March 20, 2026
12 min read
By Albert Wong, PhD · Clinical Psychologist
I'm going to tell you something that TherapyNotes' marketing team won't.
TherapyNotes is solid. Their billing integration is genuinely the best in the category — claims process at scale, insurance contracts, denials tracking. Their system doesn't crash during your appointment. You can call someone and get a human on the phone within 10 minutes. They've been doing this for 13 years. They know what they're doing.
But the interface looks like 2012 got preserved in amber. The note-taking is manual — you're typing everything yourself, every time. There's no client app. No AI. No way to let your clients fill out between-session homework or send you a secure message. And once you're locked in, exporting your data is possible but it feels like unscrewing a bolt that wasn't meant to be unscrewed.
I'm Albert Wong. Psychologist. Built Practice Harbor because I spent five years writing progress notes at 9 PM and two years watching therapists scroll past three EHR options and land back on TherapyNotes because "I know it works."
Here's what I actually think. For the right practice, TherapyNotes is still the answer. But for a lot of therapists — therapists who want modern tooling, therapists who are tired of typing, therapists who want clients to do some of the work — there's a better fit now. And I'm going to show you exactly why.
The short answer
TherapyNotes remains the best pure insurance-billing engine in therapy software — if claims dominate your week, staying is defensible. Therapists leave for the interface and the typing: the main alternatives are SimplePractice (polish, higher price), Sessions Health (lean, ~$39/month), and Practice Harbor (AI notes included at $19/month, free pre-licensed).
If you're here for the shortlist: SimplePractice is the category's default — more modern interface than TherapyNotes, weaker billing, and the pricing has crept up steadily (we wrote a full SimplePractice alternatives guide). Jane App is beautifully designed but built for multidisciplinary clinics, not therapy-first workflows. Sessions Health is a lean, therapist-focused option at a lower price point. And Practice Harbor — ours — is the AI-native option: free for pre-licensed clinicians, $19/month licensed, with AI notes included rather than sold as an add-on.
The rest of this article is the deep version: an honest look at what TherapyNotes genuinely does better than everyone (including us), and where a switch pays for itself.
Let's start here. I'm not going to pretend they're bad at things they're good at.
This is where they shine. Claims clearinghouse built in. Denials management. Insurance contract tracking. If you bill insurance — all insurance, dozens of plans, complex credentialing — TherapyNotes' billing is a cathedral and everyone else is building with blocks. The claims process rate is 99.2%. They'll catch scrub errors before submission. The appeals workflow is automatic.
If you're generating $500k+ annually in insurance claims, you should probably be on TherapyNotes. The 40 minutes a month you save on denials appeal paperwork is worth $300-400 right there. They're not charging extra for this. It's just part of the system. That's restraint.
Downtime is rare. Like, genuinely rare. Not "down once a quarter," but "down maybe once a year for 20 minutes." Their telehealth doesn't drop calls mid-sentence. Your appointment schedules don't vanish at 3 AM. SimplePractice? 500 outages in two years. TherapyNotes? Their status page looks like someone checking on a perfectly healthy patient every 15 minutes and finding nothing to report.
If your practice runs on schedule and consistency — if downtime costs you actual money because clients are showing up and you can't access the chart — you're paying for reliability. TherapyNotes delivers it.
A person answers the phone. Within minutes. You don't navigate a bot tree or wait 40 minutes to hear hold music while a therapist somewhere processes their own anger about the system. TherapyNotes' support team actually knows the product. They fix things or explain why they work the way they do.
That's worth something. It's worth real money. In a crisis — a client's chart is missing, the backup failed, your intake forms corrupted — you want a human on the phone who knows this software inside-out.
Now for the harder part. The part their sales team skips over.
I'll say it plainly: TherapyNotes looks like it was designed in 2012 and nobody's touched the interface since. Buttons are small. Navigation requires clicking through nested menus. The color palette is — well, it looks like a hospital database. You can get used to it. Your fingers will learn the path. But there's no joy in it. There's no design elegance. Just function. Cold, gray function.
This matters because you spend 40+ hours a week in this interface. You're looking at those gray buttons every day. Your clients see the portal. They see something that looks like it was built in 2011 and shipped that year without updating. Design isn't cosmetic. It's how software feels to live with.
Here's the thing. TherapyNotes doesn't have built-in AI note generation. You can integrate with TherapyFuel — their partner service — but it's $40/month extra per provider. And TherapyFuel requires you to use their app to record sessions, then process the audio outside TherapyNotes, then copy the transcript back in. It's bolted on. It's not native. It's not elegant.
So you're looking at $69/month for TherapyNotes + $40/month for AI if you want modern documentation tools. That's $109/month. For someone writing 80 notes per month, that's $1.36 per note. That adds up to $1,300+ a year just to avoid typing your own progress notes. And you're still dealing with the 2012 interface for everything else.
TherapyNotes has a portal. Clients can see appointment schedules and pay invoices. But they can't fill out between-session homework. Can't do intake forms ahead of time. Can't message you securely about cancellations or crises. Can't upload documents or photos. The portal is read-only for most things. It's a window, not a door.
This means you're managing all client communication manually. Emails for homework assignments. Phone calls for intake forms. Manual note-taking about what they said in their last message. You're doing work that the software could do but doesn't.
Yes, you can export your data. But it's not the default. You have to call support. You have to wait. They'll generate a file and send it to you — usually in a proprietary format that another EHR has to translate. It's not FHIR-compliant. It's not a standard export. It feels like they're saying, "Sure, you can leave. But here's a file that only works with us."
The implication is clear: They're not excited about you taking your data elsewhere. Fair enough — it's their business. But it means switching costs are real and sticky.
I built Practice Harbor because TherapyNotes solved the wrong problems for me.
I was spending two hours a week typing progress notes. Every single week. That's 100 hours a year typing documentation that my brain already processed, my mouth already said, my clinical intuition already understood. I kept the notes, but I lost the time. And I couldn't find an EHR that wasn't either locked in the past (TherapyNotes) or locked in quarterly price increases (SimplePractice).
| Feature | TherapyNotes | Practice Harbor |
|---|---|---|
| Base Price (Solo) | $69/month | Free or $19/month |
| AI Note Generation | $40/month extra (TherapyFuel) | Included |
| Telehealth | Included | Included |
| Client Portal | Read-only (schedule, pay invoices) | Full (homework, intake, messaging) |
| Insurance Billing | Excellent (built-in) | Not yet (roadmap) |
| Data Export | Possible with support call | One-click, FHIR standard |
| UI Age | "Hospital database" energy | 2026 design language |
| Total Cost (80 notes/mo, solo) | $109/month (with AI) | $19/month |
You record a session. The AI listens and generates your progress note. Not as an external service. Not as an addon. As the core of how documentation works. You can spend three minutes on editing or 45 seconds just accepting what the AI drafted. Your call.
The AI is Anthropic's Claude running on Groq's speech-to-text. Both companies signed HIPAA BAAs. Your audio is encrypted in transit and at rest. We don't train on your data. Your session recordings are yours. We don't sell them or learn from them.
Your clients fill out intake forms before the first session. They do their homework between sessions. They send you a message: "I'm having trouble with the grounding exercise." You log in and see it. That's time you're not typing. That's work your clients are actually willing to do — they want to do it because they own their treatment.
The portal works both ways. It's not read-only theater. It's an actual tool for actual clinical work.
You're writing real clinical notes. Your supervisor is reviewing your documentation. Your hours are real. Your work is real. The software shouldn't cost anything. It doesn't. Everything — scheduling, intake, telehealth, unlimited AI notes — is free until you get your license.
When you get licensed, it's $19/month. Same product. You just cleared the bar. Now you can afford it.
Click one button. Get a FHIR-compliant export of everything. Notes, charts, client records, session transcripts, documentation. Not in a proprietary format. In a standard that any EHR on the planet can read.
We're not afraid of you leaving. A company that's confident in what it builds doesn't make leaving hard.
Practice Harbor isn't TherapyNotes. And I'm not going to pretend it is.
I'm going to be direct. If these things are true about your practice, go with TherapyNotes and don't look back:
And if these things resonate, we're probably your answer:
If you're thinking about moving, do this. In this order.
TherapyNotes is a solid, reliable, insurance-focused EHR for therapists who bill insurance and like knowing the software works every single day. They've earned their reputation. They deserve it.
But they're not for everyone. If you're drowning in documentation, if your clients are doing private pay, if you're tired of paying $100+/month for a 2012 interface and limited client tools, there's something better now.
Practice Harbor costs $19/month for licensed therapists. Free if you're pre-licensed. Your data is always exportable. Your notes write themselves. Your clients do homework. Your interface is designed by someone who still sees clients, not by committees.
If you spend your evenings typing notes instead of living your life, try us. You'll know within 48 hours if it's right.
It depends on why you are leaving: SimplePractice if you want the most polished mainstream experience, Sessions Health if you want lean and inexpensive (~$39/month), and Practice Harbor if documentation time is the pain — AI notes are included at $19/month rather than sold as an add-on, and it is free for pre-licensed clinicians.
Almost never because of billing — that part is excellent. The common reasons are the dated interface, fully manual note-typing, and thin client-facing features (portal, messaging, client app) compared to newer platforms.
At roughly $69/month, it is worth it for insurance-heavy practices that use the billing engine daily. Private-pay or low-claim practices are paying for infrastructure they rarely touch and can get modern documentation and portals for less.
Free for pre-licensed clinicians. $19/mo when you get licensed. No credit card required.
AI notes included. Client portal included. Telehealth included. Your data always exportable.