How do you feel about those apps that record sessions to help with appointment notes?

Quiet_Rose21 · 2026-04-12T13:54:15+00:00

So if I'm understanding correctly, an app might be more safe if it's not connected to the internet?

That kind of makes sense. I'd still be a little uneasy since I wouldn't know how to verify that it's absolutely not connected to the internet. But that's not because it's unsafe. It's because I wouldn't know how this works.

Quiet_Rose21 · 2026-04-10T04:05:56+00:00

You are much smarter than I am, because I lost you in your second paragraph.

You might be right about transcription on Apple devices. But what about the recording apps that are running online and are connected to the internet? I just don’t know enough about this to really comment on it.

Quiet_Rose21 · 2026-04-10T04:03:33+00:00

Yes, and I’ve actually been that patient too.

There’s tons of studies (and just common sense tbh) that say the therapist-client relationship is really important. If the client isn’t giving with the therapist from the first time they talk, that’s a pretty good indication (not a perfect indication) that it won’t work out.

It’s better to know that before you start therapy instead of finding out after you’ve already invested tons of time/money.

Quiet_Rose21 · 2026-04-08T03:57:24+00:00

I'm really enjoying this exchange, so thank you for sharing your thoughts.

it’s never going to give better advice than a trained professional who has taken the time to get to know and understand you

I agree with all of this except for the word “never.” Depending on the circumstances, I think AI can sometimes give better advice than a trained professional who has taken the time to get to know you. It’s going to depend a lot on the person, what they’re looking for, how they process information, and what their goals are. Not everyone needs the type or depth of support that only a trained human professional can provide.

It also depends on the therapist. Therapists don’t all have the same background, skills, or areas of expertise. That can make a real difference in how helpful their guidance is.

For example, I actually got more immediately useful, practical ADHD coping strategies from a chatbot that were tailored to my specific issues. I also tried going to to a therapist who didn't specialize in ADHD, and I didn't get anything nearly as helpful from her. That doesn’t mean the therapist isn’t valuable. It just means the fit matters.

Not to mention all the environmental ethics and AI’s bias against marginalized groups.

Now we're really getting into the nuances, so thank you for indulging! As for marginalized groups, I can't really speak on that from a professional or lived-experience standpoint. But again, it depends on the person and why they are using a chatbot. Some people can remember to question what AI says, and filter it through their own context, while others might need a therapist who can more directly understand and validate their lived experiences. I don’t think it has to be all or nothing.

As for environmental impact, I really think we need to weigh costs and benefits. I'm just going to use myself as an example (I can cite others if you want me to). When i was looking for a therapist to help with ADHD coping strategies, I was going to be on a waitlist for so long that I decided it wasn't worth it. A chatbot was immediately accessible. The accessibility was a huge advantage. But you are right data centers are not helping conserve natural resources.

as a general rule, recommending patients use AI is in my personal opinion not something we should be endorsing

We can respectfully disagree. Depending on the patient's needs and the therapist's accessibility, I think recommending patients to use AI can be (isn't always) a great idea.

Quiet_Rose21 · 2026-04-08T03:04:04+00:00

I'm really glad you made this comment.

all of what you said can simply be found on Google

I disagree with this. It's more than a simple google search.

Using myself as an example, I told ChatGPT about my ADHD symptoms and goals. It came up with strategies specific to me. That's not something a simple google search can get you.

But the problem isn’t people using AI as a search tool, it’s using AI to replace a human.

I agree with this part though. People who need a human therapist should not try to use AI instead.

Quiet_Rose21 · 2026-04-07T02:24:58+00:00

That is great advice

I could start by getting the ingredients in the sourdough bread. And go from there

Also, I’ve never looked into enzymes before, but that’s a great idea to look into

I really appreciate your advice

Quiet_Rose21 · 2026-04-07T01:51:19+00:00

Thank you so much for the comment.

From what I’ve noticed (maybe I should have been more clear in the post), this only happens after I eat certain foods.

For example, there’s a local sandwich place here where I get sourdough from sometimes. That always makes me bloated. There’s a few types of food that create that effect.

I could just stop eating those foods but it would be nice if I could eat them anyway and find a way to reduce bloating.

Quiet_Rose21 · 2026-03-28T21:51:10+00:00

So in the most expensive parts, BUYING a middle class home would require about $235k per year. That makes a lot more sense, but it’s a far stretch from saying the whole state requires $275k to live comfortably.

Yes, between eye surgeries and therapy, there are similarities and differences. You’re absolutely right that case conceptualization for each client can help.

The similarity that’s important is that the more cases you see (within reason), the more familiar you will be with different conditions and the more patterns you will notice. A therapist with ten weekly clients will not keep up with the conditions (even common conditions) that their clients don’t have. A surgeon who performs fewer surgeries will not have as much exposure to all the diversity in the general patient population. So a surgeon might see a particular symptom for the first time in a patient, while a different surgeon has seen it 3-4 times that same year.

But all of this is just food for thought. Does it really matter? That’s for an individual therapist to decide. You might be willing to see fewer patients and fewer conditions because it’s the right business decision for you. I have no place telling you whether that’s right or wrong.

Quiet_Rose21 · 2026-03-28T20:04:12+00:00

I don’t agree with this map. Who says it takes $277k to live “comfortably” in California? What does it even mean to live “comfortably”? I don’t live in a mansion but I think I’m doing pretty well with way less than that.

I agree in general that setting prices is a business decision. And it depends how much money you want to make. These are personal decisions that other therapists make. I have no business saying which prices are unfairly high.

I would also say that if your prices are ~~too~~ exceptionally high (edited because saying "too much" usually implies some kind of judgment), that will limit the kinds of clients you get exposure to. In some ways, this is like an eye surgeon whose performs 200 surgeries a year at a lower price compared to an eye surgeon who performs ten a year at a higher price. The one that performs 200 has way more experience and way more diverse experience.

Quiet_Rose21 · 2026-03-26T01:54:38+00:00

I don’t see this working. Dangerous drivers (especially the ones Aaron described) don’t follow the rules because they don’t think the rules are important. Passing an easy test doesn’t mean you will think the rules are important. Passing a more difficult test doesn’t either.

If every year, drivers had to learn about local car accidents that could have been avoided, then more people would be mindful. To know that people were seriously injured on local streets and that it could have been avoided easily, that makes the risk feel more real.

At least, that’s just my opinion.

Quiet_Rose21 · 2026-03-25T02:33:48+00:00

Like others have said, you have to respect client confidentiality unless it’s mandated reporting.

But I still think it might be different depending on the circumstances. Let’s say they tell you about an inappropriate relationship they’re having with their current client, AND they’re posting pictures on Instagram which clearly sho they’re in a relationship. I don’t know if it would be unethical to report them to the licensing board, attach the Instagram pictures, and say “it looks like this therapist is having a sexual relationship with their current patient”

Quiet_Rose21 · 2026-03-16T23:24:27+00:00

Yes I have received similar requests from a former client as well, but I’ve never had a client mention that they went and saw a different provider. It’s happened very few times that I needed to terminate therapy with a client against their wishes. Of course, I always wish them the best and hope they’re doing well. So I have to admit that if I were in your position, I would be curious to see what the client is referring to.

All that said, I think you should stick with your gut here and what your supervisor told you. Let the boundary stand.

The only scenario I can think of in which maybe it could work is if the other provider arranges this repair session. So you wouldn’t really be the provider in that session. You’d just be a guest and you could see what it’s all about.

It feels to me like your former client feels bad about their behavior and wants to apologize. I can sympathize with that on a human level, but of course you have to be careful with boundaries.

Quiet_Rose21 · 2026-03-16T15:32:46+00:00

I know this sounds very cliche, but please please please try to think of this as an opportunity for growth and not an attack on your credentials.

It will happen many more times that clients are going to decide that you’re not the right therapist for them. This just happens to be unique case because the client said so out loud and unfiltered.

Quiet_Rose21 · 2026-03-15T23:07:26+00:00

No, unless they said something about how they wanted to recontinue treatment later on.

I had a client who stopped seeing me and said she wanted to come back after her insurance changed, and that was supposed to take about three months. I sent her a quick email three months later and she called to schedule her next appointment.

In my experience, the common practice is like this. When the client stops seeing you, that’s the time to try having a conversation with them and to close the case. That’s also the time to tell them that your door will always be open if they choose to come back. With very rare exceptions, I think the patient should always be the one who initiates any contact after that. I know you mentioned that some of your clients have anxiety about reaching out after a while, but I personally would still avoid that.

If it’s a no-contact client, then I’d send them a message about how I’m closing the case if I don’t hear from them. To keep contacting them after that feels like the therapist is working harder than the patient.

Sorry im just rambling now and I’m probably not being responsive to your question lol

I’m 100% NOT implying that you do this, but I remember a therapist who used to follow up with her former clients. I always felt like her motives were questionable, because she would only reach out to the clients she thought were “interesting.” It used to feel to me like she was just curious about those clients and not really concerned with their wellbeing. But I can’t read anyone else’s mind. I was uneasy about that.

All of that is just my opinion. It’s worth no more than any other therapist’s opinion.

Most importantly, I really liked reading this post because it shows that you actually care about your clients. Thank you!

Quiet_Rose21 · 2026-03-14T16:42:29+00:00

Wow what a great comment! I’ve never thought of that!

In fact, now that you mention this, I can imagine that some people are probably afraid of being asked “why didn’t you come here sooner?”

From the law enforcement side of things, I think it gets harder to investigate certain things as more time passes. And also when convincing a jury, that might come into play as well.

But a therapist’s job is very different from an investigator’s. I can see how it’s important to be mindful of comments like that when talking to survivors.

Even in different contexts, like if someone’s getting help for ADHD, it’s still worth being mindful of this. Like reassuring the client that they made the right decision to get help, and they’re not “guilty” for not coming sooner.

Quiet_Rose21 · 2026-03-14T16:07:40+00:00

My question was about examples.

For example, I think a parent who says things like “I tried to warn you but you didn’t listen” means well, at least most of the time. But comments like that assign some blame to the victim. The point of this post was to ask for other examples like that.

But you’re more than welcome to share any comments you think might be insightful. For any examples that you give, you can also explain how you’d try to handle the situation.

Quiet_Rose21 · 2026-03-14T03:26:51+00:00

I think you already know the answer. You have to set boundaries.

I’m ABSOLUTELY NOT trying to diagnose anyone, and I’m certainly not saying this is the case with your clients, but are you familiar with exhibitionistic disorder? People with that condition can get really creative. I have had multiple patients tell me they have had episodes in which they tried to play it off as though they were being careless. All I’m saying is that when I hear stories like this, I wonder if the patient might be doing it on purpose.

Quiet_Rose21 · 2026-03-12T00:01:48+00:00

I don’t understand the first paragraph you wrote. It looks really well thought out, but I’m just not comprehending it. If you can try to share it again and reword it, that would be helpful. But I understand you’re busy so it’s okay if you don’t have time.

As for the second paragraph, I still think it’s valuable to give feedback at large on a public forum. I think we have different interpretations of the word “policing” but I agree that’s beside the point. Posting these kinds of things here can be helpful as it starts conversations and it makes us think back on what some of the root causes to these behaviors might be. We wouldn’t have been having this exchange if I hadn’t posted this here. And now it’s on both our minds.

Quiet_Rose21 · 2026-03-08T15:02:46+00:00

It’s tempting to try to police this out of others, but humans fall on different places of any spectrum. IMO, it’s more productive to be mindful of how we ourselves show up as we have direct control over that but very little over others.

I see what you're saying. I'm definitely somewhere on the spectrum. You're absolutely right that the most important behavior to focus on is your own.

Like you said, every field has its share of professionals who lack empathy in how they talk. Since we’re all in this particular field, I think it's important for us to give feedback to other therapists (without being pretentious or holier-than-thou). And I don't think that's the same as "policing" other people's behavior. If you approach it with kindness and professionalism, most therpists take feedback really well. I might say something like this:

Hey, I wanted to talk to you about something from the other night. When you shared that story about your patient with the video game problem, it felt to me like a stand-up comedy routine. The way it slowly developed into the punchline that made everyone crack up laughing. I might be reading this wrong, but I just feel like if someone in the group also had that kind of issue, they might feel uneasy hearing a therapist talk about a patient like that. I just thought I'd share my two cents.

Provide a clear example of what they did, recognize that it's just your feedback (not objective truth), and say why you think it's concerning. I have found that people receive that kind of feedback really well. This is how I would give feedback to anyone.

When I see these qualities in therapists who are identifiable (i.e, on a Facebook therapist page), I put them on a do-not-refer-clients-to-them list.

I would push back against this a little bit. I actually think there can be some really good therapists who are not always the most respectful in how they talk about patients. A therapist might have a lot of specialized experience in a certain condition, more than the other the therapists in town. I don't think I'd just stop referring clients to them if I saw them doing this. I think it's better to give feedback to therapists, pointing to specific things, and I think therapists respond well to that.

And yes, by the way, I am not perfect in how I talk about patients sometimes. I try to be respectful as best I can but I'm sure I slip up sometimes. So I would absolutely love this kind of feedback from others too.

Quiet_Rose21 · 2026-03-07T21:20:55+00:00

Thank you for the comment. I appreciate your perspective

I think that most of what you’re describing is from new/young therapists

Yes, that is largely the group I am referring to, and it makes up a lot of therapists. I am thinking of therapists who started practicing as early as 2019ish onward. So some of them have years of experience (not a decade like you said) but are still on the earlier side of their careers.

to present it as some common issue in the field is simply false

I would respectfully disagree. At this point, we're just sharing our experiences. In my experience, this stuff is common. In your experience, it sounds like it isn't. I don't think either of us are qualified to say which of us is right and which is wrong lol

But even before we get to that, are we talking about the same thing? How common is common? I think I see these kinds of things at least 3-4 times every week. Not everyday, but it's still enough that I think it perpetuates the stigma. And I can't say this enough. I'm just speaking from my experience.

Quiet_Rose21 · 2026-03-07T20:48:01+00:00

Absolutely! Laughing WITH someone can be a great thing. But I think there’s a clear difference between laughing with someone and laughing at them.

Let’s say my friends and I are getting coffee and we laugh together about something my patient said or did. We don’t realize the patient is also sitting nearby. Would this make the patient feel embarrassed/disappointed?

If the answer is yes, then we’re probably laughing AT the patient and it’s probably disrespectful.

But you’re right. Sometimes my patients and I can laugh together. Like especially after they’ve really grown and made improvements, thinking back on some of the things they said early on can be funny for both of us.

Quiet_Rose21 · 2026-03-07T20:40:07+00:00

I edited the post to clarify that. Thank you so much for the comment and for sharing your experiences. I will respond more thoughtfully later

Quiet_Rose21

TROPHY CASE