Psychotherapeutic work with sexually abused children can prove to be highly taxing, not only for the children in question but also for the psychotherapists who must cope with a heavy emotional, aggressive, and sexual charge. Be it because of the nature of the trauma experienced by these children or because of the defense mechanisms that they use in psychotherapy, the clinician’s capacity for containment is severely tested. In this theoretical and clinical article, we reflect upon the psychic harm that sexual abuse can inflict on children and the psychic functioning engendered in them by this abuse. In addition, we examine the differences in how children who are developing well and those who are sexually abused express sexuality during psychotherapy. Finally, we present the technical and countertransference challenges that psychotherapists who work with sexually abused children are liable to face. Brief clinical vignettes are provided to illustrate particularities of the therapeutic work conducted with these children.