AI for therapists: notes and case formulation

You write up the session close to midnight, from memory, after three more clients. Before the next appointment you scroll back through messages to remember what you talked about two weeks ago, and you carry fifteen clients around in your head. Next to that, a general-purpose chatbot looks like a rescue: paste in a few paragraphs, and a minute later you have a tidy note. After a long day, it’s easy to see the appeal.

For clinical work that shortcut has a cost, and you want to know it before the first client’s story goes into a chat window.

What goes wrong with a general chatbot in clinical work

The first problem is the data. Whatever you paste into the chat goes to the servers of a general-purpose service, and from then on you don’t decide how long it stays there or who can read it. You are the one answerable to the client for confidentiality, and when they ask “where do my words end up?” you won’t have an honest answer.

On top of that, a chatbot keeps no record of the client. Every conversation starts from a blank page. To get a useful note, you retell the presenting problem, the history and what happened in earlier sessions, again. A couple of months in, you have twenty scattered chats, and none of them knows what came before.

The output also depends on how you phrase the request. The same summary comes back as a SOAP note on Monday and as an essay full of advice for the client on Tuesday. You explain the format every time, and then check whether the bot added things nobody said in the session.

Finally, nothing is tied to the session. The note sits in a chat, the intake form in your inbox, the homework agreement in a message thread. Pulling it all into a picture of the case is still your job, which is the job you opened the chatbot to get help with.

What a limited assistant does

In CognitEase the assistant is built into your practice. Each client has their own record, and the assistant writes only there and only what you allow.

If you turned on the intake form, the client is asked to fill it out before the first session, and you read a short summary of their answers instead of three paragraphs. After a session you chose to transcribe, a draft clinical note is waiting in the format you picked: SOAP, DAP or your own set of up to six sections, such as “beliefs, triggers, interventions, plan” for CBT. The draft is built from what was said in the conversation. You edit any item, remove what doesn’t belong, add your own and confirm.

Confirmed notes build the client’s case file on the 5P model: presenting problem, precipitating, predisposing, perpetuating and protective factors, plus the treatment plan and progress. The case file updates only after you confirm a note, and an unconfirmed draft doesn’t touch it. You can edit any section by hand, and every update from the assistant is saved as a separate version, so you can see what was added after the March session.

Before the next appointment you have a briefing: where you left off, which themes keep coming back, which questions are still open and what to watch for. It draws on the case file and up to three of the most recent confirmed notes. After a long break, the briefing flags it and suggests finding out what happened in the meantime.

The assistant also picks up homework agreements from the conversation and suggests them, and you decide what gets assigned. Everything it writes stays a draft until you confirm it, and only what you confirmed goes into the case file. The Smart dossier page covers notes, the case file and the briefing in more detail.

What you can hand to the assistant is the work that eats your evening: the first version of a note, sorting facts into the case file, getting ready for the next session. What’s true about the client and what to do about it stays your call.

What the assistant deliberately doesn’t do

These limits were set on purpose, so that when a client asks about their data you have a short, accurate answer:

• Session video is never recorded.
• Audio is recorded only when transcription is on for that client, and it’s deleted right after it’s turned into text. If a client doesn’t want to be recorded, you turn transcription off for them, and nothing is recorded.
• The raw transcript is kept only until the note is ready, then deleted. It isn’t shown to you, and the client’s exact words are not stored. What remains is the note, the case file and the homework.
• The assistant doesn’t diagnose. It drafts from what was said in the session, and clinical judgment stays with you.

Notes and case files are stored encrypted, and only you can see them. The client sees none of the notes, the case file or the briefing. The full path of one session’s data, along with wording you can give your client, is on How CognitEase protects client data.

What this looks like in practice

Carl Jung runs a private practice online. On Tuesday at 6 p.m. he has a session with Anna Freud, and transcription is on for her. They talk about work: for three weeks Anna has been putting off a conversation with her manager, and she isn’t sleeping well.

By the time Jung finishes his next session, the DAP draft for Anna is ready. He tightens one phrase from “work anxiety” to “anxiety about the conversation with her manager,” deletes an item he finds unnecessary and confirms. Avoiding difficult conversations now appears among the perpetuating factors in Anna’s case file. In the session they agreed that until next time Anna will note the evenings when she can’t fall asleep. The assistant found that agreement in the conversation and suggested it as homework, and Jung confirmed it.

Jung works with Viktor Frankl without recording, as they agreed in their first session. After those sessions Jung writes the note himself, and no audio enters the system.

A week later, five minutes before Anna’s session, Jung reads the briefing. Where they left off: Anna still hasn’t talked to her manager. Open question: sleep on weeknights. Watch for: Anna changes the subject when her sister comes up. He doesn’t need to scroll through messages or old notes.

CognitEase is free during the beta, so you can try the draft note with one client before trusting the assistant with the rest.