When a client dies during the course of treatment, the therapist is left with a residue of grief, with no formalized connection to the mourning process, and with many questions about the consequence of therapy itself. The therapist must deal with an intense loss within the strict confines of professional confidentiality. Death-and its finality-brings to the fore the central paradox of the clinical relationship, the therapist's knowing a patient so intimately and yet being totally outside the social structure of that person's life. Three psychotherapy cases will illustrate the complexity of feeling generated in the therapist when a patient/client dies.