGEABLE. THE FOLLOWING KEY ELEMENTS OF THE SANTA CLARA COUNTY PROGRAM SHOULD BE CONSIDERED BY ANYONE ATTEMPTING TO PROVIDE THERAPY FOR SEXUAL ABUSERS OR THE SEXUALLY ABUSED: THE PROGRAM IS PART OF THE PROTECTIVE SERVICES-JUSTICE SYSTEM, THE PROGRAM PROVIDES A FOCUS FOR MULTIPLE SERVICES, THE PROGRAM USES BOTH IN-HOUSE AND OUTSIDE REFERRAL RESOURCES, STYLES OF COUNSELING AND MODES OF THERAPY ARE ADAPTED TO THE TASKS AT HAND, THE PROGRAM SPONSORS AND SUPPORTS A SPECIFIC SELF-HELP ORGANIZATION, AND THE PROGRAM PROVIDES FOR THE MORALE AND EMOTIONAL GROWTH OF ITS STAFF. WITH THE HELP OF COMPASSIONATE AND ENLIGHTENED PSYCHOTHERAPISTS WORKING IN A COORDINATED SYSTEM OF SOCIAL AND LEGAL INTERVENTION, CHILDREN AND THEIR PARENTS CAN BE TREATED AND TAUGHT APPROPRIATE WAYS OF HANDLING CONFLICT. (DEP)