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If you are really interested, here are two serious but quite readable scientific critical articles on the effectiveness of psychotherapy.
Start with this one:�http://gaverdovskaya.ru/public/consam/story1805.htm
Then look at this one; it's very deliberately written, but you can only read the last two big paragraphs, it's quite clear – and interesting:�http://evolkov.net/practic.psychol/effect/Lauterbach.95.html
Excuse me: right now on the shore of Lake Baikal, my Internet is bad, and links are not inserted in the usual comfortable way)
Yes, it is possible that science in principle cannot determine exactly what affects what – we always limit ourselves to the assumption that it is likely that A causes B, which looks very plausible. If you answer this question in a more applied format, for example,” How important is the contextual effect in psychotherapy?”, then you need to introduce two clarifications: a) everything strongly depends on the type of psychotherapy used and the diagnosis, b) types of therapy are divided into clinically tested and non-empirically confirmed (i.e., they do not have an empirical confirmation). in any case, you can get to a therapist who practices something that does not have a proven effectiveness, for example, NLP or symbol drama), c) the contextual effect (i.e. placebo) remains always, the effect of therapy with clinically proven effectiveness = contextual effect + the effect of the active ingredient.
In general, all conversational therapy can be divided into two large chunks – psychoanalytic and cognitive behavioral. They overlap (for example, there are cognitive-analytical and schema therapies), there are doubts about whether to distinguish conversational therapy based on psychoanalysis as a separate type, and not as an intricate and poorly structured form of cognitive-behavioral therapy, but, in general, the picture is this.
There are a lot of diagnoses in psychiatry, but the roughest touch can be divided into externalizing (which are associated with increased activity and cause maladjustment through causing damage to the environment and others, for example, ADHD, conduct disorder, etc.) and internalizing (associated with reduced activity and avoidance, for example, depressive and generalized anxiety disorder). Actually, if we consider cognitive behavioral therapy in the context of its effectiveness in the treatment of these disorders, it is, in most cases, much more effective than a false intervention that creates only a contextual effect (waiting for treatment; relaxation; maintenance therapy, in which the therapist simply listens to the client).
In most cases, CBT appears in Western recommendations for the treatment of various psychological disorders as the gold standard (it is not recommended to use drug therapy until it is confirmed to be ineffective in a particular case, for example, such recommendations exist for the treatment of insomnia and anxiety disorders) or first-choice therapy (the patient or doctor can choose at their discretion between pharmacotherapy and CBT, for example, for depressive disorder).