This essay argues with urgency the need for psychoanalysts to redress a dangerous lacuna in psychoanalytic praxis. There is, Lentz argues, a disturbing inattention to the quiet but devastating reality that many treatments end because the analyst has died or has become too ill to practice. Lentz focuses on patients’ traumatic experiences of this kind of loss, which can ultimately render the treatment harmful rather than healing. Through clinical examples, literature review, and autobiographical narrative, she demonstrates the many ways that the “patient goes missing,” both on a psychical level and as a result of a collective disavowal by the field. Lentz discusses commonly-held patient affects, including the patient’s “felt insignificance” to the analyst, and resonances of boundary violation which can permeate the patient’s sense of loss. At root, this is meant to be an activist essay, calling on reform in the field, and offering some suggestions for change.