AI Is Taking Over Therapy Notes but Patients Say They Never Signed up for a Third Listener
The line between efficiency and intrusion.
Therapists across the U.S. are quietly flipping the switch on AI tools that record sessions, transcribe conversations, and draft clinical notes automatically. For some patients, the discovery that their most private moments are being processed by an algorithm feels like a betrayal. Molly Quinn, a 31-year-old librarian from Fayetteville, Arkansas, learned this the hard way when she noticed her therapist’s iPad propped up mid-session, per NPR.
“She wasn’t taking notes like she usually did,” Quinn says. That’s when she realized the conversation was being recorded. The moment she walked out of the office, the weight of it hit her. “I felt completely violated.” The technology is marketed as a time-saver for overworked clinicians. Companies like Berries, SimplePractice, and Blueprint charge monthly fees ranging from $19 to $99, promising to cut hours of paperwork so therapists can focus more on clients.
Berries Co-CEO Tal Salman says the system records audio in real time, deletes it immediately, and stores transcripts on HIPAA-compliant U.S. servers. “Therapy session content remains private and is not repurposed for training,” he says. But for patients like Quinn, the reassurances don’t erase the unease. “This person who I’m supposed to be able to trust with some very private and very intense emotions had just completely disregarded something I said I was not comfortable with.”
The pushback isn’t just coming from patients
Some therapists warn that even the presence of AI changes the therapeutic dynamic. Marisa Cohen, a couples and sex therapist in New York, says clients often sense when something else is listening. “That awareness can subtly alter their disclosure,” she says. Therapy relies on the illusion, or the reality, of absolute privacy. Introducing a digital third party, even passively, can erode that foundation.
Cohen also worries about accuracy. “If errors are introduced and a clinician isn’t meticulously checking the notes, that error is now part of the record,” she says. If those notes are ever subpoenaed, they become part of someone’s permanent history.
Not all clinicians share those concerns. Kym Tolson, a therapist who runs a fully remote practice while traveling full-time, says AI documentation has given her “my life back.” She used to spend 15 to 20 minutes per client on notes. Now, it takes about two. “I don’t have notes following me around, haunting me,” she says.
Tolson reviews every AI-generated note before it’s finalized and makes sure clients know the recording is optional. Still, she acknowledges the risks. “There are times it will hallucinate,” she says. “The clinician has to be very careful. You have to double- and triple-check.”
The divide over AI in therapy is about efficiency and trust
A national survey by YouGov found that only 11% of Americans would be open to using AI for mental health care, and just 8% trust it. Nearly half are reluctant, citing concerns about privacy, accuracy, and the lack of human understanding. Those fears aren’t unfounded. A separate survey from the health research organization KFF found that 77% of Americans worry about how their health information would be stored and used by AI systems.
Kellie Owens, an assistant professor of medical ethics at NYU Grossman School of Medicine, says HIPAA compliance doesn’t eliminate the risk of breaches. “There are plenty of systems that are fully HIPAA compliant that still experience major data breaches,” she says. For patients sharing deeply personal information, the stakes feel even higher.
Owens also questions whether written consent forms are enough. “We have a wide body of research showing that a consent form on its own does not mean a person is making an informed choice,” she says. Many patients scroll through forms without reading them or feel pressured to agree. She argues that recordings should always be discussed verbally. “Any time you are recording a conversation, that should require a verbal conversation that a recording is taking place,” she says.
Without that transparency, the therapeutic relationship can fracture. For Quinn, the damage was done. After her therapist offered to stop using the tool, she canceled her next appointment. “The trust was gone,” she says. By January, she had found a new therapist – one who doesn’t use AI.
The debate is playing out in larger health systems too
Another NPR report states that in March, 2,400 mental health care providers for Kaiser Permanente in Northern California and the Central Valley went on a 24-hour strike. One of their concerns? The potential for AI to replace licensed clinicians in triage roles.
Ilana Marcucci-Morris, a licensed clinical social worker at Kaiser Permanente in Oakland, says the system has already started shifting triage duties to unlicensed operators following scripts, or even e-visits. “What used to always be a 10- to 15-minute screening from a licensed clinician like myself is now being conducted by unlicensed lay operators,” she says.
Kaiser Permanente insists AI isn’t replacing clinical expertise, but the shift and the future possibilities using AI presents has left many therapists uneasy. The strike highlights a broader tension in mental health care: the push to adopt AI tools while preserving the human element. Vaile Wright, senior director of health care innovation, American Psychological Association, says most AI adoption so far has been limited to administrative tasks like billing and documentation.
“Most providers want to help people, and when they get mired down with excessive paperwork or documentation in order to get paid, that takes away time from direct patient care,” she says. Nearly 40 companies now offer transcription and documentation support services for therapists, but the clinical use of AI remains rare.
Wright warns that the rapid adoption of AI tools demands caution. “At this point, because there is little regulation, it is incumbent on the provider to do the legwork and the research to figure out, ‘Are the tools that are on the market and available, safe and effective?’” she says.
(Featured image: Alex Green on Pexels)
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