How can you be certain that how a patient comports themselves in the therapy office is the same as how they behave in other social contexts? The way we treat a credentialed person that we are paying is wildly different from how we treat a partner who has driven us nuts for the hundredth time or a child that we have institutional power over, for instance. Patients don't magically become a new person when they walk through the door... but to be oblivious to the massive ways in which social context and power change behavior from moment to moment is...pretty detached from what most research shows on human psychology and behavior.