Yeah, I encountered these during my clinical postdoc. Two patterns that jump out at me: A few patients who marked low scores and continued to return for really productive sessions. When I followed up about the pattern, they had simply confused the scale anchors and forgot to correct it. It was much more common for people to mark me with higher ratings and then simply not return for therapy. So I didn't weigh them too heavily: I just did my own check in with people about their services. Sometimes I talked about the items, most of the time I didn't mention them.