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Therapists are secretly using ChatGPT. Clients are triggered.
Some therapists are using AI during therapy sessions. They’re risking their clients’ trust and privacy in the process.
By Laurie Clarke
Declan would never have found out his therapist was using ChatGPT had it not been for a technical mishap. The connection was patchy during one of their online sessions, so Declan suggested they turn off their video feeds. Instead, his therapist began inadvertently sharing his screen.
“Suddenly, I was watching him use ChatGPT,” says Declan, 31, who lives in Los Angeles. “He was taking what I was saying and putting it into ChatGPT, and then summarizing or cherry-picking answers.”
Declan was so shocked he didn’t say anything, and for the rest of the session he was privy to a real-time stream of ChatGPT analysis rippling across his therapist’s screen. The session became even more surreal when Declan began echoing ChatGPT in his own responses, preempting his therapist.
“I became the best patient ever,” he says, “because ChatGPT would be like, ‘Well, do you consider that your way of thinking might be a little too black and white?’ And I would be like, ‘Huh, you know, I think my way of thinking might be too black and white,’ and [my therapist would] be like, ‘Exactly.’ I’m sure it was his dream session.”
Among the questions racing through Declan’s mind was, “Is this legal?” When Declan raised the incident with his therapist at the next session—“It was super awkward, like a weird breakup”—the therapist cried. He explained he had felt they’d hit a wall and had begun looking for answers elsewhere. “I was still charged for that session,” Declan says, laughing.
The large language model (LLM) boom of the past few years has had unexpected ramifications for the field of psychotherapy, mostly due to the growing number of people substituting the likes of ChatGPT for human therapists. But less discussed is how some therapists themselves are integrating AI into their practice. As in many other professions, generative AI promises tantalizing efficiency savings, but its adoption risks compromising sensitive patient data and undermining a relationship in which trust is paramount.
Suspicious sentiments
Declan is not alone, as I can attest from personal experience. When I received a recent email from my therapist that seemed longer and more polished than usual, I initially felt heartened. It seemed to convey a kind, validating message, and its length made me feel that she’d taken the time to reflect on all of the points in my (rather sensitive) email.
On closer inspection, though, her email seemed a little strange. It was in a new font, and the text displayed several AI “tells,” including liberal use of the Americanized em dash (we’re both from the UK), the signature impersonal style, and the habit of addressing each point made in the original email line by line.
My positive feelings quickly drained away, to be replaced by disappointment and mistrust, once I realized ChatGPT likely had a hand in drafting the message—which my therapist confirmed when I asked her.
Despite her assurance that she simply dictates longer emails using AI, I still felt uncertainty over the extent to which she, as opposed to the bot, was responsible for the sentiments expressed. I also couldn’t entirely shake the suspicion that she might have pasted my highly personal email wholesale into ChatGPT.
When I took to the internet to see whether others had had similar experiences, I found plenty of examples of people receiving what they suspected were AI-generated communiqués from their therapists. Many, including Declan, had taken to Reddit to solicit emotional support and advice.
So had Hope, 25, who lives on the east coast of the US, and had direct-messaged her therapist about the death of her dog. She soon received a message back. It would have been consoling and thoughtful—expressing how hard it must be “not having him by your side right now”—were it not for the reference to the AI prompt accidentally preserved at the top: “Here’s a more human, heartfelt version with a gentle, conversational tone.”
Hope says she felt “honestly really surprised and confused.” “It was just a very strange feeling,” she says. “Then I started to feel kind of betrayed. … It definitely affected my trust in her.” This was especially problematic, she adds, because “part of why I was seeing her was for my trust issues.”
Hope had believed her therapist to be competent and empathetic, and therefore “never would have suspected her to feel the need to use AI.” Her therapist was apologetic when confronted, and she explained that because she’d never had a pet herself, she’d turned to AI for help expressing the appropriate sentiment.
A disclosure dilemma
Betrayal or not, there may be some merit to the argument that AI could help therapists better communicate with their clients. A 2025 study published in PLOS Mental Health asked therapists to use ChatGPT to respond to vignettes describing problems of the kind patients might raise in therapy. Not only was a panel of 830 participants unable to distinguish between the human and AI responses, but AI responses were rated as conforming better to therapeutic best practice.
However, when participants suspected responses to have been written by ChatGPT, they ranked them lower. (Responses written by ChatGPT but misattributed to therapists received the highest ratings overall.)
Similarly, Cornell University researchers found in a 2023 study that AI-generated messages can increase feelings of closeness and cooperation between interlocutors, but only if the recipient remains oblivious to the role of AI. The mere suspicion of its use was found to rapidly sour goodwill.
“People value authenticity, particularly in psychotherapy,” says Adrian Aguilera, a clinical psychologist and professor at the University of California, Berkeley. “I think [using AI] can feel like, ‘You’re not taking my relationship seriously.’ Do I ChatGPT a response to my wife or my kids? That wouldn’t feel genuine.”
In 2023, in the early days of generative AI, the online therapy service Koko conducted a clandestine experiment on its users, mixing in responses generated by GPT-3 with ones drafted by humans. They discovered that users tended to rate the AI-generated responses more positively. The revelation that users had unwittingly been experimented on, however, sparked outrage.
The online therapy provider BetterHelp has also been subject to claims that its therapists have used AI to draft responses. In a Medium post, photographer Brendan Keen said his BetterHelp therapist admitted to using AI in their replies, leading to “an acute sense of betrayal” and persistent worry, despite reassurances, that his data privacy had been breached. He ended the relationship thereafter.
A BetterHelp spokesperson told us the company “prohibits therapists from disclosing any member’s personal or health information to third-party artificial intelligence, or using AI to craft messages to members to the extent it might directly or indirectly have the potential to identify someone.”
All these examples relate to undisclosed AI usage. Aguilera believes time-strapped therapists can make use of LLMs, but transparency is essential. “We have to be up-front and tell people, ‘Hey, I’m going to use this tool for X, Y, and Z’ and provide a rationale,” he says. People then receive AI-generated messages with that prior context, rather than assuming their therapist is “trying to be sneaky.”
Psychologists are often working at the limits of their capacity, and levels of burnout in the profession are high, according to 2023 research conducted by the American Psychological Association. That context makes the appeal of AI-powered tools obvious.
But lack of disclosure risks permanently damaging trust. Hope decided to continue seeing her therapist, though she stopped working with her a little later for reasons she says were unrelated. “But I always thought about the AI Incident whenever I saw her,” she says.
Risking patient privacy
Beyond the transparency issue, many therapists are leery of using LLMs in the first place, says Margaret Morris, a clinical psychologist and affiliate faculty member at the University of Washington.
“I think these tools might be really valuable for learning,” she says, noting that therapists should continue developing their expertise over the course of their career. “But I think we have to be super careful about patient data.” Morris calls Declan’s experience “alarming.”
Therapists need to be aware that general-purpose AI chatbots like ChatGPT are not approved by the US Food and Drug Administration and are not HIPAA compliant, says Pardis Emami-Naeini, assistant professor of computer science at Duke University, who has researched the privacy and security implications of LLMs in a health context. (HIPAA is a set of US federal regulations that protect people’s sensitive health information.)
“This creates significant risks for patient privacy if any information about the patient is disclosed or can be inferred by the AI,” she says.
In a recent paper, Emami-Naeini found that many users wrongly believe ChatGPT is HIPAA compliant, creating an unwarranted sense of trust in the tool. “I expect some therapists may share this misconception,” she says.
As a relatively open person, Declan says, he wasn’t completely distraught to learn how his therapist was using ChatGPT. “Personally, I am not thinking, ‘Oh, my God, I have deep, dark secrets,’” he said. But it did still feel violating: “I can imagine that if I was suicidal, or on drugs, or cheating on my girlfriend … I wouldn’t want that to be put into ChatGPT.”
When using AI to help with email, “it’s not as simple as removing obvious identifiers such as names and addresses,” says Emami-Naeini. “Sensitive information can often be inferred from seemingly nonsensitive details.”
She adds, “Identifying and rephrasing all potential sensitive data requires time and expertise, which may conflict with the intended convenience of using AI tools. In all cases, therapists should disclose their use of AI to patients and seek consent.”
A growing number of companies, including Heidi Health, Upheal, Lyssn, and Blueprint, are marketing specialized tools to therapists, such as AI-assisted note-taking, training, and transcription services. These companies say they are HIPAA compliant and store data securely using encryption and pseudonymization where necessary. But many therapists are still wary of the privacy implications—particularly of services that necessitate the recording of entire sessions.
“Even if privacy protections are improved, there is always some risk of information leakage or secondary uses of data,” says Emami-Naeini.
A 2020 hack on a Finnish mental health company, which resulted in tens of thousands of clients’ treatment records being accessed, serves as a warning. People on the list were blackmailed, and subsequently the entire trove was publicly released, revealing extremely sensitive details such as peoples’ experiences of child abuse and addiction problems.
What therapists stand to lose
In addition to violation of data privacy, other risks are involved when psychotherapists consult LLMs on behalf of a client. Studies have found that although some specialized therapy bots can rival human-delivered interventions, advice from the likes of ChatGPT can cause more harm than good.
A recent Stanford University study, for example, found that chatbots can fuel delusions and psychopathy by blindly validating a user rather than challenging them, as well as suffer from biases and engage in sycophancy. The same flaws could make it risky for therapists to consult chatbots on behalf of their clients. They could, for example, baselessly validate a therapist’s hunch, or lead them down the wrong path.
Aguilera says he has played around with tools like ChatGPT while teaching mental health trainees, such as by entering hypothetical symptoms and asking the AI chatbot to make a diagnosis. The tool will produce lots of possible conditions, but it’s rather thin in its analysis, he says. The American Counseling Association recommends that AI not be used for mental health diagnosis at present.
A study published in 2024 of an earlier version of ChatGPT similarly found it was too vague and general to be truly useful in diagnosis or devising treatment plans, and it was heavily biased toward suggesting people seek cognitive behavioral therapy as opposed to other types of therapy that might be more suitable.
Daniel Kimmel, a psychiatrist and neuroscientist at Columbia University, conducted experiments with ChatGPT where he posed as a client having relationship troubles. He says he found the chatbot was a decent mimic when it came to “stock-in-trade” therapeutic responses, like normalizing and validating, asking for additional information, or highlighting certain cognitive or emotional associations.
However, “it didn’t do a lot of digging,” he says. It didn’t attempt “to link seemingly or superficially unrelated things together into something cohesive … to come up with a story, an idea, a theory.”
“I would be skeptical about using it to do the thinking for you,” he says. Thinking, he says, should be the job of therapists.
Therapists could save time using AI-powered tech, but this benefit should be weighed against the needs of patients, says Morris: “Maybe you’re saving yourself a couple of minutes. But what are you giving away?”
https://www.psychologytoday.com/us/blog/meditation-modern-life/202210/finding-peace-in-anxious-world
Finding Peace in an Anxious World
https://psyche.co/ideas/dance-showed-me-the-untapped-power-of-our-attention-muscle
Dance showed me the untapped power of our attention muscle
by Sara Melzer, mindfulness teacher and tango dancer
Through tango, I sharpened attentional skills that make any moment richer. But these can be honed on or off the dancefloor
Like jazz musicians, dancers of Argentine tango riff in real time, co-creating each move in each new instant. Unlike most couple dances, the tango is essentially improvised. Which leg will I move next? Will I step backward, forward or sideways? Will it last a half beat, four beats, or eight? I’m often in the dark until micro-seconds beforehand.
To dance this way, tango dancers communicate via invisible signals, felt inside our bodies. We feel our partner’s intentions to move before the outward physical steps occur. This allows two bodies to step seamlessly together into the unknown. I began learning this new sensory language during my first tango lessons 10 years ago. At first, I couldn’t differentiate a random twitch from a meaningful signal. But, gradually, I detected subtle sensations – such as the tightening and loosening of my partner’s chest and leg muscles – that signalled when, where and how to move.
Learning this dance is really about paying close attention. Skilful attention turns tango into a kind of moving meditation – an informal mindfulness practice that sharpens your focus and heightens your awareness. It might seem odd to connect tango and mindfulness, especially since many people assume mindfulness is about stress-reduction and finding calm. Although mindfulness does produce these effects, it does so by cultivating the power of attention.
A formal mindfulness practice develops attention the most fully, and it explicitly trains you to transfer attentional skills to all parts of your life. Yet many other life activities train attention as well, from learning to play a musical instrument to working in an emergency room. Cultivating my own attention on the dance floor, as well as off it, has shown me the power of this ordinary ability to transform my experience of myself, others, and the world into many extraordinary moments.
The most useful description of attention, for me, comes from the meditation teacher Shinzen Young and his Unified Mindfulness system. As he describes it, attention is composed of three skills working together: concentration, sensory clarity and equanimity.
Concentration
This is the skill of directing your focus toward what matters most, in each changing moment, and keeping it there as long as you choose. My first tango lesson challenged my concentration. I was learning the most basic element of tango’s sensory language: the felt difference of a partner shifting their weight from one leg to the other. In class, we paired up, taking turns leading and following. First, we had to discern where our partner’s weight was and mirror it by shifting to the same side. ‘Focus on your bodies’ was the instruction – that’s where the important information is. But the force of habit overpowered my concentration, and my thoughts took the lead. They kept calculating the odds of a next move, as if I were at a roulette table, betting on what steps my partner would choose. Predictably, this did not work.
When I did keep my focus on our bodies, subtle signals began to register. Still, it remained challenging to sustain my concentration there. In knee-jerk fashion, my mind routinely directs my attention upwards toward my thoughts. In an ongoing effort to rewire my circuitry, I work out in my mental gym, treating my concentration like a trainable muscle. I reframe my distracting thoughts as resistance bands that help build muscle strength. When my mind wanders, I bring it back to our bodies. Over time, it works.
I needed sensory clarity to differentiate signals from noise, and track those signals in real time
Many life activities ask the same question of us: what should we concentrate on? This is why, for example, athletes and business executives hire coaches – to train them to stay focused on what matters most as their needs shift and their habits threaten to box their focus into a corner.
Sensory clarity
In addition to concentrating on what matters most, I needed sensory clarity to differentiate signals from noise, and track those signals in real time. In class, we added another move: after shifting weight, partners could take a side-step. But how could I distinguish an intended side-step from a weight shift? I had to detect finer gradations. Did the building pressure in my partner’s torso direct our energy out to the side (signalling a side-step) or into the ground (signalling only a weight shift)?
Practising this kind of awareness helped me break the code of our bodies’ signals. And even discern that there is a code. Improved sensory clarity allows me to unpack myriad signals bundled up inside tiny sensations, indicating the speed, direction, rhythm, size and spirit of a step.
Many life activities, such as learning a foreign language, require a similar capacity. For example, English-speakers learning French often don’t initially hear the difference between the auditory signals of ‘l’amour’ and ‘la mort’. But their meanings are as different as love and death. Developing sensory clarity is essential for detecting the distinctions that carry meaning.
Equanimity
What ‘equanimity’ refers to here is an equilibrium in the emotional quality of how you pay attention, allowing experience to come and go freely. In my tango lessons, I felt pushed off my emotional axis because I was a beginner. I wanted to be an expert – immediately! Resisting the reality of being a rank beginner, I would often find myself lured into fantasies of doing advanced, dramatic steps with sexy men.
This conflict surfaced during a lesson with a legendary tango teacher from Argentina. She stopped me mid-song: ‘I can’t really feel your heart. Receive me. You are so far away…’ Far away? How could I possibly get any closer? Of course, she was right: my mind was miles away. She, my partner in real time, was but a substitute, standing in for my fantasies of all the men I’d be dancing with once I learned this impossible dance. ‘Receive me,’ my teacher repeated.
My fantasy seemed within reach a year later, when I was dancing in the mecca of tango, Buenos Aires. But soon the dance floor became so crowded that our bodies could barely move. My partner led me in lots of weight shifts and small, basic steps. Nothing was happening, I feared. And so, my mind skipped off to yet another dance, with another partner, imagining the complex, dramatic steps we could do, if only the conditions were different. This friction between my desires and the reality made me miserable. I travelled to Buenos Aires for this?
I felt the energy in his body gain momentum, until we both glided together in perfect synchrony
Then, I recalled my teacher’s words (‘Receive me’) and something changed. My buffed-up concentration and sensory clarity muscles redirected my attention back to my current partner, on that particular, crowded floor. With no place to go, and nothing to do, space cleared out in my awareness. Suddenly, sensations in my legs tugged on my focus. They led me to press my legs into the floor. This contact woke up the sensors sleeping inside my toes, feet and legs. My internal circuits lit up. I detected analogous sensors inside my partner’s body.
Our circuits connected. Subtle signals appeared where a void had been. I felt my partner’s weight coil around his right leg, bending his knee, with his energy sinking into the floor. His sensory system flashed ‘get ready for take-off.’ I waited … but no, I felt his leg straighten out. Clearly, ‘not yet’. Traffic jam ahead. Rather than tune out in frustration, we invented some creative variations on a weight shift. We riffed on almost-but-not-quite steps. Finally, I felt the energy in his body gain momentum, until we both glided together in perfect synchrony for a few steps.
This was equanimity, coupled with concentration and sensory clarity. Equanimity allows me to let go of the movies-in-my-mind featuring dances that are not possible. My concentration shifts so I can play within the limits of what is possible. With sensory clarity, I notice the quieter sensory events already present in the narrow sliver of the now.
In that moment on the dance floor, my whole body felt like a tuning fork, and we were both resonating at the same frequency. Even when all we were doing were simple weight shifts and small ‘nothing’ steps, it felt like the biggest ‘something’ of all: we, complete strangers, communicated in what felt like a deep, mysterious, satisfying connection.
What is true of weight shifts and small ‘nothing’ steps is true of much in life. Satisfaction depends on the quality of the attention you bring to an activity, not just on the activity itself. When you sip tea or a glass of wine, if you activate your sensory circuits, you can detect the multiple flavours blended within. When you ride a bicycle, the depth of your satisfaction depends on how you attend to sensory events, such as the wind on your face, an energetic buzz in your legs, a surge in your heart as you coast along. When we ‘receive’ our experience more fully and notice additional layers within it, everything feels fuller and more satisfying.
This realisation is often inhibited by the words and concepts we use to characterise our experiences. But practising attention and developing our sensory language can help us transcend those words and concepts. The word ‘love’ is an interesting case in point. The sensory experience of love is more ordinary and pervasive than many of us realise. As the neuropsychologist Barbara Fredrickson writes in Love 2.0 (2013), love ‘blossoms virtually anytime two or more people – even strangers – connect over a shared positive emotion, be it mild or strong.’ When we sync up with others, we experience micro-moments of love. Fredrickson uses the term ‘positivity resonance’, reflecting how this comes through the body’s sensory system. Words, with their limiting definitions, can blind us to these experiences of love, just as the sun prevents us from seeing the stars in the sky. We risk missing out on micro-moments of love unless we know to look for them and develop the attentional skills that teach us how and where to look. This is why learning the sensory language of our bodies is so important, whether or not you wish to dance the tango.
Words like ‘love’ are calibrated for large timescales like months, years or decades. But we live our lives in moments, and we might not always have the terms to describe what happens in fleeting snippets of time. We tend not to notice what we have no words for. But beneath the surface of our words, the body still registers sensations of connectedness. As in tango, when we detect these pleasant sensations, and ‘receive’ them with all of our attention, life’s little ‘nothings’ can be transformed into bigger ‘somethings’.
Sara Melzer is a professor in the humanities at the University of California, Los Angeles, and also teaches mindfulness there. A tango dancer, she has travelled all across the US and Europe to dance in tango festivals.
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