An appraisal of selection criteria for dynamic psychotherapies and implications for setting time limits

Practitioners of short-term dynamic psychotherapies commonly hold the working assumption that through rigorous selection procedures the progress to be expected in a specified length of time can be predicted. We question this assumption and draw upon relevant findings from the psychotherapy research literature, as well as from our own clinical and research experiences, to support our skepticism. Without minimizing the demonstrated effectiveness of short-term therapies, we propose that setting prearranged time limits be either replaced or supplemented by the implementation of a "time limited attitude." We further propose that this attitude can contribute to more efficiently conducted treatment, regardless of length. The concept of a time-limited attitude is defined, and the suggestion is made to arrange therapy in defined but flexible durations of treatment rather than by either setting initial termination dates or leaving the time open-ended. Finally, we suggest that the initially proposed length of treatment be determined by the clarity with which a treatment focus can be established. Clinical vignettes are provided to illustrate the relationship between clarity of focus and initially proposed length of treatment.