TherapyNotes Review + Alternative: How To Fail At EHR (Updated 2026)

Five Years In: A Platform That Stopped Growing With Us

We first adopted TherapyNotes in 2018, when Dr. Elka Jacobs-Pinson was expanding Crown Counseling and bringing on our first associate. It was the right tool for that moment — easy to onboard, behaviorally focused, and solid on clinical documentation. For a small team, it just worked.

Now, six years later, we're running a practice with over 40 users — 35 of them therapists and supervisors across multiple offices. TherapyNotes has barely changed. We have.

This is our most detailed review yet. We're keeping every piece of original critique because it's all still true, and we're being upfront about where we'd go instead: Healthie.

Clinical Functionality — Still the Strong Suit

Clinical documentation is genuinely TherapyNotes' best feature, and we don't want to undersell it. The templates are well-designed for therapists, the DSM-5 diagnosis integration is helpful for newer clinicians maintaining billing compliance, and the supervisor approval workflow is one of the cleanest implementations we've seen. Treatment plans are structured, notes are easy to complete, and onboarding new clinicians is relatively painless.

The telehealth and patient portal are reliable. Intake forms, payments, and video sessions all work. But in 2025, that's the baseline — not a differentiator.

The problem is that none of this has evolved in years. TN was built for small practices, and the clinical toolset reflects that. There's no automation for sending forms to new patients, no behavioral triggers, and no way to do anything in bulk. Every action is manual, one at a time.

The Bulk Action Problem — Our Biggest Day-to-Day Pain

If there's one thing that has cost us the most time, it's this: TherapyNotes has zero bulk actions. You cannot select multiple sessions to cancel, update, reassign, or batch-adjust. You cannot change billing settings across a group of users. You cannot reassign a supervisor across all of an intern's notes when they graduate. Everything is one by one.

We have spent well over 30 hours cleaning up old sessions because of this limitation alone. When a therapist forgets to set up their billing settings or when a supervisor assignment needs to change — which happens constantly in a practice with interns and rotating supervisors — an admin cannot fix it. The therapist has to log in and fix it themselves. At scale, this is a complete operational disaster.

Billing: Functional but Fragile at Scale

Insurance claim creation works. ERA processing is functional. But the inability to bulk-update sessions, reassign supervisors, or fix note-level billing settings from an admin account creates cascading errors. One therapist oversight can produce dozens of billing mistakes that only the therapist can correct — not your billing team, not your admin, not you.

This isn't a minor inconvenience. It's a real compliance and revenue risk at the size we operate. A modern EHR built for group practices would give admins the access they need. TN doesn't.

Reporting: The Biggest Gap in the Entire Platform

We pay $400 per month to a third-party tool called PracticeVital just to get basic reporting. That is not a complaint about PracticeVital — it's a damning statement about TherapyNotes.

TherapyNotes has no graphs. No dashboards. No visual analytics. The built-in reports are static, inflexible, and tell you almost nothing useful for running a real business. For a practice doing $2M+ in annual revenue, this is inexcusable in 2025.

Every mature EHR platform — and every serious piece of business software — ships analytics as a core feature. TN treats reporting as an afterthought. We've been told it's "on the roadmap" for nearly two years.

No API = No Integration = No Future

TherapyNotes has zero API access. None. That means you cannot connect it to your CRM, your marketing tools, your data pipelines, your billing platform, or any external system. In an era where automation is the baseline for operational efficiency, TN is an island.

We cannot trigger emails when a client misses an appointment. We cannot sync data to a reporting dashboard. We cannot automate intake workflows. We cannot plug it into Zapier, n8n, or anything else. Every integration requires a manual workaround, which means more staff time, more errors, and more operational drag.

Scheduling Across Multiple Locations

We operate across multiple offices and rooms. TherapyNotes technically has a multi-location option — but it doesn't work particularly well. Calendars don't sync properly across locations, overlapping schedules are clunky to manage, and there are no team-based permission tools or productivity dashboards for supervisors. We've had to build manual workarounds just to handle scheduling at our current scale. It is not ideal.

Customer Support — Genuinely Good, but a Sign of the Times

We want to be fair: TherapyNotes customer support is actually good. They have a live phone line — a real person answers — and the team is helpful and responsive. That's rare.

Ironically, offering phone support in 2025 is also a signal of where TN is in the product lifecycle. Modern software companies have largely moved beyond phone-based support because it doesn't scale. It's a good sign for user experience and a quiet indicator that the platform hasn't fully modernized its operations either.

We were assigned a dedicated rep who listened carefully to our feedback. Almost none of the improvements we requested have materialized. We've been told "it's on the roadmap" so many times it no longer means anything to us.

Feature-by-Feature Assessment

TherapyNotes vs. Alternatives

Who Should Still Use TherapyNotes

We want to be honest about this: TherapyNotes is not a bad product. For solo practitioners and small practices with 1–5 clinicians who primarily need reliable clinical documentation and don't have complex billing or admin needs, it still delivers solid value. The interface is clean, the behavioral health focus is genuine, and the phone support is a real differentiator for clinicians who aren't particularly tech-savvy.

If you're just starting a private practice, TN is a reasonable starting point. You'll likely hit its ceiling eventually — but it's not the wrong choice on day one.

Who Has Outgrown TherapyNotes

If you're running a group practice with more than 10 clinicians, operating across multiple rooms or locations, employing supervisors and interns, managing insurance billing at volume, or trying to build any kind of operational visibility into your practice — TherapyNotes will hold you back. That is not a prediction. It's what we have lived for the past three years.

Frequently Asked Questions