"In my earlier days of doing psychotherapy, treating persons with a negative self-image was most distressing," recalled, "I would become angry because it seemed to me that the patient preferred to wallow in the mire of his fantasied worthlessness." "The trick in therapy," he concluded, using the English equivalent of the word "mussar" employed ("tachbulah") to describe both the evil urge and methods to defeat it, "is to remove the distortion" of view that hindered psychological and moral growth. Starting out with an old-fashioned moralism that emphasized the stubborn will as chief stumbling block to self-improvement, Twerski ended up with the premise that psychological blocks were essentially involuntary and therefore tantamount to physical disabilities, albeit ones subject to remedy.