ABSTRACT: The literature on music therapy with hospice patients often accentuates the positive aspects of the process and places less emphasis on difficulties the therapist may face. This article examines specific obstacles that may arise when working with dying patients. Four vignettes are presented, which include issues of apathy, depression, anger and frustration. The seemingly overprotective family member scenario is also viewed in relationship to its effect upon the dying patient. A closer look at such difficulties may deepen the understanding of what a person may experience when approaching death. The therapist's reactions to the patient's experiences (countertransference) are explored and emphasized as well. The author's work within the hospice setting was guided in weekly Analytical Music Therapy supervision sessions, whereby, over a period of one year, helpful lessons on coping with patients' rejection were discussed. The lessons and the supervision techniques that were used to teach them are outlined at the conclusion of this article. The title Patient Declined refers both to the psychological issues related to the patient's final physical decline towards death and to the patient's decline of music therapy services. In reviewing the growing body of literature on the topic of hospice music therapy, I have found that the case descriptions focus almost exclusively on the patient's problems and/or decline and much less on the therapist's challenges or difficulties, perhaps out of respect to the topic of death, or to the memory of the deceased patients. Additionally, the cases that are brought forward in the literature usually end on a positive, comforting note. In contrast, in this article, I chose to focus on the difficulties that I faced in my work at a home-based hospice agency. These difficulties associated with the process of dying resulted in patients declining music therapy services and were brought to my weekly Analytical Music Therapy supervision meetings to be analyzed in depth with the support of my supervisor. This article summarizes one full year of therapy sessions and supervision meetings. The purpose of this article is to examine and analyze some of the difficulties that may arise, for patients and therapists alike, when working with people who are dying. Four vignettes are presented, focusing on patients with apathy, depression, anger, and frustration. The hardship of working with family members who are seemingly overly protective is presented as well. There has been a valuable discussion in the music therapy literature regarding the various needs and problems of hospice patients (e.g., Gilbert, 1977; Krout, 2000; Maue-Johnson & Tanguay, 2006; West, 1994). Unlike previous writings, however, this article includes an examination of possible psychological issues that may arise within the therapist as a response to the patient's problems. In addition, it presents some of the most helpful lessons that were learned in supervision through the supervisory techniques that were used to teach them. Since the supervision was anchored in the theoretical perspective of Analytical Music Therapy, some of the key theoretical highlights of this method are featured, specifically, discussions of countertransference and the possible defenses that are parallel within the patients and the therapist. Clarification of Terms In my training and philosophical background, I am an Analytical Music Therapist. Analytical Music Therapy (AMT) is an indepth music therapy method pioneered by Mary Priestley in the early 1970's in Great Britain. Based on the concepts of Freud, Klein, and Jung, the underlying theory of this method acknowledges the existence of an unconscious and identifies its effects on people's behaviors. AMT presumes that in any therapeutic relationship conscious and unconscious feelings of the client towards the therapist (transference) and of the therapist towards the client (countertransference) are inter-related and may affect the course of the therapy (Priestley, 1994). …