Why Your Therapy Session Notes Don't Need to Live in the Cloud

Cloud-based practice management has become the default, and for many therapy practices it works well. But "default" doesn't mean "necessary" — especially for solo therapists whose session notes are the most sensitive data in their practice.

If you're a solo practitioner, the question is worth asking: do your notes actually need to live on someone else's server?

What cloud storage means for your session notes

When you use a cloud-based practice management app, your session notes are transmitted from your device to a remote server. They're stored in a database managed by the vendor, often hosted on AWS, Google Cloud, or Azure. The vendor's employees — engineers, support staff, database administrators — may have some level of access to that infrastructure.

This isn't inherently bad. Good vendors encrypt data at rest and in transit, limit employee access, and maintain audit logs. But it introduces a chain of trust: you're trusting the vendor, their hosting provider, their subprocessors, and every employee with database access.

For a hospital or multi-provider clinic, this tradeoff makes sense — cloud infrastructure enables the collaboration and access controls they need. For a solo therapist writing notes on their phone after a session, the tradeoff is less clear.

The risks you take on with cloud notes

Cloud-based notes carry risks that local notes don't. Data breaches at the vendor level can expose thousands of therapists' notes at once — and healthcare data breaches are among the most common and most costly. Policy changes can alter how your data is handled; vendors can update their privacy policy with an email you might not read. Vendor shutdowns can put your data at risk if the company goes out of business or gets acquired. Subprocessor chains mean your data may be processed by third parties you've never heard of.

None of these risks exist when your notes live on your device and nowhere else.

What you lose without cloud — and why it might not matter

The main thing you lose with local-only notes is multi-device access. You can't pull up session notes on your laptop, your tablet, and your phone interchangeably. For a solo therapist who does everything from one device — usually their phone — this isn't a meaningful loss.

You also lose automatic cloud backup. But you can back up your data manually (JSON export, iPhone backup) and store it somewhere you control. It's one extra step, and it keeps you in full control of your records.

What does SimplePractice's Terms of Service say about your notes?

This is worth knowing before you store clinical notes in any cloud platform. SimplePractice's Terms of Service include broad licensing language: by using the platform, you grant SimplePractice a perpetual, irrevocable, royalty-free license to use, copy, modify, and distribute content you submit. The stated purpose is service delivery — making the app work. But the scope of that license is worth reading carefully before trusting your most sensitive client notes to their servers.

This isn't unique to SimplePractice. Many cloud SaaS companies use similar ToS language. The point isn't that they're acting maliciously — it's that once data is on a third-party server, the terms of its use are defined by their legal team, not yours.

What happens if SimplePractice gets acquired, goes bankrupt, or gets breached?

Acquisition: If SimplePractice is acquired, the new owner inherits the platform, its data, and its Terms of Service obligations. Your notes could pass to a company you've never heard of. You'd receive notification (maybe), and you'd have a window to export — if you're watching your email that week.

Bankruptcy: In bankruptcy, customer data can become an asset on the balance sheet. Courts have allowed bankrupt companies to sell user data in ways that seemed to violate stated privacy policies. Unlikely, but not impossible.

Breach: Healthcare data breaches are the most expensive and most common category of data breach. A breach at a practice management vendor exposes notes from thousands of therapists at once. Your clients become victims of a hack they had no knowledge of.

None of these scenarios are possible when notes live only on your device. Your notes, on your phone, under your control.

Session notes that stay on your device

Local-first session notes give you a simpler security model. Your notes are on your phone, protected by your passcode, your biometric lock, and your app's PIN. Nobody else has access. There's no server to breach, no vendor privacy policy to monitor, no chain of third-party trust to evaluate.

For a solo therapist doing private-pay work, this is often the right tradeoff: simpler, more private, and fully under your control.

Cloud storage is a tool, not a requirement. For solo therapists handling sensitive clinical notes, keeping that data on-device is the most private and the simplest approach — and it might be all you need.