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The Version of You You've Never Met
A good note can still become a wrong record
Darcy came to counselling on a cold, grey Tuesday last November. Over six sessions, they talked about the year their marriage ended, about drinking more than they meant to, and about waking at two in the morning, unable to escape thoughts of doom.
In the second session, the counsellor asked the question counsellors are trained to ask.
Darcy said no, and meant it. The note read: Asked about suicidal thoughts. Denies.
That note met every standard of good practice. It also rested on something every therapist works to build: Darcy answered honestly because they trusted the room. What happened to the note afterward, and what it could mean for that trust, is the subject of this week's episode of Trust by Design.
Watch: The Version of You You’ve Never Met on YouTube
Listen on Spotify, Apple Podcast or your podcast app: Trust by Design podcast page
Darcy said no. The record says otherwise.
Months later, Darcy’s file meets an AI model that reviewers found to be 95 percent
accurate, a decision that seemed reasonable to everyone involved, and a research project that needed exactly this kind of record. Nobody in the story is careless. That is what makes it worth hearing.
“The name is gone. Everything else about Darcy is still there.” — from the episode
The episode follows Darcy’s record out of the counselling room and gives a name to what it becomes. This post picks up the questions it leaves for therapists: what it means for the alliance, for informed consent, and for the trust a client places in the room.
The therapeutic alliance is what is at stake
Darcy did not disclose to a database. They disclosed to a person, in a relationship built for that purpose. A large body of research links the strength of the therapeutic alliance to outcomes across many approaches to therapy (Flückiger et al., 2018). Much of what makes the alliance work is the client’s sense that what they say will be held with care.
Informed consent covered the room, not the record’s future.
Consent conversations at intake usually address the limits of confidentiality: risk of harm, legal orders, supervision, and how records are kept. They rarely address secondary use, where a de-identified version of the record may be linked, flagged by AI and used to train models. In many settings, the therapist would not know this was possible either. Consent can only be as informed as the people giving and seeking it.
Consent in therapy is a process, but reuse may not offer a moment to revisit it.
Therapists are taught to return to consent as circumstances change. A record’s uses can change months or years after care ends, with no session in which to ask again.
Trust lost here may show up as silence.
If clients come to believe their words could become a flag they never see, some may hold back what matters most. The record may then look complete while missing the very content care depends on. Holistic Research Canada calls this a disclosure winter. The cost would land first in the alliance, and then in the quality of the data that future models learn from.
Therapists may be the only people in this chain who can see both sides: the person in the chair, and the record that leaves the room.
Records are being built to travel
Darcy’s record is not unusual in where it went. A new OECD report, Data Spaces between Co-ordination Challenges, Financial Viability and Public Policy, describes systems being built around the world to share data across organizations and borders, with health among the domains named. In Europe, new regulation already sets up bodies to make health data available for secondary use in research.
The direction seems clear: the record a client helps create in your office may travel much further than the room. Informed consent, and the trust behind it, has not yet caught up with that journey.
Reuse needs a social licence, not only a legal basis
Others are working on how consent might catch up. In From Principles to Practice: A Roadmap for Digital Self-Determination in Data Spaces, Adam Zable, Stefaan Verhulst and Andrew Zahuranec of The GovLab write that because data may be reused “for purposes that differ from those for which it was originally collected,” data spaces require “an ongoing social license.”
The roadmap, developed with the support of the Swiss Federal Administration, sets out four phases: build governance foundations that embed agency; enable communities to express expectations and preferences; translate those expectations into binding arrangements; and keep testing whether those arrangements still work as uses change.
For therapists, the idea may feel familiar. The trust a client gives when they ask for help is the first licence. It is given to a person, for a purpose. It does not stretch on its own to everywhere the record goes next, and it has to keep being earned.
A senior statistician who leads data for an international organization put it this way in response to the work behind this episode: “many people do not think beyond primary confidentiality.”
Removing a name is primary confidentiality.
What happens to the record after that is where the work is.
References and resources
Episode
• Trust by Design, Episode 3: The Version of You You’ve Never Met — watch on YouTube · listen on Spotify and other apps
References
• Flückiger, C., Del Re, A. C., Wampold, B. E. and Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. doi.org/10.1037/pst0000172
• Hansen, C. (2026). When Health Records Become Representations of People. Clinical Data Governance Community, Zenodo. https://zenodo.org/records/21923528
• OECD (2026). Data Spaces between Co-ordination Challenges, Financial Viability and Public Policy. OECD Publishing, Paris. doi.org/10.1787/0066f11b-en
• Zable, A., Verhulst, S. and Zahuranec, A. (2026). From Principles to Practice: A Roadmap for Digital Self-Determination in Data Spaces. The GovLab, 7 August 2026. https://thelivinglib.org/from-principles-to-practice-a-roadmap-for-digital-self-determination-in-data-spaces/
Resources
• Clinical Data Governance Community on Zenodo: the paper, the Clinical Data Governance Checklist, and an open invitation to contribute
• 9-8-8 Suicide Crisis Helpline: call or text 9-8-8, anywhere in Canada, 24 hours a day
