(Updated, July 9, 2026) The therapy practice management company SimplePractice has announced that it will begin keeping AI-created therapy session transcripts by default, raising objections from therapists over privacy and consent concerns.
SimplePractice describes itself as having an “all-in-one practice management software,” and contracts to offer help for therapists in billing, scheduling and other matters. The new policy of preserving transcripts raised objections from therapists who do not think this serves their interests or those of their clients.
SimplePractice therapists were told that the company was “retaining session transcripts that are de-identified in compliance with HIPAA’s Safe Harbor method and de-coupled from any connection between the clinician and the client,” but only those made using the SimplePractice AI service called Note Taker. The company said in its announcement a few weeks ago that the practice was optional for existing users, but would become the default after June 16 — with an option to opt out. The explanation of the practice is posted on the company site, and a version was emailed to therapists.
The move is important for several reasons. Artificial intelligence is known to make mistakes, and the clients and therapists whose sessions are turned into AI transcripts may not know about these mistakes. This is certainly true for clients, who don’t normally see any transcript or note from their therapist — but it is also true for therapists, who may want to correct and edit transcripts, but who can’t know for sure if their corrections and edits are preserved. It’s also not clear if the original unedited transcripts will be retained, and for how long.
Clinicians also have said that they are concerned that AI compilations of their work may be used to create AI therapy options, or simply for unknown reasons that have nothing to do with the therapy they are providing. This is not a hypothetical — a relatively new company, Ash, bills itself as AI for mental health, and advertises that it is “Built on real, expert data,” adding, “Most AI tools were built using data from the internet. Ash is a specialist AI in human psychology, trained on large-scale dataset of proprietary expert data.”
Also, making this policy the default — by a policy known by lawyers as “adhesion contracts,” the take-it-or-leave-it path of many online policies signed with one click — is a practice that insures the actual policy is often hidden or overlooked. Further, during a therapy session, a client may speak of issues or topics that could point to their identity, making a promise of anonymization tricky.
(If you have information to contribute on this or other topics, email jeanne@clearhealthcosts.com or call Signal 914-450-9499.)
Warning on safety
The Psychotherapy Action Network, an advocacy group for therapists, wrote a brief warning therapists that the decision raised privacy, confidentiality, boundary and safety issues, as well as questions about “informed consent, transparency, future uses of data, re-identification risks, and the broader role of AI and monitoring of what clients share and disclose in psychotherapy.”
SimplePractice wrote to its therapists: “Transcript retention allows SimplePractice to retain a de-identified and de-coupled version of a Note Taker session transcript to help us continue improving Note Taker and other AI-powered features, such as those included in Care Aide,” the company’s name for AI-powered features it has introduced for practice management.
“Transcript retention is optional. You can choose whether transcripts are retained by managing your retention preferences at the clinician, client, or session level.
“If you used Note Taker before June 16, 2026, you’ll be opted out of transcript retention by default. No action is required from you, and no transcripts will be retained unless you choose to opt in.
“If you enable Note Taker on or after June 16, 2026, you’ll be opted in to transcript retention by default and can opt out at any time.”
The company doesn’t say specifically up front that AI is used to make the transcript; it says “When you use Note Taker, your session audio is converted into a transcript.” Speech to text is a common AI usage, and the company’s site calls its Note Taker service “our first AI-driven tool,” which “creates a transcript in real time during appointments.” Here are the FAQ’s on transcript retention. In the transcript retention consent document, it says that AI is used to make the transcript.
SimplePractice has several plans offering varying levels of support to therapists in billing, electronic claim filing, credit card processing, scheduling, treatment plans and the like. It says 250,000 therapists use its services. It recently announced CareAide, an add-on service with tools for preparing for sessions and “reducing documentation,” expanding on the previous service called “Note Taker.”
De-anonymizing data
The Psychotherapy Action Network, the advocacy group, wrote in its brief on the new SimplePractice policy: “It has been shown that de-identified or anonymized data can be identifiable. Further, amassing data, especially that which is historically confidential and private, can be a valuable asset to corporations. While therapists may treat patients’ thoughts, feelings, and vulnerable disclosures with the utmost respect for confidentiality and privacy, corporations are likely to view them as a monetizable asset.
“Indeed, SimplePractice says the purpose of retaining this data is to improve its current and future AI tools.
“For many therapists, the issue is not simply whether data is technically compliant with HIPAA requirements. Privacy, confidentiality, and boundary and safety issues are much more complex and nuanced. Questions remain about informed consent, transparency, future uses of data, re-identification risks, and the broader role of AI and monitoring of what clients share and disclose in psychotherapy.
“Therapy records contain uniquely sensitive information. Even when data is de-identified, some therapists and privacy advocates continue to debate whether clients fully understand how their information may contribute to the development of commercial technologies.”
It is not clear that the use of personal health information like transcripts for the goal of improving Note Taker would comply with the minimum necessary requirement under the HIPAA privacy law, which says that “protected health information should not be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. The minimum necessary standard requires covered entities to evaluate their practices and enhance safeguards as needed to limit unnecessary or inappropriate access to and disclosure of protected health information.”
Company comment
(Updates, July 9, 2026) I asked SimplePractice to comment, but they did not reply by deadline. After deadline, they sent a statement to be attributed to “a SimplePractice spokesperson.” Here are some salient parts.
Have you heard from individual therapists objecting to this policy? “We take feedback from our customers extremely seriously and have been actively monitoring and responding to all inquiries related to our approach to transcript retention through multiple channels, including our Facebook Community page, customer support tickets, social media platforms, and a dedicated livestream to answer questions directly in a live forum. …”
Do you have a data retention policy that is distributed to both clients and therapists detailing this policy? “For clients, we have created a client-facing guide that clinicians can share to explain how transcript retention works and how client privacy is protected. We also offer a sample Consent for Use of AI Tools in Therapy Services form, which addresses disclosures about transcript retention that clinicians can provide to their clients.
“We … have sent out several communications to our clinicians to give them advanced notice of this update to our approach to transcript retention, including details on how they can opt out at the client-, clinician-, and session-level. This communication was shared via email, our Facebook Community page, resources on our website (including the SimplePractice Trust Center and our Help Center), and in a dedicated livestream with SimplePractice leads. …”
Does the act of using PHI for improving Note Taker comply with the minimum necessary requirement under HIPAA? “SimplePractice does not use protected health information to improve Note Taker. Before any transcript is retained, it is de-identified using HIPAA’s Safe Harbor method, which removes all 18 categories of identifiers, and then decoupled from the client, clinician, and practice. Our de-identification and decoupling process was developed in collaboration with licensed mental health professionals, our AI Governance Team, and legal and compliance experts….
“Our goal in retaining de-identified and de-coupled transcripts is to continuously improve existing and upcoming AI features….
“We also want to make clear that we never sell clients’ PHI or customer PII. We do not sell transcript content or share it with third parties. De-identified and decoupled transcripts are used to evaluate and improve the instructions that guide how Note Taker generates draft notes. No AI system learns directly from session content, and no transcript data is used to build clinical decision-making tools or any product designed to deliver therapy. Further, session audio is deleted immediately once the transcript is generated, and SimplePractice does not retain audio recordings. For clinicians who opt out of transcript retention, the transcript itself is permanently deleted after the note is signed and locked, or after 7 days, whichever comes first. This reflects our commitment to retaining only what is needed to improve the tools clinicians rely on.”
AI transcript practices
The practice management company Alma was offering to create notes from AI transcripts recently, but they were found to have a series of errors. These AI notes created false narratives and introduced mention of suicidal thoughts or sex abuse where none was mentioned in the session, potentially risking harm for patients and therapists, therapists and experts said. Alma said it was working to correct the problem.
It is also true that clients of therapists might not want their sessions to be transcribed automatically. Standard business practice suggests that there should be a place where clients can be notified that the transcription is taking place, with clear instructions about data preservation, opt-out practices and so on. But in at least one case, a therapy client discovered that her therapist was using AI to record her session, NPR reported.
The therapist had proposed using the AI to record the session, and the client said she’d like to research it first. But then she realized that the recording was taking place, NPR said, quoting the client, Mollie Quinn, from Fayetteville, Ark. “”The more I thought about it, the more I just started getting more and more sick to my stomach,” she says. “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. I felt completely violated.”
She canceled the appointment and found another therapist, NPR reported.
(If you have information to contribute on this or other topics, email jeanne@clearhealthcosts.com or call Signal 914-450-9499.)
Wide concern
A thread from Reddit showed the depth and breadth of concern over AI use in therapy practices. A person identifying as a licensed clinical social worker wrote: “Hello! I am an LCSW and I just started with a new therapist. She sent me her paperwork and among the things she wanted me to sign were two releases to allow AI software to listen and provide note taking functions for our sessions.” Further, the poster said that they had expressed a desire to opt out of AI tools, and received in return a message saying that the therapist has “seen a substantial benefit for clients,” but would be governed by the poster’s choice.
The thread ran to 350 responses and counting, a lot by Reddit standards. Some of the comments:
“What’s the benefit for you as the client? She just wants her notes done faster with AI 😂😂😂”
“100%, and she’s willing to sacrifice her clients’ privacy to help train AI to replace us.”
“If you just started and haven’t even signed paperwork, I’d probably just recommend finding a new therapist. If this is a large value difference for you, it sounds like it’s already impacting the relationship before it begins. “
“Agree with folks here. Find a new therapist. If the AI transcription company gets hacked would you want all the stuff say in therapy possibly leaked online”
“This is the second post I’ve seen of this nature this week. The other was from a patient talking about a primary care doctor requesting to use AI for notes. When declined, he immediately went into a defensive sales pitch. Personally I plan to push back on this loudly and persistently.”
“I’d find a new therapist. Her response makes me feel like she’s not going to actually turn it off.”
“I am not bothered by her use of a HIPAA-compliant AI note taking tool. I am, however, really bothered by the fact that she didn’t accept your decision to opt out. If she can’t respect a boundary like this, that doesn’t really bode well for the therapeutic relationship.”
“HARD NO. End of story. No explanation necessary. The privacy of therapy is sacrosanct.”
“So, take this with a pile of salt, but from what I’ve seen, it’s becoming common for clinicians in my area to use AI for note taking in general – and if consent for recording isn’t given, then the clinician will either dictate or upload a document with some rough-draft notes to then have the bot expand on language and format things correctly. I hate it. But… I have seen the increasingly strict requirements for reimbursement by insurance companies and even some state governments. It’s absolute hell and only getting worse, as pay rates keep going down, too. I think a lot of these folks are turning to AI tools to ensure they get paid, you know? Garbage in, garbage out. An AI-created note, later audited by an AI auditor.”
What you can do
For patients, it’s clear that you should be informed if these sessions are being recorded, and you should be asked to opt in. The growing practice that people are opted in by default, and must then know that they need to opt out, seems to be what Quinn encountered.
For clinicians, on this topic, PsiAn wrote that “clinicians should reflect on several questions:
“At what point would I decide that the risks to patient care are no longer worth the documentation benefits?”
“Am I comfortable with de-identified session information from my therapy sessions being used to improve commercial AI products?
“How do I evaluate the company’s claims about de-identification, privacy protection, and data governance?
“What policies should my practice establish regarding AI tools and client data, especially when using SimplePractice or other tools?
“If I decide I’m going to use AI-assisted note-taking, how do I explain my decision to clients in a way that ensures their informed consent?”
(If you have information to contribute on this or other topics, email jeanne@clearhealthcosts.com or call Signal 914-450-9499.)
