Patients who have been sexually abusive toward children in their family often have guarded prognoses. However, the legal system's promotion and support of treatment elicits cautious optimism; even limited progress can make a significant difference in the lives of these persons and their families. The authors report on their work with incest perpetrators in a psychoanalytically oriented psychotherapy group with 20 incest offenders (selected after evaluation of 50), describing major obstacles (i.e., patients' lack of motivation and countertransference) and frequent clinical issues (i.e., perversion, psychopathic tendencies, low self-esteem, and substance abuse).