Can you expand on this? It seems to me that deep seated cultural issues are the sort of thing that therapy is supposed to address. However, I may be looking at this from the wrong angle.

The people who see issues with themselves get therapy. The ones that see no issues with themselves don't.

That is what "deep-seated cultural issues" means. Some subset of the population aren't seeing a problem with their own behavior. They see nothing that needs addressing. The rest have to learn how to put up with or avoid them.

Is efficacy not part of your calculus?