The sexual exploitation of a child by one who has been recognized as a representative of God is a sinister assault on that person’s psychosocial and spiritual well-being. In 2002, the Roman Catholic Church in America was rocked by allegations of over 10,000 children sexually abused by clergy between 1950 and 2002. As overwhelming as that number is, survivors’ personal stories of sexual assault by clergy and their often courageous struggle to recover have an even more powerful impact. Many survivors of clergy perpetrated sexual abuse (CPSA) present with a range of symptoms consistent with Posttraumatic Stress Disorder as well as common co-occurring problems, including substance abuse, affective lability, and relational conflicts. Yet there are additional themes, particularly the impact of the abuse and institutional betrayal on the family, profound alteration in individual spirituality, and changes in individual and family religious practices, which differentiate this form of abuse from other traumas.Drawing from the testimonies of survivors, their families, and others affected by these crimes, this book furthers our understanding of CPSA from theoretical, clinical and spiritual perspectives with consideration given to future research needs. Understanding the profound and multidimensional effects of clergy perpetrated sexual abuse and the betrayal of trust by religious leaders on individuals, families and communities requires the collective wisdom of many voices. This book brings together the perspectives of survivors and practitioners and scholars from the professions of psychiatry, psychology, social work, theology and law to examine this highly toxic form of interpersonal violence. This book was published as a special issue of the Journal of Child Sex Abuse.