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Contemporary psychotherapy is practiced in situations in which clinical and ethical guidelines tend to be ambiguous. This allows a practitioner's self-interest, personal or economic, readily to conflict with the clinical needs of patients. Psychotherapists may direct patients who present for evaluation toward treatments the clinician knows or prefers, rather than to someone who can provide a different, more appropriate modality. For example, nonmedical psychotherapists may be reluctant to consider medication, or a psychoanalyst may avoid short-term focused interventions. A busy psychotherapist may select patients more for their attractiveness or capacity to pay than for their need of treatment. Sometimes a patient's stated goal may be rapid relief of a specific symptom; experience with time-limited psychotherapy suggests that this is a realistic goal. The author regrets that this observation has not been submitted to systematic verification. He urges psychotherapists to reassess their practice patterns, and to develop an efficient mental health system that meets the current needs of patients by providing a variety of treatment modalities that include but are not weighted toward long and intensive procedures.