This two-paper dissertation reports on the findings of a qualitative study that was designed to capture the clinical dynamics that emerge when a therapist becomes pregnant during treatment. Raphael-Leff (2004), a psychoanalyst known for her research on pregnancy as well as her own psychoanalytic theory of mothering orientation, has outlined procreative mysteries, or anxieties, that are deemed universal by pregnant women. She defines them as anxieties about formation, containment, preservation, transformation, and separation. Pregnant therapists are not immune to these anxieties, and in some instances, may even feel them to a greater degree. While there have been some empirical studies that have captured the pregnant therapist’s perspective, it is a sparse amount in comparison to the vast number of women therapists who become pregnant, and there have been to my knowledge no studies that have actually interviewed clients of pregnant therapists. This study seeks to begin to redress that crucial missing perspective by interviewing the clients of pregnant therapists, as well as first-time, formerly pregnant therapists. Using both object relations and intersubjective theories as a conceptual lens, this two-paper dissertation aims to uncover some of the processes of conscious and unconscious communication that comprise the therapeutic dyad when the therapist is pregnant. Additionally, it seeks to offer guidelines on what both practitioners and supervisors might expect when a therapist becomes pregnant during treatment. The first paper will look at the coded results of this qualitative study and its emergent themes. The second paper will expand on the findings and look at particular object relations and intersubjective theories that can be important in understanding and working with this particular “intrusion in the analytic space” (Fenster, 1983). In the second paper, I will introduce a concept I am calling “the fourth” which represents not only the therapist’s pregnancy in a literal sense, but also the figurative, symbolic, conscious and unconscious meaning which the therapist and patient each attach to the pregnancy as well as new motherhood, and their co-created meaning.