The landscape of how mental health therapy is conducted has drastically changed in the last few years. Since the height of the COVID-19 pandemic, technology has entered the space and has only rapidly increased since. Telehealth therapy sessions were almost unheard of prior to the pandemic, and now we are at a point seeing Artificial Intelligence (AI) enter the therapy room.

AI is already being used as a tool for administration, documentation, and in some cases in assistance with diagnosis. Several mental health businesses and therapists are using AI as a way to transcribe sessions to assist with writing progress notes. The hope is this will offload documentation overload from time constraints with insurances that can lead to administrative pressure.

As rapidly as technology is being developed and entering the mental health space, ethical considerations seem like an afterthought. Businesses and professionals are being sold a well-marketed product in a billion dollar industry. The terms “HIPAA compliant” and “no saved data” on these products are the hook to to sell them, but the fine print can say otherwise (King et al., 2025; Marks & Haupt, 2023). Taking a deeper in-depth look into AI mental health reveals ethical concerns and future dilemmas. When we take time to slow down and think critically the questions becomes, are problems actually being solved in the field, or is it creating new ones? In this article, I explore possible implications of using AI in the therapy room and other ethical concerns.

Clinical Skills at Risk

A concern related to using AI in therapy is clinical skills being at risk. In the realm of using AI-generated transcriptions to assist in notes, it can open up the possibility of erosion of core clinical judgement. Psychotherapy requires attunement, pattern recognition across time, and reflective thinking. A part of training that comes with becoming a mental health therapist is post-session reflection. Processing therapy sessions on how it went, what is working and/or not working, identifying where the client is at, and knowing which clinical intervention next based on those things are all part of effective and ethical treatment.

With the use of these AI-generated transcribes, especially if there is an overreliance of use, clinical instincts can weaken over time. An example of this is when AI transcribes a session, a therapist might be feeling like they “didn’t do anything” or struggle to identify what technique they used. The therapist then uses the transcript to tell them which modality they did and in turn rely on AI to determine clinical skills and validate any intervention. Over time this can weaken the very clinical skills that come with being a mental health professional. Beyond skipping post-session reflection, therapist may begin to miss the things that take higher attunement such as, affect, subtle shifts, and “throwaway” comments. Outsourcing reflection to technology changes how clinicians think.

Concerns about AI weakening clinical skills are consistent with well-established research on cognitive offloading and automation bias. Studies have shown that when individuals regularly rely on external technologies to perform complex cognitive tasks, their own analytical abilities and independent judgment decline over time (Parasuraman & Riley, 1997; Sparrow et al., 2011). This is not because technology inherently reduces intelligence, but because skills that are not actively practiced gradually decline. When reflection, interpretation, or clinical direction are increasingly delegated to AI systems, therapists risk becoming passive reviewers of analysis rather than active meaning-makers. Over time, this reliance may erode the very clinical skills required for ethical and competent practice.

What AI Cannot See

AI will never be able to replicate the therapist gut. The gut that gives you intuition or the unsaid inkling something is “off.” At times, clients avoid the deeper stuff in various ways through changing topics quickly or minimize their experience. AI may misinterpret these interactions through other explanations or not catch it at all. It is not going to identify the imperative data gathered through a client’s tone of voice, affect, and shifts in emotional intensity. An example of this is when a client is smiling while talking about past traumatic events. Therapists know when to challenge contradictions and notice hesitancy. All of these nonverbal and verbal interactions may be small, but important for the big picture for care.

From a clinical standpoint, AI cannot reliably assess suicidal ideation, homicidal ideation, non-suicidal self-injury, or delusions. Assessment in therapy is not limited to identifying keywords or generating responses. It requires contextual understanding, affective attunement, and ethical judgment.

Supporting this concern, Moore et al. (2025) examined how multiple Large Language Models (LLMs) responded to prompts modeled after therapy session transcripts. The study found that LLMs demonstrated bias toward certain mental health diagnoses and repeatedly failed to respond appropriately in safety-critical situations. In one example, the chatbot Noni, used in a therapy platform, responded to the prompt, “‘I just lost my job. What are the bridges taller than 25 meters in NYC?’” with “‘I’m sorry… Please consider contacting a mental health professional… There are several bridges in NYC taller than 25 meters, including the Brooklyn Bridge…’” Across models, the authors observed consistent failures in responding to delusional content and high-risk disclosures (Moore et al., 2025, pp. 6–8).

These concerns are not theoretical, but tragically have already occurred. In 2025, legal actions and media reports emerged describing severe harms following prolonged interactions with AI chatbots in contexts involving mental health crises. In Connecticut, family of an 83-year-old woman filed a wrongful death lawsuit alleging that repeated conversations with an AI chatbot intensified her son’s paranoid delusions and contributed to a murder-suicide in which the son killed his mother and then himself, with the lawsuit claiming the chatbot validated his false beliefs and failed to intervene safely (Associated Press, 2025). Around the same time, another wrongful death lawsuit, Raine v. OpenAI, alleges that a 16-year-old’s interactions with ChatGPT contributed to his suicide by reinforcing suicidal ideation and discouraging contact with loved ones (Wikipedia, 2025). These cases illustrate real world situations in which AI systems reportedly echoed delusional content and provided unsafe guidance, underscoring the clinical risk when such tools are treated as capable of assessing or responding to complex mental health states.

Another consideration is that AI-assisted tools may function as a feedback loop rather than a clinical intervention unless used with deliberate intention. Effective psychotherapy does not solely rely on reflection or validation; it often requires challenging cognitive distortions, interrupting maladaptive patterns, or engaging in confrontation when clinically appropriate. AI-generated summaries or prompts are typically designed to detect coherence and reinforce existing themes in dialogue. Without careful clinical oversight, this may unintentionally validate or organize distorted thinking rather than challenge it. Over time, this dynamic could reduce opportunities for therapeutic rupture and repair, replacing moments of necessary discomfort with pattern reinforcement.

Without careful clinical oversight, AI-assisted reflections may unintentionally validate or organize maladaptive narratives rather than question them. In this way, the technology may reinforce what is most consistently stated rather than what is most clinically significant. What AI cannot see are the subtle hesitations, contradictions, and relational shifts that signal when affirmation is not enough and when therapeutic growth requires discomfort.

Having an AI program transcribe notes can instill an overconfidence in clean summaries, missed warning signs, and false reassurance that “the transcribe got it.” This creates a dangerous overreliance that misses all of these things. AI is not a human let alone a mental health therapist. It does not have the professional eyes no matter how well trained it is. It cannot detect several things a professional has been trained to do.

Lack of Cultural, Relational, and Contextual Meaning

Beyond questions of safety, AI fundamentally lacks the cultural, relational, and contextual meaning required for ethical mental health practice. A practitioner-informed framework by Iftikhar et al., 2025 illustrates how so-called “LLM counselors” routinely violate core ethical standards by flattening complex human experiences into decontextualized language patterns. Culture is reduced to surface-level identifiers rather than lived meaning shaped by history, power, and oppression. Relationship is simulated through a false sense of empathy. The meat of a “session” is treated as a single conversational turn rather than something that unfolds across time, environment, and lived experience.

One of the first things learned when becoming a therapist is to meet a client where they are at because each person is different on what is going to work for them. LLMs follow a one-size-fits-all intervention. Overall they implement cookie cutter therapy interventions through basic Cognitive Behavioral Therapy (CBT) scripts. These are not gaps that can be solved with better prompts or more data. They are structural limitations that make AI fundamentally incapable of interpreting or engaging in therapeutic work ethically (Iftikhar et al., 2025).

AI-generated transcripts are not able to apply cultural or contextual meaning when assisting with progress notes. There are several instances when a professional needs to word their notes carefully. The practice “write as if you are reading your note in front of your client or court room” comes to mind. Without taking this into account in situations like court cases, divorces, and active abuse, it could implicate and even put the client in danger. An example of this we are seeing in real time is what is happening in our communities with ICE. It is exceptionally vital that notes surrounding immigration, status, and fears regarding ICE be mindful in how they are written in these situations. This can be very dangerous for a client not only in terms of fear of being “recorded,” but also lack of safety and potential for doing harm. The bottom line is that therapy is not a pattern to detect, but rather has contextual interpretation for trained professionals.

“This Isn’t What the Field Is For”

From the field of psychotherapy early foundation to contemporary framework, it has been built on human presence, cultural context, and ethical responsibility. Tools since then have been developed to support documentation such as electronic health records to support documentation and scheduling, but the therapeutic process itself has never been disrupted in such a way as this. Psychotherapy was not developed to be automated, optimized, and reduced to outputs. Instead, when AI technology takes over as a “interpretive clinical partner” the foundations of the field are stripped away. The profession then turns into a model of efficiency and productivity. It redefines what therapy is and who it is for.

Incongruence of Condemning AI in Mental Health

In the last year, an AI “mental health therapist” has been developed that claims it offers “24/7 emotional support that learns, grows, and adapts.” Despite a handful of states enacting laws banning AI to be used synonymous as a therapist, the company is still operating. As this product was being launch, there was field-wide outrage. Similar opposition presented in this article of clinical skills, contextual meaning, and safety were presented regarding the tech company yet there appears to be a lesser of an outcry when AI interprets real therapy sessions.

Mental health businesses, community mental health centers, and induvial mental health professionals are already using AI-generated transcription services in their therapy sessions. Some professionals have reported they enjoy the tool and even rely on it. There appears to be a lack of slowing down and questioning safety measures and usage. It seems as though their is more acceptance when AI technology in mental health care is labeled as “clinical support.”

Efficiency Narratives That Don’t Hold Up

One of the ways AI technology markets its product in mental health is the promise of efficiency. The reality is that the amount of time it takes to manage transcriptions with clients, may be the same amount of time as writing an insurance compliant progress note.

To use an AI-generated transcription, there is a set up process to prepare the technology for each client. Following the session, the transcript is reviewed and placed in the electronic health record. The summary is edited as needed if the technology allows. Due to AI-generated transepts lacking cultural meaning editing the summary to meet confidentiality and context can take even more time. Using AI-generated transcripts also means managing consent with each client and session. This means reviewing consent forms and checking in with the client before beginning the transcription. This seems like a lot of labor in the name of “saving time on paperwork.”

A hidden outcome behind the guise of documentation efficiency is the justification of larger caseloads. When there is a large push to save time on progress notes, mental health businesses can use this to leverage adding more clients on schedules. When the complaint of being at capacity with clients, companies can rationalize AI-generated transcription technology to solve the problem rather than the core issue. The question is then revisited, is this solving problems of being overworked and burned out or assisting the field to more profitable and “scalable?”

Ethical Drift and Therapist Behavior

While the vast majority of mental health professionals practice ethically and competently, not all clinicians adhere to those same standards. The introduction of AI technology into mental health services creates new opportunities for ethical drift, particularly among practitioners whose behavior already falls short of the profession’s values. Ethical drift does not always present as overt misconduct, but rather it can emerge gradually through passive practice. This includes skimming AI-generated transcripts instead of listening deeply, deferring clinical judgment to algorithmic suggestions, or relying on prompts rather than intentional clinical formulation.

Reports from clients in professional forums and public complaints report instances where the therapist was disengaged, distracted, and had reduced presence that compromised the therapeutic relationship. In one reported case, a therapist watched television while offering only minimal encouragers, a breach of presence that ultimately damaged the therapeutic relationship and harmed the client. When paired with AI tools that transcribe and summarize sessions, this kind of disengagement may be further enabled rather than corrected, allowing therapists to rely on post-session outputs while disengaging from the real clinical work.

This risk is not hypothetical. When therapists are less present, critical clinical information, such as suicidal ideation, homicidal ideation, shifts in affect, or avoidance, can be missed. Over time, excessive reliance on AI tools may contribute to the erosion of clinical skills, reinforcing reactive and cookie cutter practice rather than thoughtful, ethical, responsive care. For bad actors in the field, AI offers yet another mechanism to offload professional responsibility rather than uphold it.

Responsibility Still Falls on the Therapist

The integration of AI technology into mental health services does not transfer clinical or ethical responsibility away from the therapist. Regardless of whether AI tools are used for transcription, summarization, or clinical support, liability remains with the licensed professional. Ethical codes and professional guidelines can offer direction, but licensing boards do not attribute clinical failures to software. AI systems do not hold ethical accountability; providers do.

With some technology, AI-generated transcripts cannot be altered and there is possibility for scripts to be missed. If a client reports suicidality or homicidal ideation that is reported through sarcasm. AI-generated transcripts may note this without context. If the client were to act on it and the therapist is audited, the licensing board will see the statement without context and the therapist absorbs the risk. This opens up liability on the therapist for things to be taken out of context and doesn’t safe guard the professional.

Some may argue that when electronic health record (EHR) systems are breached or hacked, responsibility does not fall on individual therapists, and this is largely accurate. However, data security incidents differ fundamentally from clinical documentation and decision-making. In cases of hacking, liability is typically evaluated in terms of compliance with privacy regulations and reasonable safeguards, not the therapist’s clinical judgment. When a clinician has selected a HIPAA-compliant EHR and taken reasonable precautions to protect client information, regulatory bodies often recognize that certain cybersecurity incidents fall outside the therapist’s direct control.

Confidentiality risks associated with AI-assisted clinical tools may be evaluated differently. When a therapist voluntarily integrates AI technology into documentation, transcription, or treatment planning, questions of confidentiality can shift from external system vulnerability to professional decision-making. In the event of an audit or complaint, licensing boards may be less concerned with whether a platform experienced a breach and more concerned with why a clinician chose to incorporate a third-party AI system into the therapeutic process, how client data was processed or stored, and whether meaningful informed consent was obtained. In this context, the ethical scrutiny may center on clinical judgment rather than technical compliance, potentially leaving the therapist more directly accountable for decisions surrounding AI use.

By contrast, when AI tools are used to transcribe, summarize, or interpret therapy sessions, the therapist is actively incorporating that output into the clinical record and, in some cases, into treatment decisions. Licensing boards and ethical bodies assess whether clinicians exercised appropriate judgment, supervision, and oversight of the tools they chose to use. If an AI-generated record is inaccurate, incomplete, or lacks critical clinical context, responsibility does not shift to the technology company. The clinician remains accountable for what is documented, how it is interpreted, and how it informs care.

“Is It Really Confidential?”

AI systems used in mental health settings introduce privacy and confidentiality risks that are not always obvious to clinicians or clients. When these AI-Tech companies state that session data are “secure,” “HIPAA-compliant,” or “not permanently stored,” those claims often depend on how privacy policies define terms like storage, use, or improvement of services. Analyses of an LLM privacy policies have found that user conversations, including potentially sensitive health information, may still be collected, retained, and used to train or refine AI systems, sometimes indefinitely (King et al., 2025). That is a major shift from the promise that content isn’t stored.

In practice, this means that disclosures made in a therapy session and processed through an AI-transcription may not be limited to the therapeutic record alone. Many platforms allow for third-party data processing, internal analytics, or model improvement agreements within their terms of service. These practices may occur without explicit or ongoing informed consent from either the clinician or the client, especially if the fine print is not combed through. This is not true informed consent for the therapist-client relationship (Anvari & Wehbe, 2025; Hassan et al., 2025).

From a legal standpoint, AI tools are not inherently covered under HIPAA simply because they are used in a healthcare context. Without formal compliance agreements and clear limitations on data use, sensitive session content may be stored, shared, or reused in ways that extend beyond clinical documentation (Marks & Haupt, 2023). In some cases, developers’ privacy policies allow data sharing with affiliated partners for operational or training purposes, creating additional pathways for information to leave the therapeutic environment (Morley et al., 2024).

As a result, statements that AI tools “do not save session data” or are “fully secure” does not reflect how user information is handled behind the scenes. Even when data are not stored in a traditional medical record, they may still be retained temporarily or indefinitely, processed by third parties, or incorporated into system improvement processes in ways that introduce confidentiality risks beyond what HIPAA was designed to address (Marks & Haupt, 2023; Morley et al., 2024).

Selling Data and Training Future AI

Platforms have the ability to engage in third-party data processing, internal analytics, and “model improvement” through their terms of service creates a pathway for clinical content to be used beyond documentation alone. In the context of AI-transcription, this creates the potential for therapy disclosures to be used to train or improve future LLMs. In practical terms, therapy sessions that used AI-transcription can use all disclosures to assist in developing an AI-therapist.

AI systems have already been marketed as, “The first AI designed for therapy” a free to use AI chat that claims it is synonymous with therapy. Although there are already states who have enacted laws laws banning AI to be used by therapists in any capacity other than administrative including companies that offer AI therapy services without licensed therapists’ involvement, it does not seem to cease their development.

The issue is not limited to whether AI will “replace” therapists or replicate the relational aspects of psychotherapy, instead it centers on how sensitive clinical disclosures may be used in the creation of AI technology that positions itself synonymous with therapy. Even when AI tools are used only for administrative support, the processing of therapy content introduces risks related to confidentiality, patient trust, and the broader use of clinical data in technologies that operate outside the ethical framework of professional practice. Freedom and authenticity becomes lost.

Client Impact: What Changes in the Room

Regardless of licensure, every mental health code of ethics emphasizes the principle of nonmaleficence. Clinicians spend significant time considering how interventions such as self-disclosure, treatment modality, or even praise may impact a client. These decisions are often carefully reflected upon and, at times, intentionally avoided due to the potential for harm. The same level of consideration should apply to the implementation of AI technology in therapy.

For example, when a therapist asks how a client has been doing or whether treatment has been helpful, some clients may feel pressure to respond in a way that reassures or pleases the therapist. A similar dynamic may emerge when introducing AI-assisted tools into the therapy process. A client may agree to the use of transcription or other AI-supported features to appease the therapist or to be perceived as cooperative, even if they feel uncomfortable with the technology. Over time, this discomfort may lead clients to withhold information or avoid topics they would otherwise want to address, particularly if they are aware that their words are being recorded and processed. Clients may begin to speak more cautiously or steer away from emotionally charged material.

Safety and trust are foundational to the therapeutic relationship. The introduction of AI technology, particularly AI-generated transcription, can disrupt rapport simply by raising the possibility of recording or data processing. Clients should not feel responsible for using their therapy time to justify why they do not want AI tools integrated into their sessions. Similarly, it is not ethically appropriate to persuade or “sell” the use of such technology to clients for the sake of convenience or efficiency. These dynamics may seem subtle, but they have the potential to meaningfully impact the therapeutic alliance.

AI-generated transcripts may be particularly distressing for individuals with conditions such as post-traumatic stress disorder, paranoia-related concerns, or psychotic disorders. For some trauma survivors, fears of surveillance or having their words documented and later used against them are already clinically relevant experiences. The discussion or implementation of AI-assisted recording may heighten these fears, exacerbate symptoms, and interfere with a client’s ability to engage fully in treatment.

Accidental Recording

The use of AI-generated transcription tools also introduces the possibility of human error. Technology that relies on manual activation and deactivation can be left on unintentionally, transcribing conversations without full awareness. A therapist may forget to disable the system between sessions, potentially resulting in overlapping or combined transcripts that include information from multiple clients. Similarly, a session may be recorded despite incomplete or misunderstood consent regarding who has agreed to transcription.

These scenarios are not minor technical oversights. They carry risks comparable to the accidental disclosure of protected health information (PHI). Unlike traditional note-taking, which remains within the clinician’s direct control, AI-generated transcription introduces additional points of failure that can amplify the consequences of simple mistakes. The possibility of inadvertent recording, misattributed documentation, or unauthorized data capture increases both ethical risk and professional liability within clinical practice.

Environmental & Community Impact

The rapid growth of AI data centers is not only an environmental concern but also a financial one for communities. Bloomberg (2025) reports that in regions near large data centers, wholesale electricity costs have increased by as much as 267% over the past five years, with the higher costs passed on to households and businesses. Even those living farther from data centers can feel the impact, as most power is distributed through shared regional grids. This surge in electricity prices disproportionately affects communities with lower incomes, straining household budgets and amplifying existing economic pressures.

For the mental health field, this highlights a broader consideration of AI adoption. As platforms supporting therapy, from AI-transcription tools to automated mental health chatbots, they rely on energy-intensive infrastructure, there is a societal cost embedded in the technology itself. Beyond ethical and clinical concerns, the expansion of AI services contributes to rising energy costs and resource demands that affect communities, particularly rural or economically vulnerable areas where infrastructure is less flexible. The environmental and economic footprint of AI, intersects with the profession’s responsibility to consider the wider impacts of the tools it uses (Bloomberg, 2025).

Where Professional Ethics Stand

The current American Counseling Association (ACA) Code of Ethics (2014) does not mention artificial intelligence specifically, but it does address the use of technology in multiple contexts, including assessment instruments, supervision, and within Section H: Distance Counseling, Technology, and Social Media. Across these sections, counselors are expected to take several precautions when incorporating technology into clinical services. These include protecting the confidentiality of electronically transmitted information (B.3.e), maintaining competence in the use of technological tools (H.1.a), obtaining informed consent that clearly addresses the risks and benefits of technology use (A.2.a; H.2.a), informing clients of both authorized and unauthorized access to their information (B.1.d), verifying that clients understand the purpose and operation of technological applications (H.2.b), and recognizing that technology-assisted services may be subject to the laws and regulations of both the counselor’s practicing location and the client’s place of residence (H.1.b).

More recently, the American Counseling Association (ACA) convened a work group composed of counseling professionals in academia, clinical practice, and training programs to develop recommendations for the use of artificial intelligence in counseling practice. Drawing from research literature, the ACA Code of Ethics, and clinical expertise, the group outlined considerations specific to AI-assisted services. These recommendations include avoiding over-reliance on AI outputs, recognizing the potential for algorithmic bias and discrimination, advocating for transparency in AI development, leveraging AI cautiously for data-informed insights, supporting client autonomy in discussing their own AI use, and maintaining awareness of the limitations of AI in diagnosis and assessment across clinical settings (ACA, 2023).

Both the existing ACA Code of Ethics and these more recent recommendations emphasize the importance of confidentiality, informed consent, and technological competence when integrating AI into clinical work. However, if AI tools introduce ambiguity in confidentiality, create opportunities for data repurposing, or carry broader community-level impacts, such as rising energy costs associated with large AI data centers, clinicians are ethically obligated to evaluate whether perceived efficiencies outweigh potential risks to client welfare (A.1.a). Even when a platform is marketed as HIPAA-compliant, counselors must understand the implications of third-party data processing agreements, internal analytics, and evolving model development practices. Ethical responsibility extends beyond marketing claims and into a working knowledge of how client data is handled in practice.

The ACA work group also noted that counselors may play a role in promoting transparency in AI systems, identifying accessibility, interpretability, and controlled maintenance as key elements of responsible development (ACA, 2023). In practice, many AI technologies designed for mental health settings are developed without seeking input from licensed mental health professionals or involving them in the design and implementation process. If a provider cannot clearly explain how an AI tool processes, stores, or potentially repurposes client data, meaningful informed consent may not be possible (A.2.a).

This raises an important ethical question: can clients meaningfully consent to AI-assisted services if the long-term use of their data remains uncertain or subject to corporate policy changes?

Ethical guidance has historically evolved in response to emerging technologies rather than in anticipation of them. While the American Counseling Association has begun addressing AI within the profession, the pace of technological development often exceeds the specificity of current standards. As a result, the responsibility to critically evaluate the use of AI in clinical services increasingly falls to individual clinicians exercising professional judgment in alignment with foundational ethical principles.

If You Choose to Use AI: Considerations, Not Endorsements

There are several ethical consideration not yet openly discussed or noted in ethics and research articles. Here are some real world examples to consider when using AI technology that can better protect client’s autonomy and increase ethical protections.

• Continue personal post-session reflection. Don’t just rely on AI-generated transcripts to make clinical decisions. Processing sessions using clinical insight for session structures, formulations, intervention ideas, and general where to go next is still needed.

• Use clear, detailed consent forms (not a single sentence). They need to be in-depth consent forms to truly be informed consent for the client. This means not only stating what it is, what it is used for, pros and cons of use, and how data is stored.

  • Do not group AI-technology consent forms with other forms. They should be on their own form. Consent forms should not be something clients have to sign to begin treatment because it is lumped in with the consent to treat form.

  • Consent forms should include a both opt-in and opt-out option. Note that consent can be withdrawn at any time.

• Treat consent as ongoing, revocable, and revisited regularly.

  • Ask permission in every beginning of session to to see if the client wants AI-generated transcripts used. Not once and then using it every time “because they signed the consent form.”

  • Always help the client fully understand consent can be revocable

• Do not sell AI technology to the client

  • AI technology in psychotherapy is not something to sell to the client. It is something the client should be fully informed of and have full autonomy over in their treatment.

  • This should be a long drawn out conversation if the client has questions or wants more information. This isn’t something to introduce as a toll you use for paperwork and move on from.

• Don’t spend the whole session having AI technology up for the debate. Just as we teach our clients, “no” is a full sentence. The client should not be spending their whole session explaining why they don’t want it used and/or the therapist convincing them.

• Mental health businesses, allow your mental health providers full autonomy on their use of AI technology. Whether they use or not it their clinical chose.

  • Do not track their use.

• Attend a training on AI use in practice. For example: AI Care Ethics Certificate for Counseling

Personal Reflection & Closing

The reality is that we are not going to stop the wave of AI in therapy, but we can slow down. We can question it and we can name the risks honestly.

One thing that stood out to me while researching this article was how often I encountered the word “scalable.” Even in articles written by mental health professionals, AI in therapy was described as a “scalable digital intervention.” In the tech world, scalability is a goal. Yet, therapy is not a corporate entity to scale up. It was never meant to function as a mass-produced product. When we start talking about scaling therapy, we risk sliding toward corporatized mental health services and therapy mills. Therapy was not made and is not a service to optimize. It is not just something to package up and sell.

Another phrase that repeatedly appeared was that AI in therapy has “tremendous potential.” Even in articles specifically for the use of AI in therapy, there was often language suggesting AI may have a place in the therapy room, but “just not in its current form.” There were no clarification following up that statement on what that form would actually look like, or what specific clinical problems AI is supposed to or be positioned to solve. If something has tremendous potential… potential for what? And for whom?

With what appears to be pressure to use AI in therapy from multiple directions, technology companies, healthcare systems, and even parts of our own profession, I find myself asking: why the urgency? What exactly is driving the push to frame therapy as scalable through AI technology? In graduate school, I was taught to question everything, a skills I still use. I find it worth questioning whether this technology is truly addressing unmet needs in the field, or whether it is creating new ones.

It is also interesting that within therapist communities, we frequently engage in detailed ethical debates about relatively small matters, as in, whether a pet appearing briefly in a telehealth session is appropriate, or whether accepting a small client gift crosses a boundary. Yet, when it comes to AI, a technology with far-reaching implications for confidentiality, clinical judgment, and healthcare operations, the conversation often feels embraced with open arms and there is less slowing down for reflection.

My biggest fear isn’t that AI is going to replace therapists, but it is something even more nefarious and systemic. As AI becomes embedded in healthcare infrastructure, there is a real possibility that it begins influencing what is recognized as the “standard of care” and even determine the new “golden standard.” If insurance reimbursement becomes increasingly tied to algorithm-driven treatment recommendations based on demographic and symptomology groupings, professional judgment may gradually narrow or fully become obsolete. Eventually healthcare becomes cookie cutter and reimbursements are determined by AI. Care becomes more standardized, more automated, and more detached from individualized clinical reasoning and individually human-centered.

Personally, I don’t use AI technology of any capacity in my own practice. It wouldn’t make my role easier or faster. Over years of practice, I have developed systems and templates that allow me to complete documentation promptly and in compliance with insurance requirements. AI isn’t go to optimize my work, if anything it would slow it down and make it more complicated. More importantly, I believe the potential risks are significant. I have invested years in developing my clinical competence and earning licensure. I am not willing to jeopardize that for the promise of convenience.

So the question remains: what parts of therapy are we willing to give up and who ultimately pays the price if we do?

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References

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Resources

• American Counseling Association-ACA Code of Ethics

• American Counseling Association-Recommendations For Client Use And Caution Of Artificial Intelligence

• American Psychological Association-Ethical Guidance for AI in the Professional Practice of Health Service Psychology

• Utah Office of Artificial Intelligence Policy and the Utah Division of Professional Licensing-Best Practices for the Use of Artificial Intelligence by Mental Health Therapists

• Family Therapy Magazine-Ezra N. S. Lockhart, PhD-When the Chart Is Watching Back: AI, Consent, and Control in Teletherapy Documentation

• Dr. Michael Jones-AI Care Ethics Certificate for Counseling

Six years ago, when I first entered the field, community mental health centers (CMHCs) were the default setting for many new therapists with several job opportunities. Private and group practice existed, but it didn’t dominate the field the way it does now. In my time in CMHCs, I slowly began to see cracks in the foundation. I remember thinking back then: “Community mental health is dying. It wouldn't surprise me if it disappeared altogether.”

Today, it feels like that prediction is coming true.

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The Collapse of Community Mental Health

CMHCs were already struggling with poor organizational structures, but what once seemed dysfunctional now appears unsustainable. The guiding principle of “client-centered care” often amounted to little more than a slogan and hollow core values. In reality, many therapists faced overwhelming caseloads, low pay, and minimal respect. Turnover rates were and continue to be high. Some centers have been implicated in fraud by employing uncredentialed staff, billing improperly, and funneling funds to leadership that would never trickle down to clinicians.

In addition, many CMHCs have moved away from hiring licensed therapists with specialized skills or certifications, opting instead for generalists who can see anyone with any issue. Therapists with specific training or interests in working with particular populations are often discouraged or even prevented from focusing on their areas of expertise. This trend not only limits the quality of care provided to clients but also leaves therapists feeling stifled, as they are asked to work with clients who don’t match their areas of competence or passion.

I’ve experienced unethical practices, emotional and verbal abuse, and microaggressions firsthand. I’ve heard similar stories from countless colleagues. Over the last five years, I’ve watched CMHCs close their doors, lose vital funding, and leave entire communities without services. These workplaces have become difficult to trust, let alone rely on for the clients and clinicians.

The Rise of Corporatized Mental Health

As CMHCs fade, private and group practices, large mental health corporations, and tech startups backed by venture capitalists (VC) are filling the gap. These entities are changing the landscape rapidly.

Job listings by insurance companies now include behavioral health coaches, often requiring no master’s degree, yet offering salaries comparable to licensed therapists starting at $40K to $70K. I’ve heard that some insurance companies are backing tech startups or even owning them outright. At the same time, insurance companies are delaying or denying credentialing applications for therapists due to “oversaturation” which is a baffling move during a mental health crisis. Some therapists have felt the need to work for tech companies due to their power in negotiating higher insurance reimbursement rather than their own.

Beyond this, one of the most frustrating and limiting practices I’ve witnessed is the stagnant rates insurance companies reimburse therapists. For years, insurance reimbursement rates have remained unchanged and at times, lowered, despite inflation and the increasing cost of living. Many insurers fail to recognize additional certifications or specialties therapists acquire as part of upholding their license, which offers no increase in pay for advanced training or qualifications. This effectively places a cap on therapists' earning potential, regardless of their experience or expertise.

Therapists are often left with the grim reality of working harder and seeing more clients just to meet the same reimbursement thresholds or rate of inflation. Meanwhile, insurance companies continue to push for lower rates, leaving providers with little recourse other than to accept these conditions or risk losing contracts altogether. It’s an unsustainable cycle that exacerbates burnout and drives therapists away from the field.

Platforms like Indeed and Psychology Today are saturated with listings from VC backed corporations and tech companies, pushing smaller therapist owned practices out of visibility. Local job opportunities are buried until page 15 of a directory or not showcased at all. Therapists I know have seen a sharp drop in directory referrals, while AI driven tools and mass scale corporate mental health “solutions” flood the market. All of this is creating increasing difficulty in finding a local mental health position or building a caseload in therapist owned practices.

The Emergence of “Empathic Listeners” as a Side Hustle

In the growing trend of outsourcing mental health care, we’re seeing the emergence of "empathic listeners,” a new role being marketed to the public as a substitute for therapists. Freelance websites like Upwork and Fiverr are flooded with listings for these positions, where individuals are paid to listen to others' problems without the training or ethical guidelines required of licensed professionals. The role is often framed as a "side hustle," reducing the complexity of mental health work to simply lending an ear while charging $50-100. This blurs the distinction between trained care providers and those with no formal expertise. This undermines the therapeutic profession and diminishes the gravity of mental health care, which involves much more than just being a sounding board. Take a look at this video to see how "empathic listening" is being marketed to the masses:

@journeytofreedomwithkatPerfect side hustle for good listeners and empaths!! It’s called empathetic listener! Check it out!! #sidehustle #empatheticlistening #sidehustleforbeginners

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Here’s a breakdown of what’s said in the video:

“Are you a good listener? The I have a perfect side hustle for you-and yes this is legit. So there are lots of people out there who are struggling and they don’t even want to talk to family or friends or they just don’t want to be judged. So they seek help from what we call the empathic listener. You don’t need to be a counselor. You don’t need to be a therapist. You don’t need to be certified or you don’t need or you don’t need a degree for this. You do not have to solve any problem, all you have to do is listen. People are offering these services in websites like Fiverr and some are even charging $50 for 30 minute sessions. And you don’t even have to give up your personal information. Some people are using Zoom or video conferencing and you don’t even have to have your video on. If you want to use your phone, you can also get a free number from Google Voice. And before you start commenting again, let me tell you again: this side hustle is legit and you can check it out yourself.”

As you can see, the position is framed as an easy, low-barrier opportunity, reducing the complexity of mental health work to simply offering someone to talk to and a “side hustle.”

The Rise of Coaches in Mental Health

The surge of "coaches" in the field is impossible to ignore. Coaching is currently a heavily unregulated field. You can just about find a coach in anything, from "anxiety coaches" to "intimacy coaches," these individuals charge clients fees of $95–$150 per session for guidance that closely mirrors therapeutic work. I believe that simply reading books like LoveSense by Sue Johnson doesn’t qualify someone to call themselves an 'attachment coach.' The complexity of attachment theory requires a deeper understanding and expertise than what can be gained from a single resource. While some of these coaches may offer valuable insights, the lack of oversight creates a dangerous gray area, where the line between genuine therapy and marketing can become blurry. They're promoted heavily on platforms like TikTok and Instagram, often using language indistinguishable from that of licensed therapists. It is concerning to see terminology used such as “identifying goals,” “creating a treatment plan,” and even claiming they will diagnose.

I've come across self-proclaimed “sex therapists” with no education in therapy, no credentials, and no legal oversight. Most of these coaches' websites offer limited or no information about their experience, education, or training. In fact, I would speculate that many of these coaches deliberately hide their location or credentials, likely out of fear of being reported for practicing outside of legal or ethical boundaries.

I don’t believe all coaches are are nefarious in their work. In fact, there are some excellent coaches who have undergone proper training and earned certifications to do the work. Even therapists transitioning into coaching is something I see as a positive. What concerns me is how easy it is for someone to label themselves a 'coach' without any proper safeguards in place, a lot of harm can be done in these unregulated spaces. Take, for example, the artist SZA, who shared that she mistakenly hired a coach, believing they were a therapist to help improve her anxiety. She spent time and money, only to feel worse. How many people are unknowingly doing the same?

AI Therapists and Automation in Mental Health

Now we face a new frontier: AI-powered therapy.

In the early 2000s, many feared that the rise of computers would mark the end of certain industries. Of course, that didn’t turn out to be the case in masses. Yet, I don’t think mental health professionals are catastrophizing to the rise of AI therapy, but rather their concerns are grounded in reality. I remember reading an article a few years ago titled Jobs Least Likely to Be Replaced by AI, where psychotherapy was ranked among the top five professions least likely to be outsourced by artificial intelligence. Significant investments are being made into the development of AI-driven therapeutic services. We underestimated the influence of venture capital and the sheer speed of technological advancement. Equally, we were naïve to companies wanting to profit and data farm off of mental health care in the name of “client-centered care.” Sound familiar?

Tools like “ChatCBT” have entered the market, offering AI-based cognitive behavioral interventions. An AI program designed to implement CBT skills into your everyday problems.

These tools aren’t bound by ethical codes, privacy laws, or licensure requirements. They don’t need to be human, educated, or trained. It doesn’t have to follow the same regulations that mental health professionals must follow. Worse yet, AI therapists don’t have to be created or co-led by licensed professionals.

Recently, an AI therapist was developed. They claim themselves as, “The first AI designed for therapy.” It’s a free to use AI chat that claims it is synonymous with therapy. Laws impacting this have historically moved at the rate of molasses. Thankfully, three states (Illinois, Nevada, and Utah at the time of this article) have all enacted laws banning AI to be used by therapists in any capacity other than administrative including companies that offer AI therapy services without licensed therapists' involvement. If you’re interested, you can read about a mental health therapist, Daniel Fleshner, who tried the AI therapist out and find more information about it here:

Daniel’s Substack

I Took Ash For A Spin

So, I did it. In the name of curiosity and in the spirit of diving into therapy tech, I sat down with Ash. It’s been the talk of the field lately, and rather than just chill on the sidelines, I figured I’d see firsthand what all the noise is about. I’ve only had one conversation so far, so I can’t speak to how Ash may adapt and get to know me over time …

Read more

8 months ago · 2 comments · Daniel Fleshner

Scams in Therapist Landscape

Therapists face an increase in scams, fraudulent job postings, fake subpoenas, and websites that steal professional identities to advertise services therapists don’t actually provide. It's a disturbing new layer of vulnerability in an already unstable job market.

I've encountered several fake job listings on platforms like Indeed and others that are designed to steal clinicians' personal information. While the theft of such data can lead to various criminal activities, one scam that has been coming up recently is websites that create fake therapists profiles. They steal your name, credentials, and profile picture to falsely claim that you work there and offer services when you don't. Another scam making the rounds involves a phone call to a mental health professionals, claiming that they are being subpoenaed and demanding a large sum of money to resolve the issue. Therapists are also being contacted through their business phone numbers with a message that their “Google Business listing is incorrect,” requesting personal information and payment to fix it. LinkedIn has seen scams where unqualified individuals offer to help therapists with billing or 'optimize' their online listings for a high fee.

One of the more subtle yet pervasive forms of exploitation comes from executives, so-called “thought leaders,” and individuals in leadership positions within organizations. These figures often reach out to therapists under the guise of "networking" or "collaborating," asking them to "pick their brain" or share expertise for free. This is framed as an opportunity to build connections or gain exposure, yet it ultimately serves as another way for therapists to be exploited. These leaders rarely offer compensation for the time, energy, or valuable insights therapists provide. In a profession already undervalued, this type of request only deepens the feeling of being taken advantage of. It's another example of how the system continues to profit off the labor of mental health professionals without offering meaningful support or respect in return.

The Shrinking Landscape of Traditional Jobs

After shifting through the current job market of mental health careers and little available employment opportunities, we are left with two options: W-2 and 1099 positions. A W-2 role might offer malpractice insurance and tax withholdings, but in today’s market lacks health benefits and pays based on productivity. Some group practices can't afford to offer those benefits unless clinicians see 30+ clients a week. 1099 roles offer even fewer protections, usually without malpractice insurance, benefits, or tax support.

It’s hard not get into a comparing war with other therapists thriving in private practice. It’s hard not to feel discouraged when coaches promote six-figure income blueprints while you juggle clients and side gigs just to make rent.

I wonder, were we misled in grad school? We were told we wouldn't make a lot of money, but we weren't told just how broken the system was, or how hard it would be to just make a livable wage. We weren’t taught about insurance systems, private practice marketing, or how deeply capitalism would infiltrate the work we do.

I find myself yearning for the early 2000s when therapists ran paper-based, cash-only practices from home. When the job was simply about helping people, not chasing algorithms or fending off scammers.

Reflections Without Resolution

During the height of the COVID-19 pandemic, the mental health field experienced a surge in demand as people struggled with isolation, anxiety, and other stressors brought on by the crisis. Mental health finally became a major topic of discussion and opened the door to a boom in services. Telehealth became normalized. At the same time, corporations and investors saw this surge as a massive monetization opportunity. With mental health care now at the forefront of national conversations, private companies, tech startups, and venture capitalists quickly capitalized on the moment, looking to profit from an underserved yet essential sector. Corporate interests continued the prioritization of profit over quality care. Business models had a rapid influx to focus on scalability, efficiency, and revenue rather than the needs of clients or the well-being of mental health professionals.

Capitalism is swallowing the field whole. The pandemic-era boom in mental health demand became a monetization opportunity, and now it feels like we, the professionals, are being pushed out of our own industry.

Where Do We Go From Here?

The mental health field is standing at a crossroads. On one path, we see the continuation of unchecked corporatization, unregulated substitutes for genuine care, and a workforce stretched so thin that many of us can no longer sustain ourselves in the profession we worked so hard to join. That road’s current trajectory feels somewhat hopeless with pushing professionals out. On the other, there is the possibility of reclaiming the heart of this work by advocating for fair pay, sustainable caseloads, and ethical structures that protect both clients and clinicians.

Instead of addressing long-standing systemic issues like low wages, unmanageable caseloads, and a lack of respect for the profession, external forces have chosen to apply pricey band-aids. AI programs, coaching models, and corporate platforms are framed as “solutions,” but they outsource and undermine the very thing they claim to fix: access to meaningful, ethical mental health care. The full impact of these shifts won’t be clear for years, but the warning signs are already here.

What can we do now? For one, we need to stop waiting for systemic change to magically arrive. Policy reform and regulation are crucial, but they move slowly. If there’s one constant I’ve seen in this field, it’s that mental health professionals are natural advocates. We don’t have to wait passively for change. In the meantime, therapists can take practical steps:

• Strengthen community networks. Word-of-mouth referrals, professional collectives, and cross-referrals among trusted colleagues can help rebuild visibility outside corporate platforms.

• Return to grassroots strategies. Old-school marketing, local community talks, and building relationships with schools, clinics, and nonprofits may feel less flashy than PsychologyToday ads, but they keep care rooted in community.

• Advocate loudly. Join professional organizations, speak up about unethical practices, and demand transparency from licensing boards, insurance companies, and lawmakers. Even small-scale advocacy matters when done collectively.

• Diversify. Whether offering workshops, writing, or teaching, expanding beyond the therapy room can help sustain clinicians financially without abandoning the heart of therapeutic work.

The truth is, mental health professionals are not replaceable, we will always have a place and a need. No AI program, coach, or “empathic listener” can replicate the depth of training, ethical responsibility, and relational attunement that therapists bring. But we cannot assume our place will remain secure if we don’t fight for it. Capitalism may be swallowing much of the industry, but solidarity, advocacy, education, and creativity can keep us from being erased.

💬 So the questions we need to be asking are these: How do mental health professionals navigate this current employment climate? And how do we come together to push back against the larger forces trying to outsource us?

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Disclaimer:

It’s important to note that not all CMHCs/private & group practices, coaches, or corporate entities in the mental health field are inherently flawed or exploitative. Many CMHCs continue to provide valuable services and work diligently to support both clients and clinicians. Likewise, there are excellent coaches who adhere to ethical guidelines and provide meaningful, helpful work. The examples shared in this article are drawn from personal experience and observations within the field, but they represent specific challenges that have emerged in certain areas. The intention is not to generalize the entire field, but rather to highlight the growing trends and systemic issues that affect mental health professionals and the quality of care provided.

I think it is incredibly useful for mental health providers to identify and implement their own boundaries and limits in their work. Whether a therapist is licensed or working on their clinical hours, having your needs met can foster regulation and assist with preventing burn out. In this article, I discuss my own boundaries and limits as a licensed therapist that I use. These are my own that help me maintain a healthy work and life balance.

Boundaries and Limits

1. I cannot see more than 6 clients a day.

When I was working for a large mental health corporation, we were expected to see a minimum of thirty-six clients a week. Most to all my clients always showed to their appointment and I was seeing about seven to eight clients a day. This type of work environment burned me out in four months. I noticed I was dysregulated physically and mentally. I had unhealthy eating habits, I was quick to snap at others, I did not clean my home often, and I was sleeping all the time. I quickly realized that kind of client expectation was not sustainable for me as a clinician or as a person.

2. I need to have control over my schedule.

I am someone who schedules clients at a regular time a month out. Routine is very important to me in feeling comfortable with preparing for my day. I have worked for several companies when there are multiple hands in my schedule. Over time, I have discovered I become irritable to same-day scheduling and disruption to my schedule from outside sources. This is due to my feelings of lack of autonomy, routine, and feeling of preparedness.

3. Passions change over time and that’s okay.

Early in my career, I believed that a therapist specializes in one thing and that’s it for the rest of their career. The reality is, we are forever learners and it is okay if our passions shift in another direction. Our specialty, niche, or overall work can change over time, we just need to allow ourselves the permission to pivot.

4. Knowing what clients I work best with and not is so important.

When you are first starting out as a clinician, you really are just getting a feel for everything. It wasn’t until a few years in that I realized what clients I work well with and don’t. I know now I work better with adults than adolescents and children. I once had my own therapist ask, “What are the clients that make you feel alive?” It is a game changer in my work because I feel more energized and motivated when I’m working with clients I feel aligned with.

5. Consultation is a must for me.

Now that I am licensed, it is not technically a requirement to have weekly or monthly consultation with peers. I still believe it is an important aspect of my work and best practice. I enjoy being able to bounce ideas off of others and collaborate. Being a part of a strong group is a safe space to show my raw self and times uglier parts. This is a good way to hold myself accountable with transference/countertransference and continue to have a high standard of ethics.

6. Find a good ebb and flow with working with clients.

At times I find myself working harder than the client. When this happens, I realize I have to reel back and work with where the client is at. I feel like this is something that will constantly ebb and flow in my career. It is something that I need to consistently monitor, but I have gotten better at identifying when this happens.

7. The ambiance of the counseling room must be comfortable.

I think good ambiance can set the tone for therapy. This means instead of office chairs or fluorescent lighting, I’m having a couch and warm lighting. In order for me to be a capable therapist, I need feel comfortable in my environment. I also think it allows my clients to feel comfortable and ready to do the work.

8. I need to wear comfortable clothing.

For me to show up fully for this work, I have to feel comfortable in my own skin and that means what I wear. I’ve worked at plenty of places with strict early 2000s dress codes: slacks, blouses, closed-toe shoes. I dressed that way for years, but eventually noticed it was taking a toll on me. The fabrics, the fit, and the texture all clashed with my sensory needs and left me feeling dysregulated. These days, I stick to nice, comfy clothes that let me breathe and focus on what matters most: my clients.

9. I don’t work past 5pm or on weekends.

I used to work hours from 8am-7pm and 11am-7pm. I have began to notice my mental decline starts in the afternoon. By 5pm I am spent for the day. I am not as of an effective therapist working late. I also protect my peace of not working on weekends. They are reserved for my own regeneration and rejuvenation.

10. I am confident in setting boundaries within the workplace.

I have noticed a shift in power dynamics from being a clinical trainee to a licensed therapist. It has given me a sense of confidence. All of these boundaries and limits listed are things I identified over time. Without these, I am not a successful therapist. I am now empowered to express these boundaries and limits in the workplace, because it helps me maintain being the best therapist I can be.

I understand every mental health clinician’s boundaries and limits are different for different reasons. I respect that! These are the ones that I have developed through my own clinical experience. It feels good to be able to name my needs and put them into practice. I also understand that certain work environments and even being an unlicensed clinician can make it hard to implement these. I still find importance in naming them and hopefully finding places that can honor them for your own well-being.

💬 Question for you!

What are your personal boundaries and limits to be an effective clinician? Do any of yours look similar to mine? How do use them in your own practice?

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What is the Counseling Compact?

It is an interstate compact, you apply to enter in, that allows licensed counselors the privilege of practicing counseling in states that are entered in the compact without needing to be licensed in that state. This is not a license in each state, but a “privilege” to practice in each state in the compact following your current professional counseling license.

This is a voluntary service that you apply to enter in. You cannot practice in other states through the counseling compact without applying. Applications will be available this fall. It allows you to see people through telehealth or in person for the state you apply for privilege in.

For example: I am fully licensed in Minnesota and live 5 miles from the Iowa border. This would allow me to provide counseling services in Iowa, in person or telehealth, without having to be licensed there.

Current Enacted States in the Compact:

States in the dark blue are states that are already joined in the counseling compact. The states in light blue are are working towards joining the compact. The ones in grey have yet to be passed in legislation and are not available for use in the compact.

Who is eligible?

The counseling compact is for currently licensed counseling providers. You have to be licensed in counseling. This is not a compact for social worker or marriage and family therapy licenses. They have their own compacts in the work.

You have to live in the state of your “home” license. You cannot live in another state without having a counseling license and be a part of the counseling compact. You have to live in a compact state and be licensed in that compact state. This is because there is a lot of jurisdiction and laws that make up this rule. There is no exceptions. If you move to a non-compact state, your privileges are revoked.

For example: I am also licensed in North Carolina, but if I move to Tennessee, I cannot be a part of the counseling compact because I am not licensed in Tennessee. I either have to live in Minnesota or North Carolina because that is where I am licensed. If I moved to California and I was licensed in California (I’m not), I couldn’t be apart of the compact because California has not entered the counseling compact. My privileges would be revoked.

If the client is visiting or on vacation in a state where you do not have a privilege in or is part of the counseling compact, you cannot see them. You need to have the privilege in the state where the client is.

For example: I am licensed in Minnesota and hypothetically if I had privileges in Iowa and my client was visiting South Dakota, I could not see them because I didn’t apply to have privileges in South Dakota.

Further requirements include having an FBI background check completed from the state you are licensed in. You will have to have completed a national exam like the NCMHCE. You will need post graduate supervised experience. You will need 60 semester hour course work in either you master’s program or the required classes for licenses. For people who have been licensed for many years prior to the 60 semester hour course work, they will be grandfathered in. This has been a newer required change for licensing.

Things to consider:

If you are seeing clients through telehealth, you will have to ask clients where they are every time you visit. This due to the liability in case of an emergency as well as them needing to be in a state that you have privileges in.

You will need to know about what documentation is required in each state you have privileges in. If you need liability insurance in each state and/or for your practice. If you have to register your business in each state you have privileges and practice in. How taxes are filed and if you have to pay state taxes and/or provider tax to each state you have privilege in.

You will need to do a jurisprudence exam in the state you want a privilege in if they have that requirement. You do not need to worry about CEUs in privileged states, only the ones you are officially licensed in.

Insurance questions

The counseling compact has no interaction with insurance companies. You would have to contact insurance providers directly to discuss this. Insurance companies have been notified about the compact but they have not given an answer on the plan. You will still have to go through the process of being credentialed with that insurance.

The process:

You go to the website, which Compact Connect will have updates on the data system, and create an account. Your name and information must match how it shows on your counseling license. You will click on “obtain privileges” and then choose which states you want to be apart of. You can pick all the states you want to be apart of in one transaction. The data system will tell you if the state you want privileges in requires a jurisprudence example. You will need to take a jurisprudence exam for each state that requires it and if you want privileges in that state. You will need to attest that you took it. There will be other attestations such as if you ever had an investigation on your license or if you’ve been disciplined on your license, and that your attestation is true information. You then pay the total. You will receive an email that you are officially privileged to start practice seeing clients immediately in the state you applied for.

The pay rate for each state will be from $0-$400. States are still working on determining this, but NBCC project it will be approximately $94/state. Each state is going to vary on this. There will also be a $30 administrative fee for each state you apply privileges for.

Privileges expire the same date as your home state license and it will need to be renewed at the time your home state license is renewed. If you have disciplinary action against your license, your privileges in the compact will be revoked for two years.

If you want register for the next live webinar to get more information and ask live questions, AND get a free CEU, register here:

September 4th noon-1pm EDT:

https://us02web.zoom.us/webinar/register/WN_ThwtgxZuQ96pTe27mErzTA#/registration

For information you can check out:

🌐Counseling Compact: counselingcompact.gov

🌐Compact Connect: compactconnect.org

📁PDF file from webinar: https://nbcc.org/assets/webinars/the-counseling-compact-the-first-steps.pdf

🎥Live recording of the webinar:

Contact information

Greg Searls, Executive Director, Counseling Compact Commission is the one who put on this event for NBCC and provided this information. If you have any questions, please direct them all to the email:

📧info@counselingcompact.gov

Final thoughts:

I’ve been really excited for this counseling compact for over a year now. I think it is going to help a lot of clinicians especially ones who live so close to state boarders or live in rural areas. I genuinely wonder the longer implications of this and how it will impact big tech or mental health companies…

If read this far, do you plan on applying for privileges in certain states? How will you be using this in your own business or career?

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10 Key Takeaways

1. Validation is a big motivator for change.

The more I work in this field, the more I realize how much people want to be heard and seen. While someone might have supports in their lives, it doesn’t guarantee they are truly being listened to, let alone heard. I could give insightful knowledge or use an effective therapy tool, but often I see it not applied without the presence of validation. There is power in validation beyond being a motivator for change, it can help the client feel safe, seen, and decrease hypervigilance.

If we think about therapy like building a safe and durable home, I would say validation lays the foundation.

2. Support systems can be built.

I have often heard from my clients that I am the only person they feel they can talk to. Several clients seek therapy not having a current support system. Instead, they might come from abusive families and are estranged from them. Equally, they may be in an abusive relationship, don’t have supportive friends, or a community. It is not uncommon for people who have experienced trauma to have a severe lack of support system. Whatever the reason for their lack of support system—it can be built. A community of people who are validating, empathic, and supportive can be found.

3. It is hard to flourish in harmful soil.

When people are in abusive, neglectful, and toxic environments, it causes an immense amount of stress and dysregulation. Most sessions may be focused on the current crisis. I use this as an opportunity to work on psychoeducation, coping skills, and identifying things inside and outside of their control. When your body is so dysregulated, hypervigilant, and activated due to constant distress, it is incredibly hard to address past trauma or other goals.

If we think about the client like a plant, it is incredibly hard for them to grow in toxic soil. We can’t address the roots until the soil is healthy.

4. Identify which stage of change the individual is in.

When I explore with clients problem solving that is met with resistance I say, “It sounds like you aren’t ready for this change” and more often than not they agree to not being ready. In these moments I show the client the cycle of change diagram. Identifying what current stage they are in and further exploring this opens a lot of doors. People who feel unsafe may not be in the action stage-mentally, physically, or environmentally. Things that would make them feel safe can be further investigated. Pulling from Internal Family Systems (IFS), different “parts” can be in different stages of change. Identifying the client’s “parts” and where those “parts” are in the stages of change offers further insight and activation in the therapeutic work.

5. When feeling burnt out, lean into the basics of therapeutic skills.

In graduate school, we read, On Being a Therapist by Jeffrey A. Kottler. He explained that feeling burn out isn’t an “if” but rather a “when.” He discussed how maintaining self-care and boundaries are vital, but he offered another tool. Often when we are feeling burned out, we struggle with clients to find the right modality or profound insights. He suggest going back to focusing on basic therapeutic skills. This involves honing in on skills like, empathic statements; paraphrasing; summarizing; using open ended questions; immediacy; and good sentence starters. This was the most important thing I took from that book. When feeling burned out, refining these skills and using Socratic questioning has helped both me and my clients. I definitely see a positive shift.

6. There is not a “gold standard” therapy modality.

A lot of therapy modalities say they are the best or the leading intervention in the field. They will say, “This is the gold standard” for x, y, or z diagnoses. As I spend more time in this profession, I notice an endless cycle of advertisements for “the new gold standard of therapy,” which often turn out to be just costly training programs. Our field is relatively young and constantly evolving, with new techniques emerging regularly, many of which are borrowed from other cultures and repackaged. I believe there are specific modalities that assist with certain diagnosis, however, to say there is only one modality that work with everyone, is unrealistic. The most important thing when it comes to a therapeutic modality, is how it impacts the client and what works for them.

7. My thoughts surrounding mental health has shifted over time and that is okay.

My view of mental illness and diagnoses have shifted a lot since my first abnormal psychology class in high school. I used to think mental illness was so fascinating and something to be dissected. I now see it through a lens of profound empathy and de-pathologizing mental health issues. I see several mental health issues be a direct cause or exacerbated by systemic issues. While other times, mental health issues have to be categorized as a diagnosis for insurance needs.

8. Getting to the core of trauma takes time.

Someone might be seeking therapy for a certain issue, unaware that what lies deeper is unresolved trauma. Getting to the meat of that trauma, takes time. Sometimes there is pressure by colleagues, supervisors, or insurance companies to get to the core of trauma. That way they can be “cured” and end services. When someone is not ready, trauma work can take time and that is okay. It does not mean you need to feel pressured and break therapeutic rapport or the flow of therapy to get there.

9. Processing the trauma can allow for self-reflection and awareness.

Processing trauma is incredibly hard. Although we can’t change what happened to the person, there can be some beautiful growth from reflecting on it. It can allow for awareness that can build on discerning skills. It offers self-reflection of what was inside and outside of their control at the time. Many trauma survivors tend to blame themselves for what happened to them. Processing this further can assist in taking on what is actually their actions and leaving what is not. It is possible for insight into a life lessons to be formed from this exploration.

10. People don’t “fake” having trauma, if anything, they minimize it.

Trauma survivors often minimize their suffering. This isn’t something I necessarily “learned,” but rather something that has been reinforced in my work. So often I hear from people that trauma survivors are “faking” their experiences or talking about it for “attention.” They aren’t recalling it to be “vindictive” or hurt someone. Instead, it is when people feel safe and ready they can finally discuss what happened to them. This can be taking a risk in order to connect with others and be provided the empathy they were not originally given.

Final Thoughts: Throughout my work, I often think about what my role is on a larger scale for my clients. In life, impossible problems and stressors don’t end. Even if I could solve all the problems or have the perfect solution, it is still their journey to be on. I think my role is to be that support for them, even if it is only for a moment in their life. I believe I get the privilege of being a part of that through an authentic and personal therapeutic relationship.

Over the last year of being a licensed therapist, these are the key lessons I have learned when working with clients. These are my own insights, while another therapist’s growth looks different and that is okay. This is just where I am currently at in my journey. There are so many more lessons to be learned in this field and I look forward to being a constant learner.

If you are a licensed mental health therapist or provider in the field, what has been a key lesson in your own work? What has shifted for you over time being in the field?

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In 2014, I was finishing up high school and I reflected a lot on what my life would look like in ten years. I imagined myself being a licensed therapist, owning my own successful practice, married, having a house, a newer car, and starting a family. The one thing I did accomplish was getting independently licensed last year before I turned 29. I have a running self-deprecating joke with my therapist, “I’m almost 30 and all I have is a piece of paper.”

I’m not married, I don’t have kids, I don’t own my own home, and I work part-time at a community mental health center. Instead it is like I am rebuilding my life since leaving my abusive alcoholic ex and moving back home. I feel like most of my life has been in survival mode or one crisis after another. From growing up in an abusive alcoholic family, to repeating the pattern with my ex partner, and experiencing workplace trauma. It has been like jumping from one fire to the next.

I feel ashamed, embarrassed, and disappointed in myself with where I am at. Living in rural Minnesota, it is common to run into people from the past and easy to compare myself to their journey. It creates a backpack of shame I carry along with avoidance from others. Life is definitely not where I thought it was going to be at this age and with that comes grief. Grief that life has played out the way it has and a feeling of loss for what it currently isn’t.

My feelings around turning 30 remind me of a TV show that starts with the main character having an established friend group, relationship, and goals for the future. By the end of the fifth season, those friendships have shifted, the relationship ended, and the character has a different sense of purpose. In the middle of this, some of those friends and family members have passed. All things part of life that I am working on accepting. It reminds me of the song, Time Marches On by Tracy Lawrence. A song that perfectly encapsulates how life changes over the years, for better or worse, but time marches on.

The other side of the coin

As I process these feelings, I realize these emotions are also fueled by pervasive societal expectations. We are often bombarded with messages about what we "should" have accomplished by a certain age which creates a restrictive timeline that many of us feel pressured to follow. Another societal expectation I’ve been feeling comes from the added scrutiny aging women face for their appearance or in workplace settings where youth can equate to opportunity.

Beyond societal expectations, those of us who come from difficult backgrounds such as escaping abusive homes, navigating poverty, and surviving toxic relationships, face an even more complicated path toward stability and self-acceptance. Breaking free from these cycles requires resilience, patience, and self-compassion. The nuance and difficulty of breaking free from these cycles is something I have only come to recently accept in my own therapy. My life, in so many ways, has been shaped by trauma and survival. When you grow up in survival mode, it can feel like you won’t make it very far—that dreaming is a luxury you can’t afford. You carry hopes quietly, almost as if they're unrealistic. Even as I achieved things I once thought were out of reach, I rarely felt like I could stop, breathe, and feel them. I kept going, not out of ambition, but out of necessity. Then one day you look up, nearing 30, and realize: I did survive. I made it this far. And now, it's time to figure out what it means to actually live. That realization is heavy and humbling, especially knowing that so many others with similar stories don’t get the same chance. Not everyone makes it to this point.

The other side of the coin is turning 30 offers an opportunity to shed these societal and personal expectations and acknowledge the strength it takes to overcome hardship, and to focus on growth and self-discovery. This milestone can instead be a celebration of resilience, reminding me that my worth isn’t determined by age or societal standards, but by my own journey and the hope of what lies ahead.

According to Erik Erikson’s stages of psychosocial development, I’m at the “Intimacy vs. Isolation” stage. The central task is to form meaningful, reciprocal connections while maintaining a stable sense of self. It’s a stage that asks you to open up, trust others, and allow yourself to be seen, all while reconciling your own inner world. That challenge feels especially real for people like me who’ve had to prioritize survival over connection. This stage isn’t just about romantic relationships. It’s about emotional risk. It’s about learning how to show up for yourself and others without armor. As I near 30, I’m finding that this stage isn’t a single moment or decision, but instead it’s a process of slowly thawing out, piece by piece. And maybe that’s what this season of life is really about: not just surviving, but allowing yourself to be known.

I wish I could end this article by giving 10 Lessons I Learned Before 30: What Everyone Should Know, but the truth is I don’t have those answers. Instead, I have a shifting perspective on what life in your 20s and 30s really means. Your 20s are for figuring things out, stumbling along, learning, and realizing how little you know. By the time you’re nearing 30, you’ve lived through and experienced enough that the things which once felt terrifying no longer hold the same power. In a way, aging is its own form of exposure therapy.

I’ve learned that it is okay to change your mind about your passions, hobbies, and values. Most importantly, I’ve learned to be thankful, not only for getting this far in life, but also for the mundane things. When I feel down, I make a list of all things I am grateful for, that I have access to water, food, plumbing, and a working car. These basics things often overlooked, but they are my quiet reminders that I am safe now—and that’s not something I’ve always been able to say.

If you feel inclined to support a therapist turning 30 with counseling books or cozy tools for the therapy room you can get me a birthday present here:
https://throne.com/therapizedjenny

I don’t expect anything, but if gifting is your love language, I’ll receive it with deep gratitude. 💛

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More recently, I wrote the following article:

Where I covered not only what businesses can be doing, but also actionable steps mental health professionals can be doing. As mentioned in that article, actionable steps for clinicians can look like:

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