This article describes a study that investigated pivotal moments in music therapy in adult mental health settings. A phenomenological qualitative method was used in order to search for answers to the questions for investigation. It included an extensive literature review, regarding pivotal moments from different fields, including music therapy. Three semi-structured interviews with music therapists investigated their experience of pivotal moments, the role function and importance of pivotal moments in music therapy. Detailed information was analysed using Phenomenological Interpretative Analysis (IPA). A case study supports the evidence gathered in the interviews and literature review, and describes the emergence of a pivotal moment and its contribution within a short-term individual music therapy treatment with a man with schizophrenia. Gathered information and results from the interview analysis highlight distinctive characteristics of pivotal moments and their contribution to the patients' lives and therapists' work. Pivotal moments are found to change the music therapy process and lead to a better understanding of the patient. The role of the therapist, the therapist's qualities and basic features or techniques that support the emergence of pivotal moments, are also discussed.