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Clearly delineated therapeutic parameters are the hallmark of psychoanalysis proper and psychodynamic psychotherapies. Analytically oriented clinical training programs and institutes underscore the imperative of distinct therapeutic relationships, structures, and settings, as well as the need for technique to be anchored in a specific analytic theory. Although classical and ego theories represent the stringent end of this spectrum, few psychoanalysts would dispute the notion that a well-defined frame is fundamental to psychoanalytic therapy and that its absence implies porous boundaries that may render the analysis ineffective or worse.
However, clinical work does not occur in a vacuum. And today more than ever, psychotherapy regularly occurs outside the traditional analytic frame or setting. Mental health practitioners work in atypical clinical settings, such as primary care facilities, college counseling centers, and primary school systems. In addition, patients present with an array of problems and crises, often precluding the luxury of time for analytic exploration. Such psychotherapeutic work, analytic or otherwise, regularly commences with a short-term focus, unusual treatment goals, and therapeutic temporal parameters straying far from the standard 50-minute session. Clinicians in medical centers, for example, work with the infirm and treat in hospital rooms or, at times, even in a patient's home. At other times, critical patient utterances often require immediate attention and direct advice as opposed to fostering patient-directed development. Many theoretical orientations are heavily focused on solutions (e.g., CBT, motivational interviewing) and therefore are more receptive to these interventional modifications. At first flush psychoanalytic approaches would appear to be particularly suited to such therapeutic expansions given the ethos of treating people rather than symptoms. However, such openness unfortunately fails to enter the mind-set of many analysts