AI in the Therapy Room
Commitment to my Clients
A recent trend among therapists is to leverage artificial intelligence notetakers, which record session audio and produce clinical notes for the therapist at the end of the session. I commit to never using AI to record our time together. I believe the words shared between client and therapist are sacred, and I don't want to invite big tech to listen in on our conversations. Even if audio transcripts are anonymized, redacted, and later deleted, it feels perilous to give a company with profit-maximizing incentives access to my clients' most vulnerable moments. Sitting with clients during these moments is a privilege and an honor, and I consider stewardship of their data an important responsibility.
I believe the therapy room is a space where clients should be able to process questions about their health, identity, immigration status, and more. I say it all the time, but there is no such thing as "TMI" in therapy. On one hand, I want clients to feel empowered to share whatever is on their hearts and minds. On the other hand, I'm mindful of administrations that police healthcare providers. Over the past ten years, we've witnessed an erosion of individual freedoms and increased oversight from federal and local governments. With this in mind, I don't trust tech firms to respond ethically to potential pressure to share session data.
It's also worth mentioning that AI makes mistakes, often. It hallucinates and glitches. It doesn't handle nuance or humor well, and both come up often in the therapy room. Even if AI-generated content improves over time, that doesn't change the fact that emotional attunement is a huge part of the healing process. If I outsourced the part of me that reflects and takes notes after each session, I would miss out on important insights with each client. Often, after you leave your session, your therapist sits in their chair, taking notes and thinking about how to be a better therapist for you. I don't want to miss out on those moments. I don't want to delegate the most human part of my job to the same subpar AI agent that makes nonsensical additions to my grocery list.
Neuroception
Another argument for keeping therapy as human as possible is neuroception. Neuroception is the nervous system's automatic system for scanning for safety or threat. It occurs through various channels, such as as the smooth muscles of the middle ear tuning to vocal frequency, facial muscles reading micro-expressions, and the vagus nerve monitoring heart rate and breath. Depending on what it detects, your body shifts along the polyvagal ladder:
ventral vagal (calm, connected, heart rate steady and variable),
sympathetic (fight/flight, heart rate up, breath shallow and fast),
or dorsal vagal (shutdown, heart rate and energy dropping).
A human therapist offers something AI structurally cannot. Your therapist has a real, physiologically live nervous system to co-regulate with. Neuroception isn't detecting information about safety. It's detecting an actual autonomic state in another body, and that state has to exist to be picked up. A human therapist has an actual vagus nerve modulating heart rate variability, breath, micro-shifts in facial muscle tone that happen involuntarily and can't be replicated with a computer. These changes occur even in telehealth environments. A client's nervous system can pick up on a real therapist's steady heart rate and slow, even breathing, like noticing their calm voice or relaxed shoulders, and start to match it, the same way your breathing might slow down just from sitting near someone calm. With AI, there's no actual heartbeat or breath to sync with, no matter how calm the words sound. It reminds me a lot of when I learned about how starlings move together. Without words or explicit instructions, they pick up on the micro-movements in their neighbor’s flight patterns, which allows them to fly in cohesive flock. In the same way, our nervous systems are constantly scanning the environment and recalibrating based on the nervous system of the people around us. Because of neuroception, I am grateful that I’m able to include therapy in my self-care toolkit. I see a real, human therapist and I allow my nervous system the benefit of being connected to a regulated nervous system.
