In assessing the family's contribution to the child's sexual victimization, the following issues should be examined: poor supervision, poor choice of surrogate caretakers, inappropriate sleeping arrangements, blurred role boundaries, and sexual abuse by a parent. Treatment issues vary somewhat depending on whether the perpetrator comes from outside the family, is a family member but not a parent, or is a parent. The family interactions in incestuous situations are pathological, characterized by abuse of power, fear of authority, isolation, denial, lack of empathy, poor communication patterns, inadequate controls, and blurred role boundaries. Other family member characteristics are extreme emotional deprivation and magical expectations of other people and the world. Members of parental incest families are usually involuntary clients. The unconventional strategies needed to work successfully with them are the therapeutic use of personal authority, the use of leverage to induce client participation, aggressive outreach efforts, and provision of total life support. The therapist also needs the capacity to focus on the child sexual abuse. Individual and group treatment should be used in conjunction with family therapy. Treatment outcomes should be monitored; available data indicate that abuse is often repeated while under treatment. Eleven references are listed.