During the first session with a client, Dr. Greenwald often says something like, "Do you want me to concentrate on your problems, or would you like us to work together in making you happy?" Immediately, he suggests to clients that in fact they are able to change and become happier.
Dr. Greenwald describes seven phases that direct decision therapy involves:
1. Decide what you want in order to be happy (or happier).
2. Find the decision behind the problem: what has your implicit decision been in your life that has established an unhappy, or less happy, pattern? Greenwald calls these life decisions: they form the center around which you organize your life. They are responsible for your attitudes, perceptions, what you value most, and your behavior.
If your life decision is to suffer, you will interpret everything that happens to you as more suffering-to-be-endured. If you are praised, you may question whether the praise has an ulterior motive. "Sufferers ... have the ability to snatch disaster from every victory."[[9]]
3. When was the original decision made? Did your life decision come from your upbringing? Did you inherit it from your parents?
4. Identify the payoffs for the decision. Even extreme unhappiness—chronic clinical depression—can have real payoffs: release you from responsibilities, gain you attention from others, allow you to return to the comfort of childhood dependency, etc. Anxiety can give you good reasons for disqualifying yourself from stressful situations and reinforce your belief that you cannot cope.
5. What are your alternatives to the behavior that is causing a problem? It is often hard to see that you are not really trapped in a state of unhappiness. There are always alternatives.
6. Choose your alternative and put it into practice. Trust yourself. "[H]appy people have a sense that whatever happens, things will eventually work out. In short, they trust themselves to react in their own best interest."[[10]]
7. Support yourself in carrying out your decision. Habits die slowly. You must be patient. Your decision has to be made over and over again, just as an overweight person who loves food must decide again and again to say "No" to this dessert today, the baked potato tomorrow. Gradually, the strength of your decision builds as you build strength into it.