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Yes, it's hard to tell cause and effect, but I am amazed by how much many women (almost always women) spend on endless and unsuccessful therapy.
I think most of us have experienced a spiral at some point of our lives, where we go over and over some topic in our heads until e.g. we hit some object or some booze. As far as I can tell, from my experience, the general factor that works in any mental health method (if they work at all) is some way of preventing and/or stopping those spirals. Going over negative thoughts repeatedly, with someone who either validates your opinions or at least stays neutral, seems like a good way to get into the habit of such spirals.
Conversely, I like Albert Ellis's iconoclastic approach, which was to playfully mock e.g. "mustabory" cognitions ("I must be successful" "I must be loved" etc.) and challenging them by the same standards one would challenge a hypothesis or practical proposal. That seems to be one of the parts of CBT that actually works, but many people shy away from it, and cultivate their neuroticisms to the point of becoming an identity. The extent to which this occurs with some trans people is unclear to me, but I can't imagine it helps with e.g. autogynophiliacs or autoandrophiliacs.
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