Clinicians are expected to treat very young perpetrators and victims of sexual abuse, often with limits on the number of sessions they may offer, the family members they may see, and the compromising circumstances of day care and housing arrangements affecting the safety and welfare of the children referred for treatment. Using specific case examples, this paper offers several therapeutic principles and their practical application to demonstrate brief and effective interventions that are sufficiently flexible to meet the challenges and needs of victimized and perpetrating children within the constraints imposed by shelters, foster and day care and other protective settings.