The biggest advance in the history of psychotherapy was to stop asking why and start asking what and how.

The psychoanalysts broadly believed that mental disorders could be treated by revealing and resolving unconscious conflicts and forgotten childhood memories. That's a very slow process, and eventually randomised controlled trials would demonstrate that it wasn't particularly effective.

Rational emotive and cognitive behavioural therapists essentially argued I don't care why you're nuts, I just want to teach you how to be less nuts. If you have habitually fearful or negative thoughts, you can learn to disregard those thoughts as unhelpful and consciously replace them with more useful thoughts. Knowing who to blame for your cognitive bugs doesn't really help you fix them. Aaron T. Beck had the good sense to subject his psychotherapeutic approach to randomised controlled trials, demonstrating that a relatively short course of cognitive behavioural therapy was at least as effective as several years of psychoanalysis.

Psychiatry, clinical psychology and psychotherapy undoubtedly has a lot of shortcomings and there are a lot of patients we don't yet know how to treat effectively. A far bigger problem however is lack of access - the vast majority of people who could benefit from psychiatric medicine simply don't get treated. In the developed world, it's usually fairly easy to get prescribed medication, but there are often long waits or financial barriers to access psychotherapy. In the developing world, most people can't even access SSRIs despite the cost being around $1 a month. Stigma and a lack of awareness are still a substantial barrier to accessing care.

We need better treatments, but the priority right now must be simply to get more people to try the treatments we do have. Trying a treatment with a 40% success rate is obviously better than doing nothing, but nothing is still the default and it's causing immense amounts of needless suffering.