With regard to these latter problems, it is important for the patient to be very specific in identifying the therapeutic
goals he wants to attain. Sometimes, this task is relatively easy, as when the goal is simply, say, to become
heterosexual rather than homosexual, or to be free of migraine headaches, or to lose weight. Often, however, the
patient's problems are more diffuse, he has vague feelings of anxiety or depression, he suffers a general lack of self-
confidence, he complains that his life has no direction or purpose. In such cases, it is important to help him
formulate as specifically as possible the conditions that would have to be satisfied in order for him to regard
himself as "cured." He should be led to formulate specific goals, psychological and/or existential, toward which he
is to work. Otherwise, therapy can become a diffuse, interminable process.
At each step of the way, throughout therapy, it is important for the patient's self-esteem and progress that he take
whatever actions are volitionally possible to him with regard to the correction of his problems. Problems are not
solved all at once; they are solved step by step. In the slow, difficult process of helping a patient build self-
confidence and self-respect, one must do everything possible to help him avoid repeating the errors that led to his
neurotic condition. Problems are not created all at once; they are created step by step; and then they are sustained
and reinforced year after year, by endless repetitions of the kinds of self-defeating practices I have discussed
throughout this book. The patient must be made aware of the things he does that he could avoid doing, which serve
to keep his problems alive. He must be made aware of, and encouraged to take, the opposite kinds of actions, so
that the process can be reversed.
For example, suppose that for many years a person has tended to retreat from any challenge or difficulty that
seemed at all threatening. As an adult he is passive, withdrawn, self-doubting, ineffective. The therapist cannot
demand of him that he immediately undertake major projects or responsibilities that clearly are light-years beyond
the range of his present level of confidence. So one begins by encouraging him to set a series of modest goals, goals
that do constitute a challenge for him and invoke some degree of fear—but a fear that is manageable, a fear he has
the power to work his way through and to overcome. The patient thus acquires the strength and confidence to move
on to more demanding goals.