Although mindfulness has become a mainstream methodology in mental health treatment, it is a relatively new approach with adolescents, and perhaps especially youth with sexual behavior problems. Nevertheless, clinical experience and several empirical studies are available to show the effectiveness of a systematic mindfulness- based methodology for treating adolescents who engage in sexual and physical aggression. In this article, the authors first explore the elements of mindfulness that are inherent in traditional cognitive-behavioral therapy (CBT) and then review how mindfulness has been systematically incorporated into several "third wave" cognitive-behavioral therapies--ACT, DBT, MBCT, and MDT--each of which have been applied with adolescents. While it can be argued that mindfulness is a "common" therapeutic factor across approaches, mindfulness can also be considered to be, and applied as, a primary modality to enhance the effectiveness of most therapies with adolescents who engage in problem behaviors, including sexual offending. The key, however, is making modifications to accommodate the unique developmental needs of adolescents. A case example is presented to demonstrate the clinical application of mindfulness with an adolescent victim and perpetrator of sexual abuse.