Psychotherapy- what it is good for?

Someone I respect a great deal recently told me that he thought psychotherapy was mostly bull[pucky].  That therapists all used the similar obtuse non sensical language (no single meaning for the word boundaries or self care, or co dependency or depression) language and that it was very unscientific, and pretty much useless.  I have to admit, I agree with this in many ways.

I think we have sold ourselves as the solution to everything from relationship problems, to trauma, to depression, to child rearing. Problem is-  first we were very good at selling this myth, and second- that it is simply bullpucky.  And, psychotherapy is NOT good, and this is backed by most all good outcome studies, at helping folks with a substance use disorder- stop using, and to stay stopped. 

Another problem is that there are no standards for outcomes.  And, when there is- say in depression or substance use (decreased depressive sx, or stopping use) if the treatment does not 'work' the patient is always to blame.  And frankly, it does not work more than it does.  How do you charge for something that rarely works?  A therapist will say- I charge for my time and skills, not for outcomes.  Sort of like your stock broker.  It's risky investment.  Strange profession.

Maybe we should say- people get better, not well! Better than what?  Than when they came in.  It's advice, take it or leave it?  We are simply not honest about what we can and cannot do.  Especially in regards to substance use disorders.  Individual psychotherapy is NOT EFFECTIVE at treating substance use disorders.  Some individual treatment can augment and improve outcomes when added to 12 step and groups treatments.  And there are now a number of effective medical interventions that help a great deal.  

So, we are left w two questions:  What works for the individual with a substance use problem, and second- what IS psychotherapy good for?  

I'll tell you my thoughts in the next week or so...