
joins me to dig into the fast-evolving world of AI in healthcare—and what it means for therapists right now. We talk through key ethical considerations, documentation practices, and communication protocols for using AI in clinical settings, with a...
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Melissa McCaffrey
Foreign.
Alison
Hi, welcome to the Abundant Practice Podcast. I'm Alison from Abundance Practice Building. I have a nearly diagnosable obsession with helping therapists build sustainable, joy filled private practices. Just like I've done for tens of thousands of therapists across the world. I'm excited to help you too. If you want to fill your practice with ideal clients, we have loads of free resources and paid support. Go to abundance practice building.com Links all right, onto the show. So I've talked about therapy notes on here for years. I could talk about the features and the benefits in my sleep. But there are a couple things I want you to know about therapy notes that doesn't typically make it into an ad script.
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Welcome back to the Abundant Practice Podcast. I'm your host, Alison par, founder of abundancepracticebuilding.com and I'm here with Melissa McCaffrey today who is@qaprep.com and like Melissa is a go to for all things, notes, documentation, all of that. And today we're talking specifically about AI, which is such a hot topic. So thanks for being here.
Melissa McCaffrey
Yeah, thanks for having me. I'm really excited.
Alison
Yeah, I know that you have been in a research tunnel about AI, making sure that you know you're sharing the right information with all your people and I'm really glad you're going to share it with mine too.
Melissa McCaffrey
Yeah, yeah. And it changes. It's so exciting because it changes every week.
Alison
I love your reframe. This isn't anxiety at all, it's excitement. Well, let's start with one of the first objections I hear is like, what about hipaa?
Melissa McCaffrey
Yeah, absolutely.
Alison
Well, should we first talk about, let's even back up before that. How are people using AI in their practices right now?
Melissa McCaffrey
Let's start. Yes. So that is probably the thing that's changing the most and has changed the most, even just in the last six months. So in general, the most common way that clinicians are using AI is for documentation. Right. Because that is kind of the biggest pain point. It's the easiest problem to solve with AI immediately. Like we have the resources to do that right now. And so people are using it, some people are not using it well or accurately or ethically. And that's why we want to talk about the HIPAA thing, because I do believe it can be life changing as like people have, have used that exact phrase with me many times. So I am absolutely not here to say don't use AI. I'm here to say use AI only when you consider these things. But most clinicians are using it for things like treatment, progress notes. Some people are using it for things like helping with diagnosis all the way up to, I think the even more practical use for it because you don't have to worry so much about the HIPAA stuff are things like business templates, like email templates for common responses or questions, help with writing blog posts, creating resource lists for your county or your community. Right. Like there are so many AI can access so much information that you can use it to really save yourself time in a lot of data collection. Resource collection, synthesizing information.
Alison
Absolutely. And I'll also say, and I'm sure we're going to talk about this throughout, you got to vet what it gives you.
Yes.
And so if you're doing a resource list, for instance, there are so many reports of like ChatGPT giving resources that don't exist, studies that don't exist, case law that doesn't exist. So make sure you click around and just make sure everything is legit.
Melissa McCaffrey
Yes, absolutely. Like my name has changed because I got divorced and so I have information from like running my business with two last names. And I was using an AI that could actually look through the Internet and find information that was recent. ChatGPT does not do that using older information, which is part of the reason you're getting sometimes this inaccurate data. But even this one that's up to date, that's like a paid service it was using my old last name. And when, when I asked it why it couldn't even tell me why it using the last name. It was just like, oh, you're absolutely right. Which is what they always do. I'm using the wrong name. And, but like even trying to dig into it. Yes, but please tell me the source where you found that. And it couldn't.
Alison
Yeah.
Melissa McCaffrey
And so you know, even something as, as basic as that. So you can imagine when you get into complex concepts or things that might change frequently, AI is a lot less reliable right now.
Alison
And so just like we say, like, not everything you see on the Internet is true. Not everything you get from AI is.
Melissa McCaffrey
Right.
Alison
Yes.
Okay. And can we also quickly go over what you absolutely should not be using ChatGPT or any of the other AI platforms for as a therapist?
Melissa McCaffrey
Yeah. Well, I think that goes into talking about hipaa because really that's, that's kind of what is informing this answer. Right. So thankfully, different from when I talk about documentation where so many requirements are vague and I'm kind of giving recommendations. Right. And options, this is actually a lot more concrete. We have actual laws and very clear guidelines around how to use AI. So HIPAA specific, that you need to use a HIPAA secure system anytime you're using like an electronic system for client data. Right. So we're all used to doing that with a practice management system or an ehr that is a HIPAA secure system, as long as you get a baa, a business associate agreement. So as a clinician, it's not that hard. You need your business associate agreement and you need to make sure that that system is HIPAA secure. I think we're used to that and most clinicians are aware of that. The thing that clinicians are doing incorrectly and that also we have very clear guidance from HIPAA on is identifying information. So phi. Right. We all know that we shouldn't. I think most clinicians know I shouldn't go into ChatGPT and tell it all about my client. Right. And try to get a progress note that way. However, I will hear a lot of clinicians tell me, well, I'm using ChatGPT to create a treatment plan for my clients or a progress note. But I de identify the data. That's what they tell me. I'm de identifying the data. And according to hipaa, that is not possible. So that's really what I want people to hear, is that if you are not using the same criteria for AI as you're using for your ehr, then you are using it unethically and likely illegally as well. So we don't want to do that. Right. And the good news is there are tons of good options that are paid, that are HIPAA secure that you can use ethically to do progress notes, to literally talk with an AI about your client's symptoms and diagnosis and dig into things so you can do it ethically. You cannot do it ethically with ChatGPT or Gemini or Claude or all of these other systems that I think are better at doing other things. Like if you do email marketing, yeah, go for it, use ChatGPT, use Claude, like, get some ideas from them, but don't use it for client data. And specifically, what HIPAA says is it, it has these 18 identifiers, which I think a lot of us are kind of familiar with. So those are the things like name, age, phone number, it really specifically identifies. When we say identifying information, here's what we're telling you it is. And most of them are like numbers. They're pretty easy. And that's when people say, I'm de identifying my note, they think I'm taking the name out. I don't put their city name. But the Last 1, number 18, is any other identifying characteristic. And so when I have talked with any attorney, any AI expert and any ethics expert in the field, they have all explicitly said a progress note is inherently identifying characteristics. And so you cannot write a de identified progress note. So that's why I say, like, please, please, please do not use ChatGPT. Do not use a free platform that is not giving you a BAA for individual progress notes or templates or anything that would go into an individual client file.
Alison
Yes, I had, like a temporary Reddit addiction for a little while and had to just delete it. But while on there, I saw a story. It was like Ask a therapist thread. And somebody had said, I, you know, had. Basically I had this rupture with my therapist because at one point he was sharing a screen to do, like, to show me something, and he forgot to stop sharing. And then he was entering in what I was saying to ChatGPT to give him responses. And I was watching the whole thing happen and didn't know what to do. Like, didn't call him out on it, sent him an email later and he apologized. But I don't think I want to go back to him. We were all like, don't go back to him. But I mean, things like that that I can't imagine doing. But I also am not a baby therapist who's learning how to do this with this technology right here that could help me feel more confident in the way I was treating my clients, slash, being a huge crutch in how I'm treating my clients. So I want to point that out as, like, don't do that, y'.
Melissa McCaffrey
All.
Alison
But, like, all of HIPAA just got wrecked.
Melissa McCaffrey
Yes. Yeah. And. And because it is there for a reason.
Alison
Right.
Melissa McCaffrey
That's such a good example of it's not there to be annoying. And it's not there simply because hackers exist either. It's there because a lot of this really does have to do with consent and discussing with your clients and allowing them to have some say in how things are going and in how you work. And it can create ruptures really, really easily if people find out later how you're using their data or that you don't know what you're doing. Right. And like, we've all been there and we're all there now with AI. I'm right here with you. I just have more information at the, at this stage, but it's going to be different in two months. So, you know, so don't. I don't want people to feel bad because often they are using these, these strategies when I'm doing a talk or something like this. But this is your, your information to now do differently. And yeah, if you need clinical support, you still need to talk to a human, get consultation, talk to another clinician.
Alison
Absolutely.
Yeah.
You mentioned things are always changing. Our laws, our ethics can't keep up with technology, so they always come a little later. And I know there's recent trends in AI, like not using AI in mental health care. Can we talk some about, like, Michigan? Is that the first state that passed that? Is it Michigan?
Melissa McCaffrey
Illinois?
Alison
Illinois, that's it, yes.
Melissa McCaffrey
So Illinois passed a law just a couple weeks ago that explicitly describes how AI can't be used for mental health services. So, you know, I'm sure that many people have heard of, there have been multiple negative consequences of, of people using ChatGPT as their therapist. And so from a constituent standpoint, politicians are recognizing that this is an issue. Right. This, this is coming up and we need to get in front of it. And, and also that tech companies, you know, for better or worse, work on a very different type of ethics mindset than we do. And they are not centering privacy or security. They center innovation.
Alison
Right.
Melissa McCaffrey
And we also want to be open to innovation, but we want to be more mindful of the other two. So in that way, I think that this has been a Positive trend politically that a lot of states are looking at that and wanting to actually protect consumer data as well. So a lot of this is coming from that perspective. So the laws are getting into talking about, you know, can for example, chat GPT even say that they have a chat therapist? Can any tech company say they have a chat therapist? So Illinois says no, that Illinois has become the most strict so far. I think it's Nevada and Utah also have laws on AI, but it has more to do with consumer protection of data. Whereas Illinois is the one that specifically says AI cannot be publicized or like promoted to be your therapist. Tech companies, you are not allowed to do that and it's your responsibility to make sure that consumers are not using it in that way, which is a pretty big deal. It also gives guidelines for us.
Alison
Yeah.
Melissa McCaffrey
So it doesn't say AI is all bad. It cannot be used in any way, shape or form. It says if it's used in a mental health setting, it needs to be monitored by a clinician and clinicians. It does state that clinicians can't use it as like a chat bot either. So that's been something that's been discussed about, like, oh, well, what if my clients kind of had access to me throughout the week. Right. And they could talk to this chat bot that I've, you know, directed to give certain responses. So Illinois explicitly says, know that anything that clinicians can use it in care, but it has to be, they have to be monitoring it. They have to approve everything that would be produced and presented to clients or used with clients.
Alison
Got it. I'm excited about those laws. I mean, I feel like there's some parts that might not be enforceable. Right. Like, I don't know how you enforce that. Like If I'm a 18 year old, you know, freshman and I don't want to talk to a person and I go on ChatGPT and I'm in Illinois, I could still use it as therapy, but they can't advertise it as therapy.
Melissa McCaffrey
And even the attorney general in Illinois admitted that and was saying, you know, I think this law is a great idea and I have no idea how we're going to enforce it and we need to look at that. So, yes, that is definitely a limitation.
Alison
I love it. They're like, we're stating a principle here. We'll figure the rest out later.
Melissa McCaffrey
Yes, yes. Yeah. And our ethics codes don't give us a lot of guidance. I know most of them are rewriting their codes right now, you know, and they're at different stages of that. But because of AI and wanting to put in something and you know, psychologists like me, APA always gives us the least amount of guidance possible, which is very helpful in some ways and very not helpful in others. Yeah. Whereas like NASW already has very explicit technology guidelines and actually encourages social workers to investigate and learn about new technologies and make sure that they're using technologies that increase accessibility, for example. So I do think there will be some variance there. But for the most part, our ethics guidelines are really stating this is still very new. It's changing. So we're not going to give you really definitive guidelines. The overarching guideline is you need client consent in order to use AI for client records or work with clients in any way. And I think that's the one that will across the board be the most consistent. And that's already consistent with our current guidelines. Right. Like, we don't need our ethics guidelines, any of us to change to know that if we're doing something new and innovative, we're supposed to inform clients of that fact.
Alison
Right.
Melissa McCaffrey
That's already something that's inherent to what we do.
Alison
So let's talk about how to do that. Both for current clients that we might want to use new technology with and newbies coming in, I'm like, they need to sign certain paperwork. I believe you need to have an actual conversation too. I'm not real big on like, hiding things you don't want to talk about in the paperwork. What?
Melissa McCaffrey
Yeah. Yes. Yeah. And so this is something that I think makes people nervous. A lot of people that are coming to me for help with documentation, it's because they're struggling with documentation. So my, my audience is, is pretty open to AI because they're like, please, God, save me. Right. Is there something that can make this easier? And then that is where the hang up is. Oh. But I'm nervous to talk to my clients about it. So really, if I can give you anything other than do not use ChatGPT for documentation, it's do talk with your clients about it in any capacity. So even if you're using it behind the scenes and you just use AI in your EHR, because a lot of the EHRs have AI now and you're just kind of using it a little bit to improve your notes after the fact, and your clients really don't have any awareness of it, you still need to get their client consent. I would say that's the most consistent thing I've seen from ethics guidelines so far. So let's not, like you said, Kind of toy around with it and be like, well, but this I'm just doing back. No, you need client consent, so get your clients consent. So how do you do that? Honestly, just bring it up with them. Most clinicians I work with, 100% of their clients say, yeah, sure, no problem. And it's like a 30 second conversation that the clinician was freaking out about and very nervous. So overwhelmingly, people are more open than the therapist community is to AI and people are used to seeing it everywhere. Now that doesn't mean that certain clients might say no, obviously, and that's their right to do so. Again, a great reason to talk to them about it. But I want to alleviate some of that pressure because most likely all or most of your clients will just say yeah, and not even have any questions. So keep it very simple and just say something like, you know, I'd like to start using AI to help with my notes, or you can introduce, you know, you know that I take notes about our sessions. I have a HIPAA compliant system that I know is really secure and I'd like to start using AI to help with your notes and just leave it at that. And then if people have questions, then you can either answer those questions or if you don't know the answer, that's okay. You don't feel like you have to know how this whole AI process works before you have this conversation with people. Just say, hey, that's a great question. Actually, I'm not familiar with that. I'll have to go back and check with the company and then email them and say, my client had this question. How should I answer? Because we're in a unique position right now where these AI companies want to help us as clinicians because they are making money off of this and they have the potential to make a lot of money off of it. And so they want their system to be good. That is the, the good thing about what a lot of these tech companies are doing is they want to be the best one. And a lot of them are kind of in this race to be the best AI for, for mental health services. So give them the feedback, ask them questions. They should reach out to you and help you and, and answer any questions that you do have and help you with talking to your clients about it. Most of them also have a consent form that you can download. So I actually don't have one yet as part of like my book or paperwork packet or anything, but almost all of them have one that you can download. There's no criteria. Right. So I don't even think that Illinois law states that you have to get signed consent as an example.
Alison
Okay.
Melissa McCaffrey
I think it's a best practice. I would still do it. It feels a little more official when you have someone sign a form, but absolutely have the conversation with people, use a form at least to know what kind of bullet points to cover with people and then also document having that conversation with people. But I think that's the biggest thing. It's really not likely to be a big deal for your clients.
Alison
And I think you're right. We are so much more hesitant. I remember years ago, an AI documentation company reached out to me and said, you know, we'd like to sponsor the podcast. And I was like, there's no way any therapist is going to let you listen in on their therapy, on their therapy sessions. Like, that's never, ever going to happen. Maybe some doctor's offices will, but I'm not comfortable bringing that in. And now I'm very happily using AI documentation in my own sessions. And yeah, I think it's just we are not the quickest on the uptake with a lot of technology in general as therapists. And I think that we hold. We value the privacy of our clients so much that sometimes we make assumptions about what's truly private and what's not. And if you're in one of these HIPAA compliant systems, like you're checking all the boxes, you were saying, like that Last criteria makes ChatGPT of PHI. Makes ChatGPT a no go. That means these other HIPAA compliant services meets everything that it needs to. Like they've covered those bases.
Melissa McCaffrey
Yeah, and they should. And I will say I don't want to end things on a scary note.
Alison
Right.
Melissa McCaffrey
And I have been very open to AI since the beginning because so many of my clients were. Were interested in it. You know, my clinician clients. And I've become a little bit more hesitant about like going all in because you want to ask these tech companies questions. And just because you have a BAA does not always mean that they are acting ethically or even according to hipaa.
Alison
Yeah, I guess we see that with big therapy tech. So, like, why would this be different?
Melissa McCaffrey
Exactly. Like, we have seen this with big ehrs recently as tech companies taking over certain companies that were started by clinicians. Right. And this is the same environment. I will say I have personally met with most of these AI companies with the founders, and the vast majority of them are really good people with seemingly really good intentions and they're not clinicians. So it's very Easy for them to have a different mindset about things. So all I would recommend for people, you don't have to become a tech expert. Like even I am spending a lot of time trying to stay up on this stuff. I can't explain to you all the technology. Guess what? Neither can the developers. They can't explain to you how it all works.
Alison
Right.
Melissa McCaffrey
But push back and ask them questions. So you do want to ask them questions about things like how is my client's data being used? Yes, is it? And tech companies will often use a phrase called anonymized instead of di. And they are saying that knowing that you're thinking de identified, it is not the same thing. De identified is a literal legal definition per hipaa. Anonymized is a more random thing that tech companies do that's better than nothing, but it's not the same. So they will use kind of certain lingo to appease you. But you have the right to ask like, what are you doing with my data? Is, is this client's information being saved? And it's a balance where for an AI to become better and to get to know your client and get to know how you write and then improve that over time and offer you suggestions about how to treat your client, which many people have said is extremely helpful. It has to save that data and use it over time. So where is that data being stored? Is it on a server? How is it being used? Is it being scrambled in the background and then compiled with other people's data? Right. There are some things that you want to ask these companies and just see what they have, what answers they give you and how they're willing to work with you. So for those of you who are a little nervous about it, ask them, ask them directly because they again, they actually do want those questions. They want to know what are potential barriers to people using the platforms and so they will work with you. And as you get answers from different tech companies. Right. From different AI companies, you'll be able to determine. Oh, okay. I really like the way this company approached answering my question versus, you know, company B. So I'm going to use company A because guess what, there's already so many of these platforms that like I can't even keep up.
Alison
Right.
Melissa McCaffrey
Reviewing them. So. Right. That will help you, you know, narrow, narrow things down as far as which one to use.
Alison
Yeah, I love it. Awesome. Thank you so much, Melissa. Y' all can go to qaprep.com I love your session note catch ups that you do where if you're behind on notes. Melissa, there's quarterly. It feels quarterly to me. But every now and then you'll do a. A catch up where you help people catch up on their notes.
Melissa McCaffrey
Yeah, yeah, we do a semester support. That's it. Yeah.
Alison
So I'm, I love that. Every time it comes into my inbox, I'm like, yes. People are going to feel so good when they're done with this because we all know how bad that. Well, not all of us, but most of us probably know how bad it feels to be behind on notes. So amazing. Well, thank you so much.
Melissa McCaffrey
Thank you.
Alison
If you're ready for a much easier practice, TherapyNotes is the way to go. Go to therapynotes.com and use the promo code abundant for two months.
Melissa McCaffrey
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Alison
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Melissa McCaffrey
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Alison
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Date: October 15, 2025
Host: Allison Puryear
Guest: Dr. Maelisa McCaffrey
This episode dives into the rapidly growing topic of artificial intelligence (AI) in private practice, particularly how therapists can leverage AI ethically and effectively in their clinical and business processes. Host Allison Puryear and guest Dr. Maelisa McCaffrey (of QA Prep) discuss common use cases for AI among clinicians, legal and ethical boundaries (especially around HIPAA compliance), evolving state laws, ethical guidelines, and best practices for informing clients. The conversation is practical, candid, and focused on protecting both client privacy and therapists' peace of mind.
(02:59–06:07)
Documentation is the #1 use-case:
Clinicians are “using [AI] for documentation,” especially for “treatment and progress notes,” which is a primary pain point for therapists.
– Melissa McCaffrey [03:03]
Expanded uses:
Vetting AI output is crucial:
AI tools often give “resources that don't exist, studies that don't exist, case law that doesn't exist.” Always verify information from AI before relying on it.
– Allison [04:43]
Limits of current AI:
Even AI systems using up-to-date information can make mistakes (e.g., using outdated names, inaccurate citation claims).
– Melissa McCaffrey [05:01]
(06:15–11:16)
Never use public AI tools (like ChatGPT or Gemini) for client data:
“If you are not using the same criteria for AI as you're using for your EHR, then you are using it unethically and likely illegally as well. … Do not use ChatGPT for individual progress notes or anything that would go into an individual client file.”
– Melissa McCaffrey [08:46]
“De-identifying” doesn’t make it HIPAA-compliant:
“People say, ‘I'm de-identifying the data.’ According to HIPAA, that is not possible. … A progress note is inherently identifying.”
– Melissa McCaffrey [09:16]
Client trust and ethical use:
True client consent and transparency are foundational, and using AI behind the scenes without consent can cause major ethical breaches and client ruptures.
– Alison & Melissa, Reddit example [10:11–11:16]
(12:32–15:38)
State legislation is emerging:
Illinois passed strict laws stating that AI “cannot be publicized or promoted to be your therapist.” AI can be used in mental health settings but must be monitored and approved by a licensed clinician—no unsupervised AI chatbots for clients.
– Melissa McCaffrey [12:56–14:53]
Other states (Nevada, Utah) focus more on consumer data protections.
Limitations and enforcement:
There are “parts that might not be enforceable,” but setting legal principles can be a good starting point.
– Allison [15:38]
(17:42–22:12)
Ethics codes lag behind technology:
Most organizations are “rewriting their codes,” but the main theme is that client consent is required for AI use with client records or work.
How to get and document consent:
Talk to clients directly:
“If I can give you anything… it’s do talk with your clients about [using AI] in any capacity.”
– Melissa McCaffrey [18:04]
Most clients are receptive:
Overwhelmingly, clients say yes; conversations are often brief and non-dramatic.
Use simple scripts and consent forms:
“I have a HIPAA compliant system that is really secure, and I’d like to start using AI to help with your notes…”
– Melissa McCaffrey [19:48]
Document the conversation:
Use forms (from your AI provider’s resources if needed) and always note in your records that you had the consent discussion.
(23:21–26:59)
Not all HIPAA-compliant vendors are equal:
Having a Business Associate Agreement (BAA) is necessary—but not always sufficient: companies may not act ethically.
Ask tough questions:
Vendor communication matters:
Pick companies that are transparent, responsive, and align with therapist values.
On AI’s rapid pace:
“It changes every week.”
– Melissa McCaffrey [02:36]
On unreliable AI output:
“My name has changed… and I was using an AI… and when I asked it why it [used my old name], it couldn’t even tell me.”
– Melissa McCaffrey [05:01]
On sharing client data with ChatGPT:
“Please, please, please do not use ChatGPT… for individual progress notes or anything that would go into an individual client file.”
– Melissa McCaffrey [09:40]
On therapists’ fears about AI use:
“We value the privacy of our clients so much that sometimes we make assumptions about what’s truly private and what’s not.”
– Allison [22:12]
On industry change:
“I have personally met with most of these AI companies with the founders, and the vast majority of them are really good people with seemingly really good intentions—[but] they’re not clinicians.”
– Melissa McCaffrey [24:06]
On asking tech vendors tough questions:
“Anonymized is a more random thing that tech companies do that’s better than nothing, but it’s not the same [as HIPAA de-identification].”
– Melissa McCaffrey [25:09]
The episode closes by emphasizing the importance of staying informed as AI evolves, being transparent and communicative with clients, rigorously safeguarding privacy, and proactively questioning tech partners. The overall tone is balanced: optimistic about AI’s potential but vigilant about protecting clients’ trust, privacy, and autonomy.
For more on Dr. Maelisa McCaffrey’s resources: qaprep.com
Connect with Allison Puryear and resources for building a sustainable practice at abundancepracticebuilding.com.