Most AI therapy note tools on the market today are built, tested, and optimized for English-language sessions. For therapists working internationally, with immigrant or expat clients, or across multiple first languages, that's a real gap — a tool that transcribes English well may produce unreliable or unusable output for a session conducted in French, Spanish, Portuguese, or any other language.
Why this matters more than it seems
A multilingual caseload isn't a niche case. Expat and international therapists routinely see clients who prefer to process trauma, grief, or complex emotion in their first language, even when they're fluent in the therapist's working language. An AI scribe that only handles English forces a choice between the tool and the client's linguistic comfort.
What to check before choosing a tool
| Question | Why it matters |
|---|
|---|---|
| Does transcription support the session's actual language, or only English? | Cloud tools built for the US market often only support English robustly |
|---|---|
| Does language switching mid-session (code-switching) degrade accuracy? | Common in bilingual households and international clients |
| Is language detection automatic, or does it require manual configuration per session? | Manual setup adds friction for a varied caseload |
How the leading tools compare
| Tool | Language support | Notes |
|---|
|---|---|---|
| Mentalyc | English-primary | Built for the US market |
|---|---|---|
| Eclio | Any language the underlying speech model supports (broad multilingual coverage) | Transcription and note generation both work independent of session language |
Why this is architecturally different for on-device tools
Eclio's transcription runs on a general-purpose multilingual speech model rather than an English-tuned cloud service — the practical result is that a session conducted in Spanish, Portuguese, French, or dozens of other languages transcribes with the same underlying approach as an English session, with no separate configuration required.
The bottom line
If any meaningful share of your caseload is conducted in a language other than English, verify multilingual support directly before committing to a tool — don't assume it, since most AI scribes in this category are built English-first. See also: Can AI Write Clinical Notes in a Language Other Than English?