Despite the widespread use of audio or video recording in psychotherapy training and research, there has been surprisingly little exploration of patient reactions to the use of recordings in psychotherapy, and there is even less written about patient factors that influence their willingness to consent to recording practices or the impact of such a request on treatment. The present study examined the relationship between pretreatment patient symptomatology and patient attitudes toward the audio or video recording of psychotherapy sessions. Treatment refusal, duration, and outcome were also examined as they related to patient comfort with recording. A total of 390 participants completed an initial intake in a university-based community outpatient clinic. Pretreatment patient symptomatology was measured at the initial intake evaluation using the Brief Symptom Inventory (Derogatis, 1993), and patient attitudes toward audio or video recording were measured using an audio/videotape comfort form. The majority of patients expressed no or slight concerns (52%), and almost three quarters (71%) were willing to consider audio or video recording. It was found that higher levels of pretreatment interpersonal sensitivity and paranoia have a significant negative relationship to recording comfort (i.e., greater pathology related to lower comfort). However, treatment refusal, duration, and outcome were not significantly related to patient comfort with recording. Significant intake clinician effects were observed in regard to patient-rated comfort regarding audio or video recordings, indicating a relationship between patients’ intake clinician and their level of comfort. Therapist effects were examined with regard to treatment refusal, duration, and outcome, and all results remained nonsignificant. This research has implications for and supports the implementation of audio- or video-recording practices in clinical training, research, and practice.