AI & Privacy In The Therapy Office

By Karli Gallo, LMHC | Unbound Psychotherapy | Pembroke Pines, FL

There's a lot of buzz right now about AI tools in mental health practice. AI note-takers, automatic transcription, session summaries generated in seconds, platforms promising to make your therapist more "efficient."

I'm not using any of them. Here's why and why I think if you've ever felt uneasy about the idea of your therapy sessions being recorded or listened to, that instinct deserves to be taken seriously.

Your concerns are valid.

If you've ever wondered whether your therapist records sessions, whether your words end up somewhere you didn't expect, or whether some AI system has "heard" what you said in a moment of vulnerability, you’re not being paranoid. Those are reasonable and valid concerns. But the honest answer is: it depends on your therapist, and you should ask.

Many clients never ask because they assume therapy is private by default. It used to be that simple, but not anymore. And you deserve to know where your therapist stands.

There's also something important to name here: the fact that you even have to wonder about this changes something. When people aren't sure whether they're being recorded or listened to by something or someone “outside” of the therapy office, they hold back. They edit themselves. They say the safe version of the thing instead of the real thing. That self-editing is completely understandable and it quietly undermines the whole point of therapy.

What's actually happening in the industry.

AI tools are being aggressively marketed to therapists right now with the pitch of efficiency. Instead of writing notes after sessions, you let an AI record, transcribe, and summarize everything automatically. Some platforms go further to include generating treatment plans, tracking patterns across sessions, and flagging clinical concerns.

In a way, this sounds like it could benefit clients. An efficient therapist could be a therapist who can focus more fully on you.

But here's what the marketing doesn't tell you: when your session is recorded by one of these tools, that audio of your voice and your words, the most private things you've said out loud, travels to a third-party server. It's processed and can be stored by a company that has no therapeutic relationship with you, no clinical training, and no stake in your wellbeing.

And buried in most of these tools' terms of service is language that permits the company to use your information to improve their product. In plain terms, your therapy session may be training an AI model.

You almost certainly didn't consent to that. You may not have known it was possible.

The therapeutic relationship isn't a backdrop. It's the work.

Here's why this matters so much to me, beyond the obvious privacy concerns:

The relationship between a therapist and client is not a delivery mechanism for techniques. It's not a context in which the "real" work happens. For many people, it is the real work. The experience of being heard without judgment, of saying something shameful out loud and having it met with steadiness instead of alarm, of feeling that another person is genuinely present with you. That's not a side effect of good therapy. It's often the thing that makes change possible.

That kind of relationship requires safety. Not the surface-level safety of a comfortable office and a soft voice, but the deeper safety of knowing that what you say here doesn’t go anywhere. That your worst moments, your most shameful thoughts, your grief and rage and confusion are held with care by a person, in a genuine relationship with you, not by a platform.

The moment a third party enters that room, even invisibly and digitally, something changes. Most people feel this intuitively. We soften our language, avoid certain topics, or speak to a version of the story we’d be okay with someone else reading. And that wouldn’t be a failure of a therapy client. It's a completely rational response to surveillance, and it costs us something in real and deep therapeutic work.

Real therapeutic work requires structural privacy.

Real therapeutic work often lives in the things people haven't yet felt safe enough to say. The thing you've been circling for months. The detail you've left out of every version of the story because you're not sure what someone will do with it.

Those are the places where the most meaningful work happens. And they only become accessible when the privacy is real. When there is no recording, no transcript, no AI listening. Just two people in a room with no third party.

If you've been in therapy before and found yourself wondering who might have access to what you said, the editing you did as a result was not a sign that you weren't ready for therapy. It was a sign that your nervous system was doing exactly what it's supposed to do, protecting you.

What recording does to the room even when it's allowed:

Some therapists record with the client's full knowledge and consent. That's legal, and in some contexts it's clinically appropriate. But even consented recording changes the dynamic.

Research on surveillance and self-disclosure is consistent: people share less and differently when they know they're being recorded. This isn't about distrust of the therapist specifically. It's about how recordings can travel. They can be subpoenaed. They can be hacked. They can exist in perpetuity in ways that in-person conversation does not.

When a client knows a recording exists, a part of their attention stays oriented toward that fact, even if it's unconscious. The uncensored self that therapy needs access to is more difficult to reach.

I don't record sessions. That's a line I've drawn because I want the structure of our work to guarantee privacy.

My commitment extends beyond the session.

I don't use AI to write a review of my notes, draft summaries of our work, brainstorm interventions based on what you've told me, or process your information in any form. My thinking about your care happens in my own mind, and in some cases in clinical consultation with trusted colleagues who are bound by the same ethical obligations I am and where all identifying information is protected.

There are administrative tools I use such as scheduling software and a HIPAA-compliant client portal that handle basic logistical information. I review the privacy policies of these carefully and will tell you if anything changes. The content of our sessions, the substance of who you are and what you're working through, never touches an AI system.

What I do instead:

After sessions, I write brief clinical notes. They're not transcripts or summaries of everything said, especially if you've shared about a traumatic experience. They capture what's clinically relevant such as themes, progress, and things I want to follow up on, because good continuity of care requires some documentation, and that documentation requires thoughtfulness, not automation. I document the way I'd want to be documented if I were the client.

I'm choosing not to use AI in my practice because what you share with me is not data. It's your life, in your words, offered in trust. That deserves to be treated accordingly.

What you deserve:

I'm not writing this to criticize therapists who make different choices, or to suggest that every AI tool in mental health is inherently harmful. I'm writing it because clients deserve to know exactly what their therapist's practices are and because most people don't think to ask. And most therapists don't volunteer the information.

If you're currently in therapy with someone else, it's worth asking. You have the right to know whether your sessions are recorded, who has access to your records, whether any AI tools are involved in your care, and what any AI tools do and their privacy policies. A good therapist will answer those questions directly and without defensiveness.

And if you've ever held something back in therapy because you weren't sure it was truly private, the things you hold back are often exactly what the work needs. Finding a therapist whose practice give you real privacy isn't excessive. It's reasonable and it matters.

If you're looking for a therapist who takes privacy seriously…

If you're carrying trauma, navigating a painful relationship, struggling with anxiety or depression, or if you've been in therapy before and left feeling like you couldn't fully show up, you're not alone and those experiences are worth processing somewhere safe.

You deserve a space where nothing is recorded, nothing is processed by AI, and nothing leaves the room. If that's what you've been looking for, I'd be glad to hear from you.

Reach out through my contact form. I respond to all inquiries personally.

Karli Gallo is a Licensed Mental Health Counselor (LMHC) and EMDR-Certified therapist at Unbound Psychotherapy in Pembroke Pines, FL. She specializes in trauma, eating disorders, and outpatient therapy following intensive treatment, and provides therapy in-person in South Florida and online throughout Florida.