Picture a day bed draped with an exotic, patterned blanket on a faded Oriental carpet in a room decorated with African sculptures and shelves overflowing with books. This image accompanied an opinion piece in yesterday’s Sunday New York Times about the ineffectiveness of long-term, unstructured, open-ended psychotherapy.

Although the author Jonathan Alpert doesn’t say it, the picture does. The kind of therapy he’s describing, in which the therapist listens passively with just an occasional nod or a “How do you feel about that?” is the psychodynamic approach practiced by Freud and his disciples. Even in the absence of compelling scientific evidence to support its effectiveness for a host of psychological problems, this type of treatment still has a tenacious hold on many practitioners today. But that’s a topic for another discussion.

The article has inspired a barrage of outraged Tweets and blog posts by therapists who’ve perceived it as a disloyal attack on our profession. Many of them practice long-term psychotherapy and, understandably, feel the need to defend their approach. While I’m not as offended by Alpert’s allegations as those colleagues, I still take issue with much of his argument.

When people seek me out for treatment, they’ve usually done their research and know I practice Cognitive-Behavioral Therapy. CBT is much more focused, problem-oriented, and time-limited than the traditional therapeutic approach that keeps patients on the couch for years on end, perhaps with no resolution of their neuroses (think Woody Allen). So if you’ve decided to work with me, you’re not expecting the process to drag on indefinitely.

Even so, problems aren’t always neatly resolved in the twelve to sixteen sessions described in the treatment manuals. That’s why, when I’m asked how long therapy will take, I always say, “That depends.”

Depends on what, exactly? A variety of factors enter into the algorithm—your willingness to push through discomfort, the presence of complicating conditions (depression, substance abuse, marital problems) secondary to the problem that brought you in, scheduling and financial constraints, the level of your current distress, among others.

I’m not trying to be vague or evasive. To the contrary, from the first session I try very hard to help my patients define clear, specific goals and understand what it will take to reach them. But it’s not nearly as simple as Alpert (“Manhattan’s most media friendly psychotherapist,” according to his website) makes it seem when he writes, “Many patients need an aggressive therapist who prods them to face what they find uncomfortable: change.” (I don’t think it’s by accident that Alpert, as media savvy as he appears, is touting an all-out assault on the fear of change. His new book, Be Fearless: Change Your Life in 28 Days, is due for release any day now.)

More important than having a particular therapeutic style, I believe, is understanding how change happens and being willing to confront the obstacles as they come up, even if it means putting the therapeutic work on hold for awhile or discontinuing treatment altogether until the interfering conditions can be resolved. Better yet, predicting and addressing potential difficulties at the outset can help speed the progress of therapy and minimize both the patient’s and the therapist’s frustration.

To that end, I spend a lot of time up front laying a solid foundation for the treatment phase of the work, sometimes taking a month or more to build the base. (So much for 28 days, and the treatment hasn’t even begun!) As tempting as it may be to offer a quick therapeutic fix, I’ve learned from experience and some unsatisfactory outcomes not to jump in too fast. And while I agree “it doesn’t take years of therapy to get to the bottom of . . . problems,” I’m also highly skeptical of Alpert’s claim that “for some of my patients, it doesn’t even take a whole session.”

Most critical to me—and, I hope, to my patients—is for us to have the same agenda. So if someone has learned to cope with her panic attacks but wants help in sorting out career issues, say, I’m fine with continuing treatment for as long as we both agree it’s helpful.

Many of my patients are ready to wrap up therapy in two months, or six. But I’ve been seeing others for four or more years, though not ever week, certainly, and not because they’re not making progress. If that were the case, I’d have referred them on long ago, possibly to a psychodynamic therapist with a different set of skills from mine. Still, I know some more orthodox cognitive-behavioral therapists wouldn’t openly admit to extending the length of treatment past the standard guidelines despite the prevalence of this practice.

Sometimes people like to come back every so often, or even on a semi-regular schedule, to stay in shape. It’s like continuing to see a trainer after you’ve achieved your peak level of fitness. Reevaluating your routine and shaking it up from time to time can help keep you on top of your game.

So I wouldn’t necessarily conclude, as Alpert does, that an extended course of therapy means the treatment is bad or ineffective. I wouldn’t even agree that someone who’s in therapy to feel better (a situation he likens to relaxing “spa appointments”) without working on specific goals for change is wasting his time, although I personally wouldn’t be treating that individual. What’s most important, in my view, is to assess what you’re hoping to get from your treatment. And if you don’t feel you’re making the progress you’d like, by all means bring it up with your therapist for review.

You might need to tweak the approach, or you might need to move on. It depends.