Childhood sexual abuse (CSA) has somewhat affected the survivors’ mental health status, such as their psychological adjustment, and their personal, interpersonal, and social functioning. Novice counselors may face greater challenges when dealing with a client with CSA history as compared to experienced counselors. This case study aimed to understand the challenges faced by Malaysian counselors as they work with their clients with CSA and to comprehend the CSA clients’ narrative description regarding their lived experiences and challenges. Four themes emerged for challenges experienced by the counselor, namely: in-session counseling process skills, cognitive and emotional journey, diversity issues, and awareness of personal values. Themes that emerged from the lived experiences of CSA clients included counseling therapy, negative body image, fear of interpersonal relationships and thought and emotional distortion. The findings provided professional counselors a glimpse of such a process, including the competencies relied upon as well as the barriers identified by the counselors.