Trust by Design with Cindy Hansen

Darcy said no. The record says otherwise.

A counselling note can be accurate when it is written and still become something very different when it leaves the therapeutic relationship in which it was created.

In this episode of Trust by Design, we follow Darcy’s record beyond the counselling room: de-identified, linked with other data, interpreted by AI, and reused for purposes Darcy may never have anticipated.

Nobody in the story is careless. That is what makes the questions difficult.

What happens to informed consent when records acquire new uses months or years after care ends? What does confidentiality mean once removing a name is no longer the end of the story? And what happens to the therapeutic alliance if clients begin wondering where their most private disclosures might eventually travel?

“The name is gone. Everything else about Darcy is still there.”

This episode explores clinical data governance, secondary use, AI, consent, and what Holistic Research Canada calls a disclosure winter: the possibility that uncertainty about future data use could change what people are willing to disclose in care.

Because the question is not only whether data can be reused.

It is whether the trust under which it was originally given travels with it.

If this raises questions you think therapists, researchers, health leaders, or people designing AI-enabled health systems should be discussing, please share the episode with them.

References & resources

Trust by Design:
https://www.holisticresearchcanada.ca/trustbydesignpodcast

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis.Psychotherapy, 55(4), 316–340.
https://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.
https://doi.org/10.1787/0066f11b-en

Zable, A., Verhulst, S., Zahuranec, A. J., et al. (2026). From Principles to Practice: A Roadmap for Digital Self-Determination in Data Spaces. The GovLab.

Clinical Data Governance Community:
https://zenodo.org/communities/clinical-data-governance

If you or someone you know is thinking about suicide, Canada’s 9-8-8 Suicide Crisis Helpline is available by call or text at 9-8-8.

https://www.holisticresearchcanada.ca/post/trust-by-design-a-new-weekly-podcast-from-holistic-research-canada

A manila folder holds someone’s story, recorded for a particular purpose at a particular moment. But what happens when that record is connected to other data, used to generate predictions, and turned into something that shapes how a person is understood?

In this episode of Trust by Design, Cindy Hansen explores how technology is is transforming clinical records into representations that can share how people are understood, evaluated and treated.

Host Cindy Hansen is the Founder and Chief Science Officer of Holistic Research Canada, with more than two decades of international experience in digital mental health, outcome measurement, clinical data governance, and equity-centred design.

Holistic Research Canada is a mission-driven social enterprise advancing ethical, human-centred approaches to digital mental health. Its work connects research, practice, and public-interest data stewardship to help build more equitable, accountable, and responsive systems of care.

Watch now, subscribe, and join me as we ask what it takes to build trust by design.

Additional Reading

In this thought leadership article, published in eMHIC Global News in August 2026, Cindy Hansen examines why de-identifying clinical data does not, on its own, resolve the questions of trust, consent, and responsible secondary use that arise when information is connected and interpreted by AI.

Read the article:
https://emhicglobal.com/expert-opinions/what-de-identification-misses-trust-and-secondary-use-in-digital-mental-health/

What happens when the systems designed to help us create gaps between what they promise and what people experience?

In the first episode of Trust by Design, I explore how we can build better bridges between people, information, technology, and accountability.

Host Cindy Hansen is the Founder and Chief Science Officer of Holistic Research Canada, with more than two decades of international experience in digital mental health, outcome measurement, clinical data governance, and equity-centred design.

Holistic Research Canada is a mission-driven social enterprise advancing ethical, human-centred approaches to digital mental health. Its work connects research, practice, and public-interest data stewardship to help build more equitable, accountable, and responsive systems of care.

Watch now, subscribe, and join me as we ask what it takes to build trust by design.