If you're one of the many therapists I'm seeing who was approached by an AI company offering six figures for "de-identified" notes, reports, etc, and you've abandoned your ethics enough to consider the offer, make sure when you negotiate your compensation that you factor in legal fees and the cost of losing your license.
I hate it here.
Every post I've seen has been a therapist saying something along the lines of, "Can you believe they would even ask this? No ethical provider would ever agree" so I do have hope for my colleagues, just not for, you know. Everything else.
@dramypsyd So gross.
@dramypsyd "ethical" doing a lot of heavy lifting here.
If my encounters contribute to statistics, we're in trouble.
@NadiaPurge @dramypsyd "Ethical" just means you follow a set of ethics. You can change the set of ethics. You can follow ethics that only a monster would follow and you're still "ethical". See every CEO on the fucking planet.
They've sufficiently altered the ethics of the situation that I doubt very much they'll be held to account for anything. "De-identified" info is used and shared quite regularly in medical research. Generally with permission but some fighting that as "too costly".
@crazyeddie @NadiaPurge IMO no moral provider would ever agree, regardless of what the ethics code says.
@crazyeddie @NadiaPurge @dramypsyd
The main issue I find with "de-identified" info is that it's not.
No name. Ok, but we know where you live because we know what therapist you see. You mention a spouse, or kids, or work, or eating habits, or entertainment, or shopping habits. Every one of those things works together to identify you.
Not-Bob, who is stressed because his kid's school requires new uniforms every year.
Not-Mary, who is stressed because her company just got bought.
Not-Stefan, who is stressed because there was a shooting at their favourite movie theatre.
"De-identifying" in this day and age is a myth.
It's the same conundrum with attempting to hide a diabetes diagnosis in a medical record. There are breadcrumbs all over the place. Visit notes. Diagnostic tests. Therapy, etc You can figure it out if you follow the clues.
@NadiaPurge Yeah unfortunately, I'm so sorry you've experienced that
Oct 29, 2026, 4:21 PM@dramypsyd "Here's the collected works of Eric Berne and Claude Steiner"
"Now go hack people" /s
@dramypsyd I didn’t have the heart to read it, but I scrolled past something about the US government providing a HIPAA exception for training AI…
Oct 29, 2026, 2:22 PM@ShiitakeToast @dramypsyd That is a nightmare, crazy to see Mickey mouse get more protection then your health data thanks to AI.
@ShiitakeToast Noooooooooooooooooooooo
@ShiitakeToast @dramypsyd wait, wut?
@doctorlaura @dramypsyd I haven’t been able to find another reference to it, so take it with a grain of salt…
@doctorlaura @dramypsyd there is something in the federal register from yesterday. I haven’t read it. https://www.federalregister.gov/documents/2026/10/28/2026-21943/health-data-technology-and-interoperability-onc-deregulatory-actions-to-unleash-prosperity
@ShiitakeToast @dramypsyd When I read the title it’s sickening. “Deregulatory Actions to Unleash Prosperity” Sounds vaguely cargo cultish and since regulations are just a word used to get people to forget they are actually about protecting people or the environment, it’s clear where this is headed.
@dramypsyd do you have guidance on how to explain to a non-technical therapist that this is even is unethical? I've had no luck getting through to my therapist.
@sbrudenell I think a big part of the problem is the ethics codes haven't caught up, so when I say "This is unethical" it's probably more accurate to say "This is immoral" because they may say, "Point to the ethics code that prohibits this." Basically, the client's information is not truly protected just because you take the name off the note, and even if it's not being shown to humans, it's still a breach to share the information with the AI.
@sbrudenell We need to call on national orgs (I'm going to send a letter to APA) to make clear statements about the ethics of these tools and specific guidance for providers. Though I do worry a bit that if we do that they'll come back with "Actually this is fine" (see APA taking a decade to declare that psychologists engaging in torture of war prisoners is actually not ok)
@sbrudenell Right now, APA has a statement out but that guidance explicitly says it's permissible for psychologists to work to develop AI for psychology tasks as long as we follow the rest of the ethics code while we do it. Which IMO leaves way too much gray area.
@sbrudenell (Sorry for blowing up your mentions, I have a lot of feelings)
@dramypsyd I'm in software. I share those feelings. based on my experience, you can count on large organizations to say "we're taking a cautious approach to AI (so go ahead and use this AI product! the company told us it's fine)"
I've had luck convincing non technical people of technical truths by appealing to their personal values. what do you value about being a therapist, that's put at risk by AI ingesting notes?
@dramypsyd @sbrudenell one deep truth we have learned is that ethics is a process. it is not a fixed set of rules. the rules are just the peace treaty that marks where the last round of fighting left off.
alas, yes, not everyone sees it that way ><
@sbrudenell @dramypsyd One direct way to go about it may be to point out that AI companies have been relatively successful at de-anonymizing data, so just stripping away personally identifying information may not be sufficient to protect the confidentiality of patients.
Here's a reference, if you need one: https://doi.org/10.48550/arXiv.2602.16800
@lrhodes @sbrudenell Thank you! I had assumed this was the case but backing it up with citations is always better
@dramypsyd @sbrudenell The most prominent companies investing in AI are Big Data and adtech companies like Google and Meta, which have long been interested in extrapolating identities from incomplete data. Think: Target serving ads for maternity goods to people who have not yet announced their pregnancies. Given how much of their research into machine learning was motivated by that desire, it's unsurprising that AI can be put to that use. Health providers should err on the side of caution here.
@lrhodes @dramypsyd @sbrudenell
Or lucrative government contracts for identifying "undesirables". I am pretty certain sexual orientation can be determined from surveillance cameras e.g. by how you look at people.
Lip reading is gonna be a big one too. "Our cameras don't have microphones so we're totally not *listening* on your private conversations."
And the US is showing the world how in hierarchical governance systems, anyone can become undesirable overnight by one election.
@lrhodes @dramypsyd @sbrudenell Out of curiosity, I went to see if I could find out who BetterHelp were getting their session transcripts processed by, and learned that they were prosecuted for handing customer health questionnaire responses to Facebook.
Anyway, their privacy policy doesn't say, but BetterHelp is owned by Teladoc, and Teladoc use Nuance Dragon for their transcripts, feeding into OpenAI via Microsoft.
https://www.teladochealth.com/newsroom/press/teladoc-health-expands-collaboration-in-ai-with-microsoft-to-address-healthcare-workforce-crisis
(I don't use BetterHelp, but their ads are everywhere so I figured it might be important who they hand data to. My therapist doesn't use any kind of AI and is horrified that others do.) #BetterHelp
@mathew @lrhodes @sbrudenell YUP they got in big trouble for selling client data to advertisers
Holy. Smokes. That's horrible.
Edit: as in, we live in a currently horrible world and my horrible meter sensitivity has been adjusted accordingly, and I'm still horrified by this.
@jmcrookston these last 20 years have been rough to say the least. Nothing feels horrible anymore to me cuz it’s all bad all the time.
Oct 29, 2026, 3:30 PMCan you prompt a different vendor's LLM to produce plausible notes for a load of fictional patients and sell them that?
@david_chisnall @dramypsyd Indeed, or take the money and send them a load of output from ELIZA https://en.wikipedia.org/wiki/ELIZA
@dramypsyd I've been hearing recently that this is (unsurprisingly) not exclusive to therapy but across the medical field with providers being told to record consultations (and who knows what else) to feed the insatiable AI appetite. Not even your most personal information is sacred any more.
@joltrast @dramypsyd speaking of sacred... is there a confessional data scraping yet? Strictly anonymized of course...
@meuwese @dramypsyd At this point I'd be shocked if there wasn't.
@meuwese @joltrast @dramypsyd The Pope has published an encyclical against the AI industry, so probably not.
@daburudar @meuwese @dramypsyd I hope everyone listens then.
@daburudar @joltrast @dramypsyd eh. He had Amodei sit in on a panel around the same time. And this also just about if any AI company asks, right?
It is important now, when seeing a medical provider, to clearly state “I do not consent to be recorded or transcribed using AI.” Ai transcriptions in dr visits have been problematic for people, where it hallucinates conditions and drugs, including in cases where people lost benefits until blood tests showed the AI was making stuff up.
@dramypsyd i guess the implication is that they're training a therapist-bot... even if this was ethically OK to do, what would it allow them to do? if they just see notes without observing what led to them they can't even *infer* the logic behind the notes. they can only learn to imitate the language and style.
what could possibly be the point of that? a machine that produces plausible-sounding notes and reports that aren't grounded in experience or judgment?
Yeah, but creating the appointment notes is enough evidence to bill the insurer. Which is the only functional aspect of therapy the bot creators probably care about.
@dramypsyd (i am not a therapist, i'm a computer guy, and this does fit the pattern... it's not just an AI thing, the biggest hubris of computer guys is that we can revolutionize a field without talking to anyone that knows how it works)
@aldimond @dramypsyd
Oh my sweet summer child.
The implication is there's a huge gaping hole in their training set regarding people's deepest and most private thoughts and they want their interpolating autocompleters to be able to plagiarize those too.
That and gaining more personal info through deanonymization.
@dramypsyd which here is that?
@Lizette603_23 This specifically appears to be going to US-based therapists (but it is possible that this is happening more places and I've seen replies stating they are in Europe describing similar issues)
@dramypsyd thanks for clarifying, it's something I hadn't yet been reading about. Appreciate you.
@Lizette603_23 Of course! I hope it doesn't spread but I am worried
Oct 29, 2026, 4:45 PMWhen they came for the coders, I did not speak out, because I was not a coder.
When they came for the maths, I did not speak out, because I was not a mathematician.
When they came for the doctors...
@dramypsyd You need to take a good look at what Cambridge Analytica did in 2016.
The more help these companies get the worse it is for the rest of us.
This just shook me.
This is bad.
This is big.
Is there something beyond 'predatory' for the scope of this sort of violent invasion? The effects this will have on people and the machines designed to kill us, I can't even figure yet.
Wow.
I'm crouched and ready for most of this, but hadn't considered this. And its potential is terrifying.
I hate Nazis.
@GGMcBG @dramypsyd
You can ask your treatment providers if they use AI.
I’ve been introduced to it and won’t use it. Neither will at least one other counselor Inwork with. The boss is unethical, so she’ll probably push it.
I’m looking for other work.
@dramypsyd Nothing is sacred or safe in these times.
@dramypsyd i wish i could find a medical provider who wasnt using ai to take notes.
Even if they're not using AI, they're almost certainly using some commercial chart software or another, whose vendor has access to the charts and can presumably sell them.
@argv_minus_one @makeitmythic Yeaaaaaah this is why my reports are stored on an encrypted hard drive and not in the EHR
Oct 29, 2026, 7:33 PM@dramypsyd @argv_minus_one @makeitmythic I used to have an incredible therapist who kept paper records and destroyed them after a certain number of years. She didn't even use e-mail, which normally I'd find frustrating but in this context, actually sensible.
@argv_minus_one @dramypsyd yeah, but ai makes it exponentially worse.
@dramypsyd De-identified data can still raise serious privacy and ethical concerns. Therapists have a responsibility to protect client trust, and no payout should come before patient confidentiality and professional integrity. AI innovation must come with accountability.