In the past trauma has been as an area to be avoided in working with people who have offended sexually because it was seen as providing individuals with exculpatory narratives. In this chapter an alternative view to this will be examined. The chapter explores a range of pathways linking different kinds of experience of adversity, oppression, and trauma and sexual offending. The utility of making sense of the developmental context of offending in order to facilitate interventions and developing case formulations will be explored. A range of interventions that focus on different biological, psychological, and social, trauma-derived processes in the lives of people who have offended sexually are explored.