No AI note-taker is confidential enough by default; one can be once you've checked it. Look for a signed health-data agreement, audio deleted straight after transcription, no training on sessions without the client's own opt-in, transcript retention you control, and consent settings per client or per session. SimplePractice Note Taker, Upheal, Mentalyc and Heidi all publish their positions on these.
The catch is that published positions change. SimplePractice, one of the most widely used therapy platforms, switched clinicians who turn on Note Taker from 16 June 2026 onwards to keeping de-identified session transcripts by default, for improving the tool, with an opt-out. Clinicians who had used it before that date stayed opted out. A therapist who checked the settings last year and one who signs up today can have different set-ups under the same product name. So treat this checklist as something you re-run, not a box you tick once.
What four therapy note tools say about audio, transcripts and training
This is a summary of each vendor's own documentation as of September 2026. Read the current version for your account before relying on it, and check your live settings, because defaults can differ by sign-up date and plan.
| Tool | Audio | Transcripts | Use for training or improvement |
|---|---|---|---|
| SimplePractice Note Taker | Deleted as soon as the transcript is created, generally within minutes | From 16 June 2026, new users are opted in by default to retention of de-identified, de-coupled transcripts | Retained transcripts are used to improve Note Taker; opt out at clinician, client or session level |
| Upheal | Deleted by default unless client consent to keep it is obtained | Can be deleted at any time; kept encrypted if retained | Only if the client opts in; de-identified data then kept for set periods |
| Mentalyc | Deleted after the note is generated, by default | Check current settings | Says it never trains on or sells your data |
| Heidi | Says audio is never kept | Retention period set by the account or organisation | Check the terms for your plan and region |
SimplePractice lists Note Taker at $35 per clinician per month after a 30-day free trial. For a counsellor seeing 22 clients a week, that's roughly 40 cents a session. The time sum matters more: if a hand-written note takes about 15 minutes and reviewing an AI draft takes about 5, that's around three and a half hours a week back, which is why the tool is tempting and why the checks below are worth the hour they take. The other vendors' prices vary by plan and region, and cost is a separate question from confidentiality; whether therapists can use ChatGPT for session notes covers the cheaper general-purpose route and why it rarely fits.
The checklist
Work through each group with the vendor's documentation, your contract and your account settings open side by side. Mark each item yes, no or unclear. An "unclear" is a question to email the vendor, and their written answer goes in your records.
A. Contract and compliance
- A signed agreement covering health information for your practice, of the kind your health-privacy law requires. Marketing pages saying "compliant" aren't enough.
- An independent security audit, such as a SOC 2 Type II report, available on request. Upheal says it has completed one.
- A list of sub-processors: the cloud and AI companies the vendor passes data to, with a promise to tell you about changes.
- Where data is stored and processed, named in the contract.
- Breach notification within a stated time. The contract clauses to look for are covered in what to check in an AI vendor's data processing agreement.
B. Audio and transcripts
- When audio is deleted: immediately after transcription, after a few days, or only when you delete it.
- The default transcript retention on your account, not the one described on the vendor's website. Look in the settings and screenshot them with the date.
- Whether you can delete a single session completely, including if a client withdraws partway through.
- What happens in backups after deletion, and for how long.
Item 9 is the one vendor pages rarely answer, so it usually becomes an email. An illustrative question and reply, filed with the date:
Asked 3 September: "When I delete a session transcript in my account, is it also removed from your backups? If not, how long do backup copies exist, and can anyone at your company restore or read them?"
Answered 5 September: "Deleted transcripts are removed from the live system immediately. Encrypted backups are retained for 30 days and then overwritten. Backups are used only for disaster recovery and aren't accessible to support staff."
That answer turns "unclear" into "yes, with a 30-day tail", which is also what your client information should say if you tell clients deletion happens "promptly".
C. Training and secondary use
- Is session data used to train or improve the vendor's models? By default, or only with permission?
- Whose permission? Upheal's approach requires the client's own opt-in; others rely on the clinician's setting. For therapy, the client's choice should count.
- What "de-identified" means in practice, and whether it's linked back to you or the client. De-identified therapy transcripts can still contain distinctive life details.
- Opt-out at the right level: per clinician, per client and per session.
D. Access and security
- Multi-factor authentication on your account, switched on.
- Who at the vendor can see session data, and under what circumstances (support tickets, quality review).
- The device you capture sessions on is yours or the practice's, locked, encrypted and not shared with family.
- Supervision access: if a supervisor or group practice admin can see notes, check they can't also see transcripts they shouldn't.
E. Consent and client control
- Clients are told and asked before each use, and you record their answer yourself. Should therapists tell clients they use AI covers the conversation; consent wording for AI note-taking has adaptable scripts.
- Clients can withdraw at any time, without it affecting their therapy, and the tool can be switched off for them permanently.
- Your client information matches your current settings. If you copied a vendor's template consent wording, check it still describes what the tool does today.
F. What goes into the note
- The draft sticks to what happened and doesn't add diagnoses, interpretations or risk judgements you didn't make.
- Third parties are minimised. Names and details of partners, family members and colleagues the client talks about stay out unless clinically necessary.
- Any separate private process notes you keep stay out of the AI tool, if your practice or law treats them differently from the clinical record.
G. Exit plan
- You can export your notes in a usable format.
- Deletion on exit is confirmed in writing. Supplier risk is real: Clockwise, an AI calendar tool, shut down in March 2026 and deleted user data rather than transferring it. What if your AI vendor shuts down covers the checks.
A solo therapist scores two tools
Here's how the checklist might look for an illustrative solo counsellor comparing two shortlisted note-takers, with the vendor names left out:
| Item | Tool A | Tool B |
|---|---|---|
| 1. Signed health-data agreement | Yes, standard on all plans | Yes, on request |
| 6. Audio deletion | Immediately after transcription | Kept 3 days for re-runs, then deleted |
| 7. Transcript retention on my account | Kept by default; I changed to 7 days | Deleted when note is signed |
| 10-11. Training | De-identified transcripts used by default; opt-out available | Never used for training |
| 13. Opt-out levels | Clinician, client and session | n/a |
| 19. Client can withdraw | Yes | Yes |
| 24. Export | Yes, PDF and text | Unclear; emailed vendor |
Neither tool is ruled out. Tool A needs two settings changed on day one (retention and the training opt-out) and a calendar reminder to check they stay changed. Tool B is cleaner on training but has an open question on export. The counsellor emails Tool B, gets a written answer that exports are available as PDFs, and chooses it. The point isn't which tool wins; it's that the choice rests on settings and written answers rather than on a "compliant" badge.
What an AI draft note can get wrong in therapy
Confidentiality isn't only about where data goes. A note that records something the client didn't say, or records far more than it should, is its own kind of breach of trust. Three illustrative problems to read every draft for:
- A risk statement the therapist didn't make. The client said "some days I wonder what the point is". The draft reads "Client denies suicidal ideation". Or, just as bad, "Client reports passive suicidal ideation." Risk assessment is the therapist's judgement and must be written in the therapist's words.
- Diagnostic language added. "Presentation consistent with generalised anxiety disorder" appears in a note for a first session where no assessment was made. Delete anything you haven't concluded.
- Too much about other people. The draft names the client's partner, the partner's employer and the details of an argument. The clinical record usually needs "conflict with partner over finances", not the transcript's detail.
If a tool keeps adding interpretation, change its note template to a plain factual format and add an instruction such as "record only what the client reported and what the therapist did; no diagnoses, no risk statements". Then check whether it listens.
Put together, the three problems look like this in a single illustrative draft, and the note the therapist actually signs:
AI draft: "Client reported ongoing conflict with partner ([partner's first name], works at [employer]) regarding a missed mortgage payment and the partner's spending on gambling. Presentation consistent with generalised anxiety disorder. Client denies suicidal ideation. Plan: continue CBT."
Signed note: "Client described ongoing arguments with partner about money. Said 'some days I wonder what the point is'; explored in session, see risk notes (therapist's own entry). Worked on noticing the thoughts that come before arguments. Plan: continue; review mood next session."
The signed version drops the partner's name, employer and gambling, which belong to someone who never agreed to be in a record. It removes a diagnosis nobody made and replaces the tool's risk conclusion with the therapist's own entry. It's also shorter, which is normal.
To test the template change, don't wait for a real client. Role-play a 20-minute session with a colleague, including one ambiguous remark about hopelessness and some detail about a third person, and run it through the tool. In an illustrative retest after tightening the template, the diagnosis and the risk line were gone, but "client appeared tearful and withdrawn" had appeared, an observation the colleague playing the client never acted out. Interpretation creeps back in as description. Add "don't describe the client's appearance or manner unless the therapist states it" and run the role-play again.
Sessions to leave the tool switched off
Even with a tool that passes every item, some sessions are better without it. Decide these in advance so you're not deciding in the moment:
- Couples and family sessions, unless every person present has agreed. One person's no is a no.
- Sessions with children or teenagers, until you've settled who agrees and how the young person's own view counts.
- Group sessions, where getting meaningful agreement from everyone each time is impractical.
- Crisis sessions, where the client's state makes a real choice unlikely and your attention belongs entirely with them.
- Sessions where safeguarding disclosures are likely, because what's said may need careful, exact recording in your own words.
- Clients who seem to agree reluctantly. Hesitation is a no.
Online sessions add a layer: check whether your video platform also records or transcribes, so you don't end up with two copies of a session in two systems. A plausible way this goes wrong: a therapist who uses a video platform for work meetings as well as sessions has its built-in meeting-summary feature switched on at account level. The therapy note-taker captures the session as intended, and the platform's own feature also writes a summary and emails it to the participants, so the client receives an automated summary of their session in their inbox, possibly one a partner can read. Before the first online session with a note-taker, open the video platform's settings and switch off its recording, transcription and summary features for session meetings, or use a separate account for therapy.
When a client asks for a copy of what the tool captured
Sooner or later a client will ask what the AI heard. Data-protection law in many places gives people a right to a copy of the personal data you hold about them, and the answer depends entirely on the settings you chose under group B. If audio is deleted within minutes and transcripts go when the note is signed, the honest reply is that the signed note is all that exists, and you can say so. If your account keeps transcripts for seven days, a request that arrives on day three includes the transcript. If de-identified transcripts were retained by the vendor for improving its tool, you'll need the vendor's help to explain what exists and whether it can still be linked to the client.
Take an illustrative case: a client ends therapy, then writes asking for "everything you recorded about me, including anything the AI kept". The counsellor using Tool B from the comparison above can answer within a day: signed notes attached, no audio or transcripts retained, vendor confirmation of backup deletion on file. The counsellor who never changed Tool A's defaults has to ask the vendor what it kept, and wait. Settle how you'd answer this before the first session, and check the answer with your professional body or a data-protection adviser if you're unsure what the request covers.
Re-running the checklist when things change
Put a reminder in your calendar every six months to re-run groups B, C and E against your live settings. Re-run the whole checklist straight away if the vendor emails about changes to its terms, privacy policy or retention; if the vendor is bought by another company; if you move to a group practice or a new plan; or if you notice a new feature switched on in your account, such as automatic summaries or client-facing insights.
The SimplePractice change is a good example of why. A therapist whose client information page says "transcripts are deleted when the note is signed" might have been accurate in May 2026 and, depending on when they enabled the tool and which settings they chose, describing something different a few weeks later. A six-monthly check catches that before a client does.
More questions therapists ask about AI note-takers
Is dictating a summary after the session safer than recording the session?
Usually, yes. If you dictate a two-minute summary after the client leaves, the tool never hears the client's own words, third parties' names or anything you'd leave out of the record anyway. You lose some detail and some time saving. Many therapists use dictation for sensitive clients and full-session capture only where the client is comfortable with it.
Do I need the client's agreement if the audio is deleted straight away?
Yes. Deletion reduces the risk, but the session is still being captured and processed by a third party, and some places require everyone in a conversation to agree before it's recorded. Explain it, ask, record the answer yourself, and respect a no without any effect on the therapy. Your professional body or indemnity provider can confirm what they expect.
Can I use ChatGPT or Claude to write progress notes instead of a specialist tool?
Not with identifiable client material on a consumer plan. Business plans don't train on your content by default, but most don't come with the health-data terms therapy records need. If you use a general assistant at all, keep to de-identified summaries you've written yourself, and prefer a specialist tool with a signed agreement for anything drawn from the session itself.
Further reads
- How to Roll Out an AI Scribe Without Losing Patient Trust — A phased rollout plan that applies to therapy practices too.
- Patient Data and AI: A Confidentiality Checklist for Small Practices — The practice-wide confidentiality checklist behind this one.
- How Much Does an AI Note-Taker Cost per Seat? — What note-takers cost per seat across the market.
- AI Vendor Lock-In: How to Keep Your Data and Prompts Portable — Keeping your notes portable if you change tool.
- Are AI Meeting Note-Takers Safe for Client Calls? — Why general meeting note-takers are a poor fit for sessions.
- AI vs Human Transcription: Which Is Worth Paying For? — When a human transcriptionist is still the better choice.
- Is an AI Scribe Worth It for a Small Private Clinic? — When an AI scribe pays off in a small clinic, three clinic types with different verdicts, a two-week test scorecard and what to check in every draft note.
- Safe AI Uses for Counsellors That Never Touch Client Notes — Twelve ways a counsellor in private practice can use AI for the business side, with examples, plus the settings that keep client data out.
- AI Tools and AI Development: The Complete 2026 Guide — the AI hub, including every tutorial in the AI-for-business series.
Sources: SimplePractice support pages and client-information guidance on Note Taker and transcript retention; Upheal data and security documentation; Mentalyc AI note taker page; Heidi Health data storage and retention pages (all checked September 2026).