In this naturalistic prospective longitudinal study, the authors evaluated the treatment selection decisions of 24 psychotherapists in private practice over a 12-month period. A comparison of the treatment selection criteria for patients who were accepted for treatment and for those who were not yielded 3 results: (a) Motivation was the outstanding factor determining whether a patient was accepted for treatment; (b) selection of short-term or long-term psychotherapy depended on the therapists' emotional response to the patient; and (c) psychiatric diagnosis and symptom severity contributed relatively little to treatment selection. These findings suggest that treatment selection in private practice psychodynamic psychotherapy is based on specific aspects of the therapist-patient relationship rather than on patient characteristics related to symptom severity or psychiatric diagnosis.