AI Scribes vs. AI-Assisted Therapy Notes: What’s the Difference?

AI is rapidly changing the way therapists approach clinical documentation. But not all AI therapy note programs work in the same way, and those differences matter.

Many AI scribes begin by listening to, recording, streaming, or transcribing the clinical encounter. This can mean that highly sensitive information from the therapy session is processed by an additional technology provider.
Other approaches allow clinicians to decide what information is provided to AI without recording or transcribing the therapy session at all.
Before choosing an AI documentation tool, clinicians may want to ask some important questions:

Does it listen to or record my therapy sessions? What information is sent to the AI? Is that information stored? Could it be used to train or improve an AI model? Who has access to it? What happens to recordings or transcripts? What do I need to disclose to my clients, and what consent might be required?

Note Designer takes a different approach.

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Comparing Approaches to AI Therapy Documentation

What should clinicians consider?	Recording/ Transcription AI Scribes	Note Designer’s Ethical AI	Note Designer Classic
AI listens to the therapy session	Yes	No	No AI
Session is recorded, streamed, or otherwise captured	Yes	No	No
Session is transcribed	Usually	No	No
The client’s and therapist’s actual words may be processed by AI	Yes	Only if the clinician chooses to enter them	No AI
Clinician controls what information is provided to AI	Depends on product	Yes	No AI
AI provider retains inputs or outputs	Depends on provider and contract	No	No AI
Content may be used to train or improve AI models	Maybe; Depends on provider and data-use policy	No	No AI
Clinician should investigate how client data are stored, shared, and used	Yes	Note Designer does not store, share or use client data	Note Designer does not store, share or use client data
Recording may require client consent	Yes, depending on applicable professional and legal requirements	Not applicable — sessions aren’t recorded	Not applicable — sessions aren’t recorded
Could clinical data be used to develop, train, or improve other AI products including patient-facing mental health tools (e.g., therapy bots)	Depends on the provider, contract, and permitted secondary uses of data. Clinicians should verify	No. Note Designer does not use your AI inputs or outputs to train AI models or develop therapy bots.	No AI
Identifying patient information needs to be provided to the AI	Depends on the product	No	No AI
Can be used completely without AI	No	Yes	Always
Therapy can occur without an AI system listening in	No	Always	Always
Supports clinician review and editing of the final note	Varies	Yes	Yes
Customizable clinical documentation	Varies	Yes	Yes
Supports multiple therapeutic approaches	Varies	25+ approaches	25+ approaches

Features and data practices vary among AI documentation providers. Clinicians should review the current privacy policy, terms, security practices, informed-consent requirements, and data-use practices of any product they are considering.

Before You Invite AI Into the Therapy Room, Know What Happens to the Data

Therapy sessions can contain extraordinarily sensitive information—not only diagnoses and symptoms, but intimate details about relationships, trauma, sexuality, family members, work, health, and other aspects of a client’s life.

This makes the way an AI documentation system obtains and processes information particularly important.

The American Psychological Association recommends that therapists evaluating AI scribes examine privacy and security, data handling, informed and legal consent requirements, and whether data may be used to train an AI model. Clinicians are also encouraged to understand whether information is stored, how long it is retained, whether third-party AI providers are involved, and whether de-identified data may be used for other purposes.

There is another question clinicians may wish to consider: Could information derived from clinical encounters ultimately be used to develop or improve other AI products?

As AI companies increasingly develop patient-facing mental health chatbots, therapeutic assistants, training systems, and other behavioral-health technologies, clinicians should understand not only whether their data are stored, but also what secondary uses are permitted.  Could data be used to train or improve an AI model? Could de-identified or aggregated information be used for product development or research? Could it contribute to the development of future patient-facing AI systems?

Note Designer does not use clinicians’ AI inputs or outputs to train AI models or to develop AI therapy bots.

The important question is therefore not simply: “Does this AI write good therapy notes?” It is also: “What information does the AI need in order to write them, and what happens to that information afterward?”

A Different Approach to AI-Assisted Documentation

Note Designer was created by mental health professionals more than a decade before generative AI became part of everyday clinical documentation.

We did not begin with an AI scribe and then remove the recording feature.

We began with a different idea altogether: clinical documentation should begin with the clinician.

When we later introduced our Ethical AI features, we designed them to support, not replace, the clinician’s own thinking and documentation process.

With Note Designer:

• Your therapy sessions are not recorded.
• Your therapy sessions are not transcribed.
• Our AI does not listen to your sessions.
• You decide what information to provide to the AI.
• Identifying patient information is not sent to the AI.
• No AI inputs or outputs are ever stored
• No AI inputs or outputs are ever used to train the AI model.
• AI is entirely optional.

Clinicians who prefer not to use AI at all can simply work without it. And for clinicians or organizations that require an entirely non-AI environment, Note Designer Classic provides our clinical documentation tools without AI.

Why Does Recording Matter?

For psychotherapists in particular, recording is not merely a technological feature.

Professional and legal obligations concerning recording, confidentiality, privacy, disclosure, and informed consent may apply. Requirements vary according to profession, jurisdiction, practice setting, and the particular technology being used.

The American Psychological Association’s guidance for therapists using AI in professional practice emphasizes transparency and informed consent and recommends that clinicians understand how patient/client information is used, stored, and shared.

APA’s specific guidance on AI scribes also advises therapists to develop an informed-consent process and documentation policy and notes that laws in some jurisdictions require specific consent before AI tools record clinical encounters.

The ethical and legal landscape continues to evolve. Clinicians should therefore consider the requirements that apply to their own profession and jurisdiction.

Questions to Ask Before Choosing an AI Therapy Note Program

Do all AI therapy note programs record sessions?

Most AI therapy programs do record the therapeutic encounter so as to produce a note. These are referred to as AI scribes that capture the clinical session through recording, streaming, or transcription. AI can, however, be used to write excellent therapy notes without listening in to the private clinical encounter.

Note Designer does not record or transcribe therapy sessions, and allows the clinician to use AI as a tool to support their documentation and notes.

Can AI help write therapy notes without recording a session?

Yes. AI does not need access to an entire therapy session in order to assist with clinical documentation.

With Note Designer’s optional Ethical AI, the clinician determines what information is provided to the AI. The AI does not listen to the clinical encounter.

Can information entered into an AI therapy note program be used to train AI?

It depends on the provider.

Clinicians should examine the data-use policies of any AI product they use. Important questions include whether inputs or outputs are retained, whether data may be used to train or improve models, whether such use is opt-in or opt-out, and whether information is shared with third-party AI providers.

Note Designer does not use clinicians’ AI inputs or outputs to train its AI model.

Do therapists need client consent to use an AI scribe?

Professional and legal requirements vary by jurisdiction, profession, and how the AI system operates.

Recording a therapy session raises particularly important consent considerations. Clinicians should determine the requirements that apply to their own practice and understand precisely what the technology does before using it with clients.

Does Note Designer record or transcribe therapy sessions?

No.

Note Designer does not record therapy sessions, create session transcripts, or have an AI system listening during therapy.

What information does Note Designer’s AI receive?

The clinician decides what information to provide.

Note Designer’s approach is designed so that identifying patient information does not need to be sent to the AI. The clinician remains in control of the documentation process.

Can I use Note Designer without AI?

Yes.

Note Designer’s Ethical AI features are optional. Clinicians can use Note Designer without using AI, and Note Designer Classic provides a completely non-AI option.

The Technology Should Support the Therapist, Not Enter the Therapy Room

We believe there is an important difference between using AI to support clinical documentation and giving AI access to the therapy session itself.

For Note Designer, clinician control is not an add-on. It has been central to our approach to documentation from the beginning.

AI can help with the work that comes after the session without becoming another presence within it.

Your client’s private story stays between you and your client.

You decide what belongs in the clinical record.

And you decide whether to use AI at all.

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