The author distinguishes between two kinds of beginning, conceptually tied to two ways of approaching the psychoanalytic situation described as epistemological and ontological. Through a clinical case, the author shows how her work with a troubled adolescent had two beginnings that corresponded to these types. In this way, she tries to expand on the literature about the ontological turn, focusing on what beginning means in this context. For treatment to succeed, a birth must emerge, a transformative moment with the potential for significant change. The combined ability to transform the most primitive, somatopsychic pain can be more effective if shared by analysts and patients in a predominantly aesthetic form.