It's as much psychology as a bunch of tarot cards. Turn it over, say what's on your mind. But then that was the quality of Troi's counseling as well.
The only thing I loved about Lost was John Locke, I held on to the bitter end trying to suck more Locke out of it only to find out the really crappy Locke was really crappy at being Locke because he wasn't Locke and I could have quit months ago.
Star Trek psychology is hilarious stuff. But they can cure 99.99 percent of everything now so all they are left to deal with is miffedness and holoaddiction. Though why they can't fix Barclay's anxiety issues I'm not sure.. unless they are something he has generated himself with no help from chemistry because they complete him. And then there are a few genuine sociopaths.