Abstract
This article takes a psychoanalytic perspective on incest and child sexual abuse. It concentrates on what could be called “the loss of the sense of reality” that is experienced by the victim of incest. The position in which a child of five is placed when she is sexually abused by her father is considered; this is followed by detailed material from the analysis of a woman who had an incestuous relationship with her brother. Transference and counter-transference difficulties that arise in work with abused patients are explored. A theoretical explanation of the damaging effects of an incestuous relationship is outlined.