When AI Notetaking In Therapy Becomes a Breach of Trust

Therapists increasingly rely on AI to record, transcribe, and store therapy sessions, but patients are pushing back against the practice, citing breaches of trust and privacy. Marisa Cohen, a couples and sex therapist in New York, argues that therapy depends on absolute confidentiality and that AI inaccuracies could distort permanent records—especially if notes are subpoenaed later. She also warns that patients may feel uneasy knowing a third party is listening, altering the dynamic of the session. Molly Quinn’s experience underscores these concerns. When her therapist introduced an AI notetaking tool without prior consent, Quinn discovered she was already being recorded. The realization shattered her trust, leaving her feeling violated. ‘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,’ she told NPR. Quinn is not alone; a YouGov survey found only 8% of Americans trust AI for mental health care, while nearly half remain reluctant, fearing their sensitive information could be exposed in a data breach. Kellie Owens, an assistant professor of medical ethics at NYU Grossman School of Medicine, emphasizes that recording therapy sessions without explicit consent undermines patient trust. Even with HIPAA protections in place, she notes that personal data remains vulnerable to leaks or misuse. ‘Any time you are recording a conversation, that should require a verbal conversation that a recording is taking place,’ Owens said. The lack of transparency risks damaging the therapeutic relationship, where patient autonomy is paramount. Critics also question the necessity of AI notetaking, which proponents argue saves therapists time. However, the technology’s potential to introduce errors into permanent records raises ethical dilemmas. If inaccuracies arise and clinicians fail to verify them, those mistakes could resurface in legal or medical contexts, affecting patients long after their sessions end. Experts urge therapists to prioritize consent and transparency, ensuring patients fully understand how their data will be used before proceeding.