Pint of Science · Vol. 14 · May 2026
Ambient listening in the consulting room
Folio 01 · Title
A working talk — not a forecast

Can AI write your psychotherapist's notes?

How evidence-based psychotherapy, quality assurance, and ambient listening are quietly reshaping the way mental health care is recorded, supervised, and improved.

Ronan Zimmermann
Psychotherapy process researcher — bringing tools that work into clinical practice
For the
Pint of Science Festival Basel · May 2026
MHIRA · Mental Health Information Reporting Assistant
— a look inside the black box —
01 / 15
Section · Executive Summary
The whole argument in one minute
Folio 02 · Map
Roadmap for the talk

The session is the black box.

Psychotherapy works, and its active ingredient is human interaction. What happens between therapist and patient rarely leaves the room — this talk traces why, and what is beginning to change.

01

Psychotherapy is an effective treatment for mental disorders.

02

Its active ingredient is human interaction — a trained, situational craft.

03

Documentation preserves only a fraction of what the session contains.

04

Ambient listening can make the conversation partially observable — therapists are beginning to open the box.

05

MHIRA, the platform I am working on, extends evidence-based assessment with clinician-approved ambient listening.

Slide 02 · Executive Summary
— effective treatment · imperfect infrastructure —
02 / 15
Section · Evidence
Across 12 mental health problems
Folio 03 · Evidence
The base case

The effectiveness of psychotherapy.

Average effect of psychological treatment vs. an inactive control, across 12 mental health problems. Larger bar = stronger effect.

Harrer, M. et al. (2025) — Effectiveness of Psychotherapy: Synthesis of a “Meta-Analytic Research Domain” Across World Regions and 12 Mental Health Problems. Psychological Bulletin, 151(5), 600–667.

1,029 randomized trials · 85,952 patients · Hedges' g · post-treatment vs. inactive control · doi: 10.1037/bul0000465

Slide 03 · Evidence
— effective, unevenly so —
03 / 15
Section · Outcome Research
The classic outcome design
Folio 04 · Outcomes
Does psychotherapy work?

Outcome research established that psychotherapy works.

Outcome research demonstrated that psychotherapy produces reliable clinical change across disorders and treatment models.

This answered the question: Does psychotherapy work?

Slide 04 · Outcome Research
— measure · treat · measure again —
04 / 15
Section · Process
A glimpse inside the session
Folio 05 · Process
Inside the consulting room

Psychotherapy unfolds through sequential interaction over time.

Five-panel comic strip of a therapy session: the patient speaks, the therapist reflects, the patient continues, a shared silence, then the therapist redirects to the present moment.
Interaction processes
turn-taking timing silence alliance rupture / repair

Process-outcome research identifies relational, therapist, and patient processes associated with therapeutic outcomes. Kazdin 2007 · Gómez Penedo & Flückiger 2026

Slide 05 · Process
— the observable layer —
05 / 15
Section · Formation
What's behind the conversation
Folio 06 · Formation
Inside the craft

How do therapists know what to do?

Therapists learn theories, frameworks, techniques, and skills — then apply them in conversations that can't be fully scripted.

What they know
  1. theories of change
  2. clinical frameworks
  3. techniques & skills
  4. training for real-time interaction
formal knowledge → adaptive practice
What it takes
  • postgraduate psychotherapy training, often 4–6 years
  • supervision
  • self-experience / personal therapy
  • specialist seminars and method training
  • continued learning after qualification
  • training costs often around CHF 35,000–90,000+
serious investment
Before & after each session
  • reviewing the previous session
  • case formulation
  • diagnostic hypotheses
  • treatment goals
  • treatment approaches & guidelines
  • selecting possible interventions
  • anticipating risks or ruptures
  • preparing next steps
  • reflecting after difficult moments
  • supervision when needed
clinical reasoning around the live encounter
On top of that
  • documentation
  • progress notes
  • treatment reports
  • insurance justification
  • reimbursement coding
  • scheduling & coordination
  • referrals
  • emails & follow-up
complex human interaction · translated into healthcare systems

Swiss psychotherapy training overview · Rubo et al., 2020

Slide 06 · Formation
— trained craft · live conversation —
06 / 15
Section · Entr'acte
Pint of Science · MHIRA
Folio 07 · Entr'acte
Entr'acte

Cheers!

Four-panel comic of two people at a pub after the talk: one asks if all that training was for one session; the other admits they can't quite believe it; they clink glasses with 'Cheers, mate.'; final panel they think they should've become a lawyer.
Slide 07 · Entr'acte
— you can take a sip now —
07 / 15
Section · Compression
From the session to the note
Folio 08 · Compression
What the record holds

Psychotherapy sessions contain more information than documentation can preserve.

Illustration of an active psychotherapy session — two people seated across from one another, with surrounding cues suggesting many simultaneous therapeutic processes and ambiguous signals.
Illustration of a therapist documenting later at night, writing a sparse compressed clinical note at a desk lit by a single lamp.

Clinicians continuously filter and compress complex therapeutic interactions under conditions of limited time and imperfect memory.

Slide 08 · Compression
— session in · note out —
08 / 15
Section · Persistence
Where the record meets the system
Folio 09 · Pressures
Pressures on the record

Why better documentation increasingly matters.

Clinical & supervisory needs
Supervision & training
  • reviewing interventions
  • alliance ruptures and missed opportunities
  • formulation development across sessions
  • reflective practice
  • continuity between supervisor and supervisee
Longitudinal understanding
  • recurring themes over time
  • trajectories instead of isolated sessions
  • subtle change processes
  • evolving risk patterns
Institutional & systemic pressures
Accountability
  • suicidality documentation
  • treatment continuation justification
  • interdisciplinary coordination
  • quality assurance requirements
  • reimbursement structures
  • evidence-based practice documentation
— Swiss Anordnungsmodell, 2022
Resource pressure
  • long waiting lists
  • increasing administrative burden
  • limited clinician time
  • pressure for efficiency
  • more documentation with less available time

Important therapeutic processes increasingly need to remain observable across time.

Slide 09 · Persistence
— clinical needs · institutional pressures —
09 / 15
Section · Infrastructure
Ambient listening systems
Folio 10 · Capability
Ambient listening systems

Psychotherapy interaction becomes observable in clinical practice.

01 audio → text

Speech-to-text

Sessions can become text.

Spoken interaction can now be transcribed with sufficient quality for clinical workflows.

  • automatic transcription
  • multilingual speech recognition
  • near real-time conversion
02 who said what

Diarisation

Interaction structure becomes visible.

Speaker attribution preserves who said what and when.

  • turn-taking
  • speaker separation
  • conversational structure
03 text → structure

Large language models

Information can be selectively structured.

Language models can assist in filtering, organising, and presenting clinically relevant information.

  • summarisation
  • thematic extraction
  • longitudinal retrieval

Together, these technologies unlock information access to psychotherapeutic interaction in clinical practice.

Slide 10 · Capability
— what becomes technically possible —
10 / 15
Section · Threshold
Fascinated, relieved, hesitant, cautious
Folio 11 · Threshold
At the threshold

Therapists are beginning to open the box.

Already entering healthcare workflows
multiple providers and startups deploying

Slide 11 · Threshold
— curiosity · caution —
11 / 15
Section · Origins
Before ambient listening — a clinical infrastructure project
Folio 12 · Origins
Where MHIRA came from

MHIRA began with evidence-based assessment.

First page of the BMC Psychiatry research article 'Mental Health Information Reporting Assistant (MHIRA) — an open-source software facilitating evidence-based assessment for clinical services' by Zimmermann et al., 2023.
Zimmermann et al. · BMC Psychiatry · 2023 doi.org/10.1186/s12888-023-05201-0
Origins

MHIRA was initially developed as a platform for longitudinal mental health assessment and clinical continuity.

  • evidence-based assessment
  • psychometric instruments
  • longitudinal monitoring
  • quality management
Development
  • Fondation Botnar supported
  • developed across multiple countries
  • designed for real-world clinical services
Later extension

Ambient listening extended this persistence model into psychotherapy interaction itself.

MHIRA emerged from longitudinal mental health assessment before extending into ambient listening and structured psychotherapy documentation.

Slide 12 · Origins
— evidence-based assessment · clinical continuity —
12 / 15
Section · MHIRA
consent · transcript · draft · clinician approval
Folio 13 · Model
Clinician-approved persistence

MHIRA: ambient listening under clinical control.

MHIRA model diagram: a clinical conversation with ambient listening (with consent) feeds into an AI system that runs speech-to-text transcription and language-model analysis, producing a structured draft of clinical notes; the clinician interprets, reviews, edits, and approves before anything enters the medical record.

MHIRA produces structured drafts and reports that remain under clinician review and approval. Designed for supervision, accountability, continuity, and evidence-based assessment workflows.

Slide 13 · Model
— draft first · clinician authority remains central —
13 / 15
Section · Representations
intake · session · supervision · assessment
Folio 14 · Forms
Different reports for different needs

One session, multiple clinical representations.

Different clinical tasks require different forms of persistence.

01 · Intake
Initial formulation
presenting problems · history · goals · context
02 · Session note
Continuity across sessions
interventions · themes · agreements · progress
03 · Supervision
Reflective clinical practice
intervention review · alliance · difficult moments · trainees
04 · Assessment
Processes over time
recurring themes · trajectories · symptom development

The same therapeutic interaction can support multiple clinically meaningful perspectives.

Slide 14 · Representations
— same conversation · different forms —
14 / 15
End of talk · Thank you
Questions, references, and a way to keep reading
Folio 15 · Colophon
Closing remarks

Thank you.

If this opened a question rather than closing one, that was the point. The references, slides, and a written version of this talk live on the MHIRA research page — along with the work the talk draws from.

Ronan Zimmermann
Psychotherapy process researcher — MHIRA
For the
Pint of Science Festival Basel · May 2026
Read the talk · slides · references
The full write-up and slide deck for tonight's talk.
https://mhira.app/research/ambient-ai-psychotherapy-notes
Pint of Science · Basel · The Future of Medicine: What Comes Next?
Get in touch
  • Emailronan@mhira.app
  • Webmhira.app
  • SpeakerRonan Zimmermann