Increasing empirical evidence points to the prevalence and devastating effects of sibling incest. The dynamics of incestuous sibling relationships are complex and typically embedded in severely dysfunctional families. Often confused and/or distressed by their incestuous experiences, many victims fail to disclose the abuse. Left undisclosed and untreated, unresolved issues of mutuality and consequent shame and guilt can lead to life-long emotional problems and dysfunctional behavioral patterns that are difficult to repair. Two cases illustrate common therapeutic themes, the importance of timely disclosure and coordinated, multi-dimensional treatment approaches, as well as the therapeutic challenges of assisting sibling incest victims who present for treatment as adults.