In the summer of 2004, a number of psychotherapists with old ties to the University of Michigan or UCLA decided to write 500-word vignettes that attempted to capture a turning point in one of their child patient's psychotherapies. What did the child and adolescent psychiatrist do to elicit such a moment? Upon receiving seven vignettes, one of us (L.T.) attempted to break them into categories based on their operating principles. In the seven "moments" included in this paper, three principles applied. They were (1) following the patient's lead, (2) being "real" to the patient when called for, and (3) helping the child to thoroughly understand the fantasy or factual aspects of his or her problem. Interestingly, all three of these principles require bringing a strong sense of reality to the child's or adolescent's psychotherapy.