Music therapists have described powerful case examples and personal experiences of providing music therapy for clients who are actively dying that suggest a complex experience that merits further exploration. This phenomenological study was conducted to gain a better understanding of the lived experience of music therapists working with clients who are actively dying. Four music therapists (2 female, 2 male), with an average of 10 years’ hospice care experience, participated in semi-structured interviews. Data were analyzed using a phenomenological approach (Moustakas, 1994). Ten themes were distilled from the interviews and grouped into four categories: ongoing assessment, intuitive processes, countertransference, and the role of aesthetics and transformation. Participants described a flexible, dynamic clinical and personal process informed by ongoing assessment. These findings point to the importance of further discussion surrounding the clinical implications of the music therapist’s internal experience and the role of assessment, intuition, and aesthetics in hospice music therapy.