Summary: This chapter addresses some of the demands, pressures and complications experienced by those who manage sex offender treatment programs. Some of the key issues for which managers are responsible include ensuring programs are faithful to risk need and responsivity principles; managing, supporting and developing treatment delivery staff (therapists); engaging the organisation and other stakeholders to support the treatment process; and ensuring that monitoring and evaluation strategies are in place. We discuss some of the challenges that managers face and offer some examples based on our experience of managing sex offender programs in three jurisdictions.