The present study examined the reactions of 24 bulimic women to their therapist's pregnancy. Behavioral checklists, process notes, and one-year follow-up questionnaires revealed concerns about loss, sexuality, competition, abandonment, dependency, jealousy, and a desire for children. Few of these responses were offered spontaneously. Length of time in treatment along with diagnoses of borderline personality disorder were associated with intensified emotional and behavioral reactions. In addition, participants indicated that the event provided an opportunity to explore the demands on women to excel in their personal as well as professional worlds. The significance of fertility for the bulimic woman, along with recommendations for managing the myriad therapeutic and practical issues that arise when a therapist is pregnant, are also addressed.