Working with families in which there have been incidences of child sexual abuse is one of the most challenging assignments for a family counselor. Beyond ethical and legal mandates for reporting such assaults, less is understood about the long-term effects on victims. After reviewing the literature on child sexual abuse and gender differences, this article critically examines the major approaches to understanding and treating such issues in family counseling. Clinicians are cautioned to examine their own assumptions about the meaning of such experiences for their clients. Implications are discussed for the practice of family counseling.