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CBT and other forms of therapy often require a certain intellectual sophistication, in order for people to actually understand what is demanded. Likewise the most hopeless cases are often not considered (they would need a lot of sessions); natural relapse is not considered, and neither is the placebo effect. All these effects add to a relatively high success rate.
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On the first point, it's this assumption that resulted in therapy only being offered to certain groups of clients, often there were class based predjudices about intellectual ability inferred from level of articulation or education.
As it has become more widely available, luckily this is no longer the case. It takes some people longer than others to access their cognitions. This could be due to level of introspection, but often it's also to do with the severity, number and type of problems. Those who find a cognitive approach difficult at fist respond well to a more behavioural focus at first, until they are at a point where cognitions may be accessed. I've seen the approach work with people with learning difficulities, with children.
CBT is used here in hospitals and by community mental health teams to treat the most chronic, with medication as well if the person agrees but often they don't. I am new to this area of work but have used it to help what some would call hopeless, life long cases with 20+ suicide attempts, people with borderline personality disorder. It doesn't suit every problem or every person. Some people need a much less focused, more dynamic approach such as psychodynamic therapy.
If a trial doesn't consider natural relapse and the placebo effect then it wouldn't make the grade and be published as a randomised controlled trial. the evidence base for CBT is based on the same methodology as for the introduction of a new medicine.
In the UK we have the National Institute for Clinical Excellence whose job it is to systematically review all the evidence and make recommendations for treatment, including drug treatment. They set guidelines for Doctors. Based on the evidence, they recommend CBT for many common mental health problems and the government is changing service delivery as a result, providing greater access to CBT. They are trying out the new structure now, you can read the original report, if you are interested:
http://www.strategy.gov.uk/downloads.../mh_layard.pdf