The authors offer reflections on what seems to work in individual psychotherapy with university students. Discussion centers around the topics of triage and disposition, referral, crisis intervention, stress management, open-ended psychotherapy, extratherapeutic factors, and the psychotherapy relationship. These observations are not intended to be a comprehensive review; rather, the effort is to stimulate interest and dialogue on this important subject. The authors draw on their experience in working in a university counseling service, psychotherapy research literature, and what has been learned from students served.