At first glance, children who have been involved in sex rings seem to present the same as children who have been abused by a single perpetrator. Upon closer examination, subtle yet significant differences begin to emerge that can confuse and puzzle even an experienced clinician: gender confusion, inconsistency in reporting, and leakage of traumatic material. Other major differentiating categories between single- and multiple-offender sexual abuse are level of fear and the ability to trust. The fear created in children who are victimized in a sex ring is unusually intense, pervasive, and long-lasting and is commonly directed at the practitioner and the treatment setting. The child of a plural-offender sexual abuse situation experiences violations of trust within many relationships, especially those external to the ring. The child often views the therapist as another potential violator of a trusting relationship. Addressing the denial and resistance within the child welfare system in relation to child sexual exploitation by a ring is crucial to a practitioner's effectiveness. Developing a therapeutic parent-child relationship is also critical to the families who must live with their child's experience. 11 references. (Publishers abstract modified)