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Psychotherapy in Child Sexual Abuse Survivors [Counseling in Child Sexual Abuse] Sexual abuse is an abuse of power. It involves sexual activity forced on a child by either an adult or an older, more powerful child. Sexual abuse interrupts normal personality, sexual development in children and forces them to deal with intensive thoughts, feelings and experiences they are not ready for and that are often overwhelming, emotionally, psychologically and physically. Because the victims are powerless to stop the abuse and aren't old enough to understand what is happening, they may suffer permanent emotional damage even if there's no physical damage. Therapists or Counsellors are people trained to listen and respond to their clients and to help them make changes in their lives. They may have different titles such as psychiatrists, psychologists, social workers, school counselors, or art therapists. The important thing is that they are trained in trauma counseling and also in child sexual abuse. Therapy or Counselling is especially important when a child is betrayed by a person close to him/her, is struggling with the effects of the abuse, and/or when s/he is not supported by the family when s/he discloses the abuse. Not all children who experience childhood sexual abuse will develop diagnosable mental health conditions. However, children who are victims of childhood sexual abuse are at risk for posttraumatic stress disorder (PTSD) as well as for other mental health conditions. Awareness of the specific symptoms of PTSD and other childhood sexual abuse–related problems (e.g., depression, anxiety, behavior problems) is important to ensure that children are assessed accurately and receive the appropriate treatment. For example, the hyperarousal symptoms of PTSD can be mistakenly attributed to hyperactivity stemming from attention deficit hyperactivity disorder (ADHD), reexperiencing symptoms (nightmares and flashbacks) may be misdiagnosed as early psychosis, and negative cognitions and beliefs about the world may be mistakenly attributed solely to depression. Providers also must recognize that comorbid conditions, such as depression and PTSD, are not uncommon. Children often believe that because they've been abused, they are different. This may make them feel isolated. So, role of therapists is to normalize the child's life. Majority of trauma-focused treatments that have empirical support for children and adolescents are cognitive-behavioral therapies, with several common cross-cutting elements. These elements include psychoeducation about trauma and its impact (e.g., PTSD); affective modulation skills, such as relaxation and controlled breathing; gradual exposure to trauma memories; and cognitive processing to address unhelpful or inaccurate cognitions, such as guilt or self-blame. Gradual exposure appears to be a particularly important treatment element, given the cumulative evidence regarding its specific impact in reducing PTSD symptoms. In brief, this involves repeated exposure to details of the trauma as a way to extinguish trauma-related emotional and behavioral responses. This treatment strategy also helps improve cognitive processing of the traumatic event(s), which has been demonstrated to facilitate recovery. As noted with most child mental health treatment interventions, involvement of a supportive caregiver in trauma-focused treatments can be another important element related to positive outcomes, including reduced dropout, increased family engagement, and improved parent-child relationships While several evidence-based trauma-focused treatments exist, the most effective and widely disseminated psychotherapy intervention for children and adolescents to date is trauma-focused cognitive-behavioral therapy (CBT). In brief, trauma-focused CBT is a structured, components-based, time-limited (i.e., 12–20 therapy sessions) intervention that includes education about trauma and its impact, strategies to promote relaxation and positive coping skills, techniques to address inaccurate or unhelpful thoughts related to abuse, gradual exposure to enable children to share details of their experience and process their trauma-related thoughts and feelings, joint parent-child sessions to increase open communication about the abuse and its impact, and parenting skills to manage problematic child behaviors that may predate or be exacerbated by the childhood sexual abuse. Childhood sexual abuse affects a significant minority of children and adolescents and heightens risk for myriad acute and long-term consequences. Initial screening for children across mental health and other health care settings can increase early identification of those who need further evaluation or treatment services. Optimal treatments, specifically those that directly target the childhood sexual abuse and associated symptoms, are associated with positive long-term outcomes for this vulnerable population.