After five years of using TherapyNotes (TN) in our expanding behavioral health practice, we’ve gained valuable insights into its strengths and limitations. This review details our journey from a single practitioner to a thriving practice with over 35 users, highlighting how TN has supported and, at times, challenged our growth.
TherapyNotes
We love it, but once you build up your practice you will find yourself extremely limited by its lack of an API and high costs.
- Strong clinical documentation tools (DSM-5, treatment plans, templates)
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Built specifically for behavioral health practices
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Reliable built-in telehealth and patient portal
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Live phone customer support
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Easy-to-use interface for clinicians
Secure and stable platform
- No bulk actions (cancel, update, reassign, or modify sessions)
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Admins can’t adjust note or billing settings for users
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No graphs, dashboards, or analytics — zero visual reporting
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No API or automation capabilities
Weak, inflexible custom form builder
- No mobile app
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Poor scalability for large, multi-site teams
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AI features cost $40/month per clinician and don’t fix core issues
- Repeated promises of updates that never materialize
After Five Years with TherapyNotes: A Platform That’s Stopped Evolving
After five years of using TherapyNotes (TN) in our expanding behavioral health practice, we’ve gained valuable insights into both its strengths and its increasingly frustrating limitations. This review details our journey from a single practitioner to a thriving practice with over 40 users (35 of those are therapists and supervisors), highlighting how TN has supported our growth—and where it has begun to hold us back.
Initial Implementation and Early Days
We first adopted TherapyNotes in 2018 when Dr. Elka Jacobs-Pinson decided to expand the practice and bring on our first associate. At the time, we needed an EHR system that could support a small but growing team with an emphasis on ease of use and robust clinical documentation. TN fit that initial need, offering straightforward onboarding and an intuitive interface that allowed us to get moving quickly.
We were especially pleased with the clinical note-taking features. The templates struck a great balance between structure and flexibility, which helped maintain documentation standards across therapists while still allowing for personal workflows.
Scaling Up: Growing Pains and Real Limitations
As we scaled from a handful of clinicians to over 40 users, TN began to show its age. The core clinical features have remained solid, but administrative and operational demands have far outpaced what the system can handle.
One glaring problem is the complete lack of bulk actions. You can’t select multiple sessions to cancel, update, or batch-adjust. Want to change session statuses, supervisor assignments, or correct billing details across many sessions? Too bad—you have to do it one-by-one. This limitation has cost us well over 30 hours just trying to clean up old sessions. Similarly, updating insurance rates or modifying claims workflows en masse is impossible, creating huge operational drag.
Even worse, session note settings can’t be managed by an admin. If a therapist forgets to enable billing settings or change their supervisor, they have to log in and fix it themselves, even if the issue affects dozens of claims. This makes post-session billing cleanup extremely tedious and error-prone, and it’s a complete disaster for practices with interns or supervision changes.
Current Usage and Integration
Despite the frustrations, TherapyNotes still handles roughly 70% of our patient-facing operations—from intake to documentation, billing, and telehealth. But cracks are becoming increasingly hard to ignore. We now rely on external platforms and workarounds for what TN should be doing natively.
Deep Dive into Key Features
Clinical Functionality
This remains TherapyNotes’ strong suit. The documentation tools are still efficient and structured, and the treatment plan module continues to be a standout. The integration of DSM-5 diagnoses helps newer clinicians maintain billing compliance and diagnostic accuracy.
But these benefits haven’t evolved. The platform has stagnated, offering very few new capabilities where modern EHRs are rapidly advancing. The recently added AI features sound promising—but come at an absurd cost of $40/month per therapist, essentially doubling our bill, for tools that don’t even address basic workflow pain points.
Financial Management and Billing
Insurance billing is one of our biggest headaches. While claim creation and tracking are functional, the inability to bulk update sessions, reassign supervisors, or edit notes administratively causes chaos. A single user oversight can cascade into dozens of billing errors that admins can’t fix without logging in as the therapist.
The payment tracking and report exports are okay—but again, no bulk edits, and no intelligent logic to simplify common tasks. This makes it difficult to run a lean operation and has required extensive manual oversight to maintain billing accuracy.
Reporting and Metrics
This is by far the system’s Achilles’ heel. There are zero built-in graphs, dashboards, or modern analytics. The built-in reports are inflexible, can’t be customized, and barely scratch the surface of what’s needed to manage a real business. We now pay $400/month to a third-party tool (PracticeVital) just to access the insights we need—something that should be baked into a mature EHR.
Patient Engagement and Teletherapy
The patient portal and telehealth features are solid. Intake forms, payments, and video sessions are all functional, but that’s the baseline in 2025. What’s missing is automation—there’s no way to automatically send forms to new patients, no way to trigger reminders or follow-ups based on behavior (e.g., dropped credit card, no-show, etc.), and no ability to plug into external tools.
The custom form builder is barely usable. It’s basic, clunky, and doesn’t integrate well into the patient experience. Most competitors now offer automation or at least APIs. TherapyNotes has zero API, meaning we can’t connect anything: marketing tools, billing platforms, CRMs, or data dashboards.
User Interface and Ease of Use
We still rate the general interface a 7/10. For basic clinical workflows, it’s clean and functional. Most therapists can get up and running quickly, but anything involving reporting, insurance, or complex admin tasks requires a ton of training or support.
Impact on Practice Efficiency
TherapyNotes helped streamline our early growth, but it’s now actively slowing down our operations. The lack of automation, inability to perform bulk tasks, and poor reporting capabilities force our admin team into tedious manual work that more modern systems have already eliminated.
Customer Support and Responsiveness
Customer support is still a bright spot. The team is available, and it’s helpful that they offer live phone support instead of hiding behind email-only systems.
However, we were assigned a dedicated representative who listened to our feedback—but none of the promised improvements have materialized. We’ve heard “it’s on the roadmap” for nearly two years, especially regarding reporting and team management. At this point, it feels more like a stall than a commitment.
Specialization in Behavioral Health
The behavioral health focus remains one of TherapyNotes’ key selling points. The templates, billing codes, and workflows are well-tailored for therapists, psychologists, and supervisors.
But specialization alone isn’t enough if the platform can’t scale to meet the operational complexity of modern group practices.
Scalability Challenges
Our practice has grown to over 25 users across multiple offices. TN has not kept pace. Complex scheduling remains a pain—managing multiple rooms, overlapping schedules, and part-time clinicians across locations is clunky at best and error-prone at worst.
There are no team-based permissions, no productivity dashboards, no supervisor tracking tools. TN was clearly built for small practices—and it shows. We’ve hit the ceiling of what the platform can handle.
Value for Money
At $30 per user per month, TherapyNotes is reasonably priced—until you factor in external tools. Once we include the $400/month reporting platform and the $40/month-per-therapist AI features (which we’ve declined), the real cost balloons quickly.
We now closely monitor every user account to justify the cost, especially for admin users or part-time staff. TherapyNotes is not priced for scale, and the lack of features makes this harder to justify every year.
Comparison to Other EHRs
TherapyNotes holds its own in clinical documentation but lags behind in automation, analytics, integrations, and modern UI/UX design. Compared to platforms like SimplePractice or newer players focused on larger clinics, it feels stuck in 2018.
Wish List: Features We’d Love to See
- Bulk editing and batch actions (sessions, billing, scheduling)
- Custom reporting and dashboards with visualizations
- Automation and form logic for onboarding, billing, and engagement
- Modern API access so we can connect other tools
- Enhanced scheduling tools for multi-site, team-based practices
- Better team and supervisor management features
- A real mobile app experience
Conclusion: Time to Evolve or Get Left Behind
TherapyNotes helped us grow from a solo practice to a team of over 25—but it hasn’t evolved with us. The clinical features are still solid, and the system remains reliable, but operational bottlenecks, lack of automation, and a stagnant product roadmap have left us increasingly frustrated.
For solo practitioners and small teams, TherapyNotes still offers great value. But for larger, multi-location practices with complex billing and admin needs, it’s no longer enough.
Unless we see meaningful updates—especially in reporting, automation, and team management—we may be forced to look elsewhere. In 2025, reliability alone isn’t enough. EHRs need to move fast, integrate deeply, and support the operational backbone of modern healthcare businesses. TherapyNotes isn’t there yet.
