The clinician must be able to understand and accept that erotic feelings toward children are part of human nature and only warrant social intervention when the impulses are acted upon to the extreme. A puritanical repressive upbringing or experiences with sexual assault may make this type of work difficult or impossible, unless these feelings are worked through successfully. Because sexual assault usually is not an issue of life or death, the timing of particular decisions will vary depending on the child and the family. Mental health practitioners must balance a sense of immediacy with the long-range consequences of their actions and must be aware of other difficulties in the family. There is no evidence that any one treatment approach is indicated in child sexual abuse or that a particular therapeutic orientation is especially effective. Therefore, the therapist must carefully assess the needs and accessibility of all family members and consider various alternatives before deciding on a course of treatment. The balance between compassionate understanding and external control is extremely difficult to maintain in dealing with child sexual abuse, and many researchers claim that court-ordered treatment is more effective than voluntary commitments. Sexually abused children and their families can induce or evoke particular types of personal responses which result in the therapist's collusion with the family system, responding to the sexual milieu, and having unrealistic expectations. Finally, therapists receive minimal positive feedback from the community for their work with sexual abuse cases, and some job satisfaction must be self-generated. The paper includes six references.