Is Your Therapist Using AI? What to Ask About Your Notes

Why I Am Writing This One

I run an AI-free practice, so I have an obvious stake here, and I would rather say that at the top than have you notice it halfway down. This is not an argument that AI has no place in mental health care. It is an argument that you are entitled to know whether it is in the room with you.

What makes it worth writing about is how quietly the shift happened. Most clients I speak with assume a therapy hour stays between two people. That assumption was mostly safe five years ago. It now depends on what software your therapist has installed.

What the Data Actually Shows

The clearest picture comes from the American Psychological Association's 2025 Practitioner Pulse Survey, which surveyed 1,742 practitioners. In 2024, 71 percent of psychologists said they had never used AI to assist with their work. One year later that figure had fallen to 44 percent. The share using AI at least monthly rose from 11 percent to 29 percent in a single year.

Two details matter more than the headline. The first is that most of this use is administrative: 52 percent of AI-using psychologists used it for writing assistance, against 8 percent for clinical diagnosis assistance and 5 percent for patient-facing chatbots. Your therapist is far likelier to be drafting a letter with it than deciding anything about your care.

The second is the number that actually concerns session content: 22 percent of AI-using practitioners reported using it for note-taking or dictation. That is the category where a recording or transcript of your hour leaves the room and enters a system neither of you controls.

Clinicians are not comfortable about this either. The most commonly cited concern among the psychologists surveyed was potential data breaches, named by 67 percent.

Why This Is a Confidentiality Question, Not a Technology Question

An AI note-taker works by capturing your session — as audio, a transcript, or both — and processing it to produce a summary. That means the raw material of your therapy exists somewhere outside your therapist's own records.

HIPAA does govern this: a therapist using a vendor that handles protected health information must have a Business Associate Agreement with that vendor. But compliance and comfort are different questions, and a signed agreement does not answer the ones clients actually care about — how long the recording is kept, whether a human ever reviews it, and whether any of it trains a model.

Note that "it's encrypted" answers none of those. Encryption describes how data is protected in transit and at rest. It says nothing about who holds it or for how long.

This lands harder in trauma work. The material people bring to EMDR therapy and complex trauma work is frequently material they have never said out loud to anyone. The question of where that goes afterward is not paranoia. It is the same instinct that made it hard to say in the first place, and it deserves a straight answer.

Five Questions to Ask Your Therapist

These are fair questions. Any clinician worth working with will answer them without defensiveness, and a good one will be glad you asked.

1. Do you use any AI tools in your practice, including for notes, transcription, or scheduling? Start broad. The answer is often "only for admin," which is useful to know.
2. Is any part of our session recorded or transcribed? This is the one that matters most, and it is worth asking specifically rather than assuming the first answer covered it.
3. If so, what happens to that recording, and how long is it kept? Retention is where vague answers tend to surface.
4. Does the vendor use session data to train their models? A clinician who has done their diligence will know this. One who has not will find out.
5. Can I decline? You can. Ask what the practice looks like if you do.

If a question produces an uncomfortable pause, that is information too — not necessarily about the therapist's integrity, but about how carefully the decision was made.

What Consent Should Look Like

Consent to recording should be explicit, specific, and revocable: told to you directly rather than buried in intake paperwork, clear about what is captured, and reversible without it becoming a whole conversation.

For virtual clients across New York and Massachusetts, this deserves extra attention. Telehealth already routes your session through more technology than an in-person appointment does, so the number of places your words could be retained is higher by default. Being a remote client is not a reason to get a less complete answer.

Where I Stand

I do not use AI note-takers, AI transcription, or session recording of any kind. I write my own notes. That is a deliberate choice about what the therapy relationship requires, and you can read the longer version of my reasoning on AI-free therapy.

I am not suggesting every therapist who uses an AI scribe is careless. Many have thought it through properly, and the documentation burden they are trying to solve is real. I am suggesting the decision should not be invisible to the person whose words are being processed.

If privacy is part of what you are weighing when you choose a therapist, ask the questions above of whoever you are considering, including me. If you would like to start that conversation, I offer a free 25-minute consultation to clients across New York and Massachusetts.