What We Lose When We Outsource Our Minds: The hidden cost of AI scribes in therapy documentation
What We Lose When We Outsource Our Minds:
The Hidden Cost of AI Scribes in Therapy Documentation
Let’s talk about AI Scribes – software systems that record your therapy session, produce a transcript and create a summary or progress note based on its transcription. AI scribes are currently being offered as part of many EHRs and by tech start-up companies riding the AI wave.
In our increasingly digitized healthcare world, AI scribes promise therapists freedom—from burnout, from paperwork, from the drudgery of documentation. And let’s be honest: few of us became clinicians because we love writing progress notes and reports. The burdens of clinical practice are overwhelming and the allure of automation is real. But as we embrace new tools, it’s worth pausing to ask: What do we give up when we surrender the act of writing our own therapy notes?
The answer may be more profound than we think.
Writing Notes As Thinking
As both clinicians and writers have long observed, writing is not merely a means of recording experience—it is the very process through which our understanding of experience takes shape. Psychiatrist and existential therapist Irving Yalom reflects on how the act of writing about his patients deepens his understanding of the therapeutic relationship, revealing emotional dynamics and insights that were only partially formed during the session itself. Similarly, author Flannery O’Connor once remarked, “I write because I don’t know what I think until I read what I say.” Her words echo a truth many therapists recognize: meaning often emerges in the space between experience and expression. Writing allows the clinician to slow down, reflect, and discover what was truly unfolding in the room—not just for the client, but for themselves. In this way, note-writing becomes an act of thinking, of presence, and of ethical engagement.
Indeed, therapy doesn’t end when the client leaves the room. Clinical work continues as we sit quietly with what unfolded—recalling what was said, what was not said, how we felt, and what is evolving. Writing therapy notes is not just a bureaucratic requirement, it is a contemplative act. It allows the therapist to metabolize the session, to transform complex, often emotionally laden material into something coherent, organized, and useful for the work ahead.
When an AI scribe does this for us—when it automatically records and summarizes the session—we risk outsourcing the very cognitive and emotional labor that helps us do our jobs well. We lose an opportunity to reflect, to question, to hold our clients in mind in a meaningful way.
Therapists Are Not Observers—We Are Participants
Unlike a surgeon dictating an operation or a radiologist reviewing a scan, a therapist is not a neutral observer. Our minds, emotions, and subjectivities are instruments of the work itself. We feel the tension in the room, we absorb the silences, we become aware of our own emotional reactions or countertransference. We respond, resonate, imagine, and react. Our experience of the client is not extraneous, it is central.
Humanistic psychologist Carl Rogers spoke of presence as one of the most vital healing factors in therapy: the authentic engagement of the therapist’s whole being. When we allow a third party—AI included—to filter or reframe our clinical impressions, we risk disengaging from that presence. We become editors of someone else’s after-the-fact summary rather than thinkers immersed in the human encounter.
When we hand off our documentation to an AI scribe, we risk treating the session as a mere exchange of facts. But therapy is not a courtroom, and a session is not a deposition. It is an encounter between two minds, two nervous systems, two histories. Reducing that to an AI-generated summary not only flattens the complexity, it misrepresents what therapy actually is.
Time Spent Thinking Is Time Spent Caring About Our Clients
There is a dangerous narrative taking hold in some circles: that documentation is a “waste of time,” that it’s administrative fluff with no real clinical value and that it takes away from really caring for our clients. This is not only false, it’s demoralizing.
Time spent writing thoughtful notes is time spent being present and caring about our clients. It is a sign of ethical commitment. Clients often wonder: Do I matter to my therapist once I leave the room? For clients with histories of neglect or trauma, this is not an idle question. The experience of being “held in mind” by another—of knowing that someone is thinking about you even when you’re not present—is a profoundly healing one. Donald Winnicott and many attachment theorists have highlighted the importance of the caregiver’s capacity to mentally represent the child in their absence.
In psychotherapy, the parallel is clear. When we reflect on our clients between sessions—when we write notes that integrate and contemplate—we create an internal holding environment. This unspoken continuity is felt by the client. And when it is absent, they feel it too. For many clients, the experience of feeling remembered, thought of, and carried emotionally even when not physically present is a radical and reparative experience.
This notion also finds resonance in philosophical ethics, where the significance of regarding the Other—not only in their presence, but in their ongoing absence—is central to our responsibility and care (Levinas, 1969). In both therapy and life, the act of keeping someone in mind becomes an expression of ethical regard.
AI Can Help—but It Cannot Think for Us
None of this is to deny that clinicians are overwhelmed. Burnout is real. The administrative burden is relentless. AI tools can be helpful—as grammar assistants, as spellcheckers, even as drafting partners for standardized language. But they must remain tools, not surrogates for the therapist’s own thinking.
To be clear: this is not Luddite resistance. It is about preserving the heart of the therapeutic process. AI can aid clarity, but it cannot replace insight. It can mimic tone, but it cannot register feeling. And it certainly cannot take the place of a clinician’s lived experience of the therapeutic relationship.
Technology with Thoughtfulness
We live in a moment of extraordinary technological possibility. But let us not be seduced by ease at the cost of meaning. Let us remember that writing therapy notes is not a task to be eliminated, but a practice to be respected.
When we write, we think. When we think, we are present with our clients. And when we are fully present, our clients feel it—even when they’re not in the room.
At Note Designer, we believe that documentation should deepen clinical thinking – not replace it. That’s why we designed our software to support clinical reflection while also helping clinicians meet the administrative requirements of the profession. Our structured content helps bring to mind the subtle aspects of a session that might otherwise be overlooked, offering gentle prompts that help therapists recognize what was present but perhaps unspoken. We do offer clinicians the possibility of using AI as a tool to help refine and re-write their notes – but not as a replacement for clinical judgment and thought.
For more insights and reflections on this important topic, I highly recommend this recent article in Counseling Today magazine.
References & Suggested Reading
Ogden, T. H. (1997). Reverie and Interpretation: Sensing Something Human. Jason Aronson.
van der Kolk, B. (2014). The Body Keeps the Score. Viking.
Rogers, C. (1961). On Becoming a Person. Houghton Mifflin.
Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. Basic Books.
Fisher, J. (2017). Healing the Fragmented Selves of Trauma Survivors. Routledge.
Holmes, J. (2001). The Search for the Secure Base. Routledge.
Levinas, E. (1969). Totality and Infinity: An Essay on Exteriority. Duquesne University Press.
Winnicott, D. W. (1960). The Theory of the Parent-Infant Relationship. International Journal of Psychoanalysis, 41, 585–595.
Patricia C. Baldwin, Ph,D., Clinical Psychologist
Note Designer Inc.
