SimplePractice Alternatives in 2026: An Honest Look at What's Out There

Let me tell you something. You already know it, but nobody's saying it out loud, so I will.

Your EHR got sold. Not to someone who cares about therapists. To a private equity firm. And now the price went up. The telehealth drops calls. The support line plays hold music long enough for you to process your own abandonment issues. You're paying more for less, and the only thing that's improved is their investor deck.

You're reading this because you opened that last invoice and something in your chest tightened. Or because the telehealth crashed mid-session — again — while your client was saying something they'd never said to anyone. Or because you spent forty minutes on hold and the answer was "clear your cache."

You want to know what else is out there. You want someone to be straight with you about it, because every "Top 10 EHR" article you've found reads like a press release wearing a blog post costume. I'm going to be straight with you. Some of what follows is going to sting. That's how you know it's honest.

I'm Albert Wong. Clinical psychologist. I built Practice Harbor because I got tired of writing notes at 9 PM. I've used SimplePractice. TherapyNotes. The free ones that look amazing in the demo and shatter like cheap glass when you're running an actual practice. Here's what I actually think about all of them.

The SimplePractice Situation

Here's what happened. SimplePractice got acquired by Vista Equity Partners through the EngageSmart deal in 2024. Vista is a private equity firm. They didn't buy SimplePractice because they love therapists. They bought it because 100,000+ clinicians paying monthly subscriptions is a beautiful recurring revenue stream, and recurring revenue streams are what private equity firms eat for breakfast.

What followed was predictable. It's always predictable. The playbook hasn't changed since the first PE firm figured out you could buy a beloved product, raise the price, cut the support staff, and coast on switching costs for five years before anyone leaves.

• The Starter plan went from $29 to $49. That's a 63% price hike. One month's notice. Same features. More money. The math is simple and the math is ugly.
• Appointment reminders got pulled from the cheap plan. Think about that. Reminders. The thing that stops no-shows. The thing that literally pays for itself. Now you need the $79/month plan for it. That's not a feature tier. That's a shakedown.
• Telehealth started falling apart. Over 500 documented outages in two years. In March 2025, providers got locked out for an entire business day. An entire day. Imagine canceling a full day of clients because your software company broke something.
• Support hold times hit 30+ minutes. And the good support — the kind where a human answers the phone — that's locked behind the $99/month plan. You have to pay extra to talk to a person when the product you're already paying for doesn't work.
• They bought Luminello and killed it. Two months' notice. Psychiatrists who'd built their entire practice around Luminello's medication management got told to migrate. SimplePractice didn't even have equivalent features yet. They just... turned it off.

SimplePractice still works. I want to be fair about that. For a lot of therapists, it's fine. Good enough. The devil you know. But "fine" is not what you were promised, and "good enough" is not what you're paying $99 a month for.

What Actually Matters (and What Doesn't)

Every EHR company wants you staring at a feature grid. Rows and rows of checkmarks. They want you counting checkmarks like a kid counting candy. More checkmarks, better product. Right?

Wrong. Here's what matters. Five things. That's it.

1. How long does it take to finish a note? You will write thousands of notes in your career. If each one takes 15 minutes instead of 3, you're losing a full workday every single week. Nothing else on the feature grid matters if the note-writing experience is slow.
2. Does the telehealth work? Not "does it have telehealth." Does it work. Every time. No fiddling. No "can you hear me now." No client troubleshooting Chrome plugins while their session clock is running.
3. Is the pricing honest? Not "competitive." Not "flexible." Honest. Can you look at the pricing page and know what you'll pay? Will it be the same number next year? If a company raised prices 63% once, they'll do it again.
4. Can you reach a human when it breaks? Because it will break. Every piece of software breaks. The question is whether someone answers the phone when it does.
5. Can you leave? Can you export your data? All of it? In a format another system can read? If you can't, you're not a customer. You're a prisoner.

The Alternatives

I'm going to go through each one. What's good. What's not. Who it's actually for. No checkmark grids. No marketing language. Just what I'd tell you if we were sitting across from each other at a coffee shop.

The Real Comparison

Here's the table you're going to screenshot and send to your therapist friend who's also complaining about SimplePractice:

The Question Behind the Question

You're not really here to compare feature grids. You're here because something broke. The trust broke. You signed up for a tool that was supposed to make your life easier, and instead it got more expensive, less reliable, and harder to get help with. That's not a feature problem. That's a relationship problem.

So here's the question that actually matters:

Who owns this company, and what are they optimizing for?

Private equity optimizes for margins. They'll raise your price, cut support staff, and gate features behind higher tiers. That's not malice. It's math. Their math. Not yours.

Venture capital optimizes for growth. They'll give you everything free until they can't, and then the price goes up and the free tier disappears and you get an email that starts with "We're excited to announce..."

I optimize for making notes take less time. That's it. That's the whole thing. It's not a strategy you'd find in a business school textbook. But it's why AI notes are included at every tier and the whole thing costs less than a single therapy copay.

How to Switch Without Losing Your Mind

1. Export everything. Client records, notes, billing. Download it all. Encrypt it. Store it somewhere that isn't your Downloads folder.
2. Try two or three options. Free trials exist for a reason. Enter real notes. Schedule real appointments. Test telehealth with a colleague, not a demo bot.
3. Ask about migration. A company that makes it easy to switch to them is confident you'll stay. A company that makes it hard to leave is afraid you won't.
4. Overlap for two weeks. Run both systems. Cancel the old one only when the new one feels right. Not "fine." Right.
5. Tell your clients. New portal link. New intake form. Quick email. They don't care which EHR you use. They care that you're organized and present.

The Bottom Line

Every option on this list has compromises. TherapyNotes is stable but dated. Jane is gorgeous but expensive. TheraNest improved a lot but the full AI scribe costs extra. TherapyZen is honest but bare. Charm is free but wasn't built for you.

And ours? Practice Harbor is new. We're smaller. We don't have a hundred integrations or a booth at every conference. What we have is a free EHR for pre-licensed clinicians, $19/month when you get your license — and a founder who still writes progress notes at the end of every workday and knows exactly how much it hurts when they take too long.

Here's what I'd tell a friend. If billing is your biggest problem, go TherapyNotes. If you want the prettiest interface, go Jane. If you run a big group, look at TheraNest.

If you're drowning in documentation — if you're spending your evenings writing notes instead of living your life — try ours. You'll know within a week.