There are many problems, like panic attacks, which usually have a fairly simple cause.  There are other problems, like low self-confidence, which have a complex, multi-level structure.  Each level of the problem is the cause of the level above it.

Frequently, a person with this kind of problem will notice feeling uneasy when doing or even thinking about doing certain activities - talking to a group of people, or being in a confrontation situation, for example.  This automatic stress or fight/flight response has behind it certain patterns of thought which are the next level of the problem, and the sufferer may or may not be aware of this.

Causing these thoughts is the likely next level of the problem, which is the beliefs - often unspoken and unacknowledged - which a person has about him/herself and the world. Examples would be "I am inferior", or "I will never be acceptable", or "people always dislike me, even if they don't always show it", for example.

These beliefs have been learned at some time in the past, usually during childhood, and the level behind the beliefs is the memory (which may be out of conscious awareness) of the original learning experiences. Sometimes an angry parent or schoolteacher may have told the child that (s)he will never succeed at anything. The child believed every word, and has believed it ever since, despite forgetting the time the teacher made the comment. Sometimes the child decided this for him/herself, after a painful or difficult experience.

A further level of the problem can be that, because a person has always 'known' they could not do it, (s)he has only rarely practiced that behaviour, and as a result may not have the repertoire of social skills (s)he needs to perform well in that situation.

Because of this complex structure, therapy needs to be particularly careful. Typically, each level of the problem is supporting or causing the others - so the therapist cannot simply deal with one level the first session, and another the next. Experience is that the most successful approach is usually to begin by teaching self hypnosis and stress management techniques to the client - who can then use daily relaxation and self-hypnosis exercises to maintain the resulting improvement him/herself. The therapist can then address other levels of the problem in subsequent sessions, and of course the experience of successfully learning the skills of self-hypnosis, and the greater control this gives has a profoundly beneficial effect of the client.

The complex structure of low self-confidence leads many sufferers, who have tried and failed to deal with the problem themselves, to decide that there is nothing that can be done. This belief is usually mistaken, and there is real hope for those who seek it. It is commonplace for this kind of problem to be totally relieved by therapy here piece by piece, and this is also the experience of many other competent therapists.