You can pretend that clinical significance is the gold standard measure of disability if you like, but you should recognize that you leave a MASSIVE gap in your effectiveness both as a diagnostician and a practitioner if you neglect all the masking your client has been doing to deal with everybody’s demands their whole life. Seeing that bias in someone pretending to treat me would be enough reason for me to walk out of the appointment and schedule with someone more capable and knowledgeable.