If you’re comparing TheraNest vs TherapyNotes for your mental health practice, you’re likely battling with a decision that feels bigger than just software. You’re choosing the software that will support every aspect of your practice, from your first client interaction to your last session note of the day.
Both platforms have earned their place as market leaders, each taking a distinctly different approach to solving the same fundamental challenge: how to make running a therapy practice less about paperwork and more about patient care.
Most comparisons focus on features and pricing between these two platforms. However, there’s a third option that has been serving behavioral health documentation needs since before either of them existed, and it’s used by therapy practices nationwide.
In short, here’s what we recommend:
👉 TheraNest (now part of Ensora Mental Health) offers maximum flexibility through its Dynamic Form Builder and caseload-based pricing that can be incredibly cost-effective for smaller practices. With unlimited staff members at no extra cost and deep customization options, it’s ideal for practices that want to tailor every aspect of their workflow. Customer support is available via phone, chat, and email during business hours, though some users report declining responsiveness since the Ensora acquisition.
👉 TherapyNotes provides comprehensive customer support with free, unlimited 24/7 phone and email assistance that users consistently praise. Its structured, form-based approach and automated To-Do List create an efficient workflow that guides you through compliance requirements. The platform includes basic outcome measurement tools for tracking patient progress. The trade-offs are limited customization options, no dedicated mobile app, and an interface some users describe as “clunky,” plus expensive add-ons like e-prescribing at $65/month.
Both platforms are comprehensive and mature, serving thousands of practices successfully. But what if there was a way to get enterprise-level features, including the advanced automated Measurement-Based Care system at a fraction of the cost?
👉 CarePaths has been serving behavioral health professionals since 2000, making it older than both competitors. At just $49/month with transparent, all-inclusive pricing, it includes features that cost extra elsewhere: telehealth (including group sessions), free electronic claims, automated appointment reminders, AI-generated session summaries, and unlimited admin users. Its key feature is the fully automated Measurement-Based Care system developed with leading psychotherapy researcher Bruce Wampold, PhD, which handles outcome tracking to improve therapy results. As insurers increasingly reimburse for MBC, it can even become a revenue generator.
CarePaths offers a free MBC-only option for up to 30 clients, making evidence-based practice accessible to everyone. Ideal for group practices of 20-30 clinicians but scaling effectively from solo practitioners to 100+ user organizations, CarePaths also offers special rates for students and supervised clinicians.
Ready to see how automated Measurement-Based Care can transform your practice? Start your 30-day free trial of CarePaths, no credit card required.
Table of contents:
| TheraNest | TherapyNotes | CarePaths | |
|---|---|---|---|
| Founded | 2013 | 2010 | 2000 |
| Ideal practice size | Solo to mid-size | Solo to mid-size | 20-30 clinicians (scales 4-100+) |
| Pricing approach | Per-client tiers with unlimited staff | Per-clinician only | Per-clinician with free MBC tier |
| Starting price | $39-42/month | $59/month | $49/month (Free MBC available) |
| Customer support | Phone, chat, email (business hours) | 24/7 phone and email | Phone and email support |
| Documentation flexibility | Highly customizable | Structured templates | Customizable with AI assistance |
| Billing features | Comprehensive but complex | Streamlined and reliable | Automated with some reported issues |
| Mobile app | Limited or discontinued | No dedicated app | Full-featured CarePaths Connect |
| Telehealth included | Extra cost ($12-25/month) | Basic included, Premium $15/month | Included with group support |
| Supervision features | Basic review and co-signing | Comprehensive with intern pricing | Comprehensive with special rates |
| Measurement-Based Care | Not available | Basic outcome measures | Fully automated with free tier |
The way each platform structures its pricing reveals their fundamental philosophy about serving mental health practices.
TheraNest uses a caseload-based pricing model that starts at $42/month for up to 30 active clients, scaling to $98/month for up to 80 clients.
Perfect for solo therapists just starting out
Ideal for practices ready for more automation
A complete solution for established practices
This can be cost-effective for solo practitioners or practices with fluctuating caseloads, as it includes unlimited staff members at no extra cost. The company also offers per-user pricing plans ranging from approximately $29/month to $89/month depending on features.
The catch? Many essential features cost extra. Telehealth runs $12-25/month per therapist. Electronic claims cost $0.17-0.23 per claim. Text reminders are $0.10 each. The Wiley Practice Planners integration adds $25/month per therapist. What seems affordable can quickly escalate.
TherapyNotes takes a more straightforward approach: $59/month for solo practitioners, $69 for the first clinician in a group plus $40 for each additional.
FOR ONE USER
Great for solo practitioners or new providers who are just getting started.
FOR THE FIRST CLINICIAN
$40/month per additional clinician
Unlimited non-clinical staff
FOR THE FIRST CLINICIAN
$40/month per additional clinician
Unlimited non-clinical staff
✅ Includes a designated account manager
They also offer a $20/month intern rate for supervised clinicians. While this seems pricier upfront, basic telehealth is included, and you get unlimited clients, appointments, and notes.
But TherapyNotes has its own add-on trap. E-prescribing costs an additional $65/month per prescriber. Their AI-powered TherapyFuel adds $40/month per clinician. Premium telehealth for group sessions costs $15/month. Electronic billing charges $0.14 per claim, ERA, and eligibility check.
CarePaths disrupts both models with transparent, all-inclusive pricing.
At $49/month per therapist, you get everything: telehealth with group session support, free electronic claims, free SMS appointment reminders, free eligibility verification, unlimited admin users at no extra cost, and even AI-generated clinical notes. For psychiatrists, the e-prescribing plan at $98/month includes all features plus comprehensive medication management.
By Bruce Wampold PhD
Complete Practice Management System
Getting Started?
The platform offers special rates for students ($5.75/month), part-time therapists, and supervised clinicians, making it appealing for growing practices and training programs.
It offers a completely free Measurement-Based Care option for practices with up to 30 clients per clinician. For practices just starting out or with low volume, a $10/month plan covers up to 15 sessions monthly.
How each platform handles clinical documentation reveals their core philosophy about the therapist’s workflow.
TheraNest focuses on customization through its Dynamic Form Builder.
Source: TheraNest
You can create unlimited custom note templates, modify existing ones, or build forms from scratch. It offers features to copy content from previous sessions, though diagnosis codes must be entered manually for each new note. The Wiley Practice Planners integration (for an extra fee) provides evidence-based treatment plans and interventions.
This flexibility comes with a learning curve. Users report that mastering the customization features takes time, and the abundance of options can be overwhelming for new users.
TherapyNotes takes the opposite approach with structured, form-based templates designed specifically for behavioral health.
Source: TherapyNotes
The templates are based on insurance audit requirements and professional best practices. While less flexible, this structure creates an incredibly efficient workflow. The automated To-Do List ensures you never miss documentation, and the “golden thread” concept maintains continuity from intake through treatment planning to progress notes.
Source: TherapyNotes
The new TherapyFuel AI feature can generate SOAP notes from session summaries or transcripts, with customizable “Clinical Voice” settings to match your documentation style. But at $40/month per clinician, it’s a significant additional investment.
CarePaths strikes a balance with customizable templates enhanced by free AI assistance.
It offers an extensive library of clinical templates that can be modified or created from scratch. The standout feature is the free, HIPAA-compliant AI tool that generates session summaries from teletherapy recordings. These summaries can be imported directly into any clinical document, reducing documentation time while maintaining comprehensive records.
Source: CarePaths
New progress notes automatically pre-populate with information from previous sessions, and the system supports batch document generation for group and family sessions, streamlining multi-client documentation.
The billing features of each platform show how they balance automation with control.
TheraNest offers comprehensive billing features with deep customization options.
When billing automation is enabled, charges can post automatically from completed notes, claims generate in the appropriate format, and the system supports ERA processing. The optional managed billing service handles the entire claims cycle for practices that want to outsource completely.
Source: TheraNest
However, users report that the billing module has one of the steeper learning curves in the platform. The flexibility that makes it powerful also makes it complex, and some experience technical issues that require careful monitoring.
TherapyNotes handles the insurance billing process.
The assisted ERA payment posting and clearinghouse claim scrubbing reduce rejections, and the integration between notes and billing works smoothly. Creating a note automatically generates a to-do item for billing, ensuring tasks are tracked.
Source: TherapyNotes
The system is particularly praised for making insurance billing accessible even to those without extensive billing expertise. The structured workflow guides users through each step.
CarePaths automates the entire billing workflow from charge creation to payment posting.
When you complete a clinical document with a CPT code, it charges post automatically, and claims generate without manual intervention. Electronic claims submission to all payers (including Medicare and Medicaid) is free and unlimited.
Some users report billing glitches and system bugs that require attention, similar to issues reported with TheraNest. However, the inclusion of all billing features in the base price, without per-claim fees, makes it cost-effective for busy practices.
The platform’s integrated MBC system can also support billing for measurement-based care services as insurers increasingly reimburse for these codes.
Source: CarePaths
The platforms differ significantly in their approach to customer support.
TherapyNotes provides free, unlimited 24/7 phone and email support. Users report the support team is knowledgeable and helpful. They report getting help even at odd hours, with support staff who walk them through issues step-by-step and provide detailed follow-up emails.
This comprehensive support is often cited as a key reason practices choose and stick with TherapyNotes, even when other platforms offer more features or lower prices.
TheraNest provides customer support via phone, chat, and email during business hours (Monday-Friday, 7 AM-7 PM CT). While the platform offers multiple support channels, many users express frustration with declining responsiveness and generic answers since the company’s acquisition by Therapy Brands (now Ensora Health). Users report that the support quality doesn’t always match the complexity of the platform’s advanced features.
CarePaths offers phone support at 800-357-1200 along with email assistance. Reviews are mixed, with some users describing support staff as very helpful with quick responses, while others report less satisfactory experiences. The platform does offer free onboarding calls and training, with particularly generous support for training clinics and universities. They also maintain extensive online resources to help users navigate the system.
An important aspect in EHR comparisons is how platforms support practice growth through supervision arrangements, a key pathway for both expanding practices and developing new therapists.
TheraNest offers basic supervision features, allowing supervisors to review and sign off on supervisee notes. The platform supports the essential workflows, but doesn’t specifically design pricing or features around supervision models.
TherapyNotes provides advanced supervision capabilities with configurable supervision settings, approval workflows, and co-signing options.
Source: TherapyNotes
They’ve introduced a $20/month intern rate for supervised clinicians, showing commitment to supporting training relationships.
CarePaths offers robust supervision support with special rates for supervised clinicians and students ($5.75/month). The platform groups supervisors and supervisees for streamlined workflow management.
This makes it cost-effective for practices expanding through supervision arrangements or university training programs.
For university training clinics serving as training grounds for master’s and doctorate students, the ability to track outcomes provides valuable data for both clinical training and research. The platform’s integrated Measurement-Based Care provides a feedback loop for continuous improvement, supporting both training programs and established therapists mentoring the next generation.
The pandemic permanently changed expectations for telehealth and digital patient engagement, making these capabilities essential rather than optional.
TheraNest offers telehealth as an add-on at $12/month for individual sessions or $25/month for group sessions (up to 20 participants).
The platform includes a virtual waiting room and requires no downloads for clients. The Client Portal allows self-scheduling, form completion, and secure messaging, with a “Client Contact Network” feature that lets parents or guardians manage minor accounts.
Source: TheraNest
Mobile access is available through responsive web design, though the status and functionality of any dedicated mobile app remains unclear.
TherapyNotes includes basic one-on-one telehealth in all plans, with premium features (group sessions up to 16 participants, HD video, screen sharing) available for $15/month extra.
The TherapyPortal provides patient engagement tools, including appointment requests, document sharing, and secure messaging.
Source: TherapyNotes
The platform relies entirely on mobile browser access, with no dedicated app available. Users can add a home screen shortcut for quicker access on mobile devices.
Source: TherapyNotes
CarePaths includes telehealth with group session support at no extra cost.
The real differentiator is the CarePaths Connect mobile app, which serves as a “Digital Front Door” for practices. New patients can find therapists, verify insurance, view open appointments, and self-schedule directly through the app.
The app also facilitates the platform’s automated Measurement-Based Care, sending assessments to patients’ devices and allowing them to track their progress with visual graphs.
While all three platforms offer various ways to track patient progress, they differ significantly in their approach to Measurement-Based Care (MBC).
TheraNest does not currently offer integrated measurement-based care features, requiring practices to implement outcome tracking through external tools or manual processes.
TherapyNotes includes outcome measurement tools that allow clinicians to send standardized assessments through the client portal, automatically score responses, and display results in graphs within the patient chart. While functional for basic progress monitoring, it requires more manual management compared to fully automated systems.
Source: TherapyNotes
CarePaths offers the most comprehensive MBC solution: a fully automated system developed with Bruce Wampold, PhD, one of the world’s leading psychotherapy researchers.
The system automatically sends assessments to patients, tracks their responses, and presents the data as visual progress graphs at the top of each patient’s chart, all with minimal administrative burden on therapists.
The evidence is clear: MBC improves therapy outcomes and reduces dropout rates by approximately 20% according to meta-analyses. It also helps justify continued care to insurers. Research demonstrates that discussing these metrics with clients leads to improved therapy outcomes, with effect sizes ranging from 0.28 to 0.53.
The American Psychological Association has established an MBC Advisory Committee and is developing Professional Practice Guidelines promoting its adoption.
Despite these endorsements, many behavioral health clinicians don’t routinely use MBC, with administrative burden cited as a leading barrier. CarePaths addresses this by automating the entire process.
The platform offers MBC completely free for up to 30 clients per therapist.
For practices focused on delivering evidence-based care and preparing for value-based reimbursement models, this advanced MBC integration may be valuable. As insurers increasingly reimburse for measurement-based care through codes like CPT 96127, this feature can actually become a revenue generator for your practice.
The best platform depends on your practice’s specific needs, priorities, and philosophy of care.
Choose TheraNest if:
Explore TheraNest’s flexible options with their 21-day free trial!
Choose TherapyNotes if:
Explore TherapyNotes with their 30-day free trial!
Choose CarePaths if:
Transform your practice with automated Measurement-Based Care. Start your 30-day free trial of CarePaths today, no credit card required.
All three platforms can successfully manage a behavioral health practice.
TheraNest offers flexibility, TherapyNotes provides reliability with strong support, and CarePaths offers an automated Measurement-Based Care system, sustainable practice growth through supervision support, and the potential to turn quality improvement into a revenue stream.
As demonstrating treatment effectiveness becomes important for both clinical practice and reimbursement, platforms that simplify outcome tracking while supporting practice growth provide valuable benefits for behavioral health practices.
