Sibling sexual abuse (SSA), despite being a complex phenomenon with potentially significant consequences for all involved, has not received sufficient empirical and clinical attention, and practitioners are therefore often left to cope without appropriate guidance. This study compared staff perspectives and experiences of working with SSA cases across two Child Advocacy Centers (CACs)–one in the U.S. and one in Israel–with different cultural and legal contexts. Findings reveal that both CACs focused on parents, the parents’ negative emotional responses to SSA, and the impossible nature of their predicament. The CAC in the U.S. tended to emphasize the needs of the victim while being attuned to the legal proceedings, whereas the CAC in Israel emphasized supportive therapeutic responses for the whole family. The authors conclude that the differences across the two CACs are related to the different legal and cultural contexts and underscore the need to review what may be the most appropriate policy and practice response to SSA that does not itself cause further harm.