Honest Comparison
TherapyDesk vs SimplePractice
(2026)
TL;DR
SimplePractice is the market leader with ~100,000 users and the deepest feature set in the therapy EHR space. But it's built for insurance-billing group practices, and cash-pay solo therapists are paying for a lot they don't use. TherapyDesk is purpose-built for cash-pay solo practice with modality-aware AI notes included at $59/mo — roughly half what SimplePractice costs once you add their AI and unlock calendar sync.
At-a-Glance Comparison
| TherapyDesk Pro | SP Starter | SP Essential | SP Plus | |
|---|---|---|---|---|
| Monthly price | $59/mo | $49/mo | $69/mo | $99/mo |
| AI clinical notes | Included | +$35/mo add-on | +$35/mo add-on | +$35/mo add-on |
| Total with AI | $59/mo | $84/mo | $104/mo | $134/mo |
| Modality-aware AI | Yes (CBT, IFS, EMDR, DBT, ACT, psychodynamic) | No — generic note formatting | No | No |
| SMS reminders | Included free | $0.04/message (~$77-154/yr) | $0.04/message | $0.04/message |
| Calendar sync | All plans | Not available | Not available | Yes ($99/mo plan only) |
| Insurance billing | No (cash-pay focused) | Yes | Yes | Yes |
| Telehealth | BYOV (Zoom, Doxy.me) | Built-in | Built-in | Built-in |
| Client portal | Yes | Yes | Yes | Yes |
| Superbills | Yes | Yes | Yes | Yes |
| AutoPay | Yes | Yes | Yes | Yes |
| Cash-pay focus | 100% | ~50% features are insurance-related | ~50% | ~50% |
Detailed Comparison
AI Notes Quality
SimplePractice rolled out AI note assistance as a $35/mo add-on. It helps format notes from session content, but it's generic — it doesn't differentiate between a CBT session and an EMDR session. The output is closer to transcription-to-SOAP formatting than clinical intelligence.
TherapyDesk's AI is trained on published clinical treatment manuals for each supported modality. When a CBT therapist uses it, the notes identify cognitive distortions and behavioral activations. When an IFS therapist uses it, the notes use parts language and capture system dynamics. When an EMDR therapist uses it, the notes track desensitization phases and SUD levels. This isn't template selection — the AI thinks in your clinical vocabulary.
Pricing and Hidden Costs
SimplePractice's base price increased 63% (from $29 to $49/mo) in recent years, and therapists have noticed. Their Trustpilot rating sits at 3.5 out of 5 with 1,591 reviews, with pricing complaints being a consistent theme.
Beyond the base price, SimplePractice charges separately for SMS reminders ($0.04 per message, which adds up to $77-154/year for a typical solo practice), locks calendar sync behind the $99/mo Plus plan, and charges $35/mo for AI notes. A solo therapist who wants AI notes and calendar sync is looking at $134/mo.
TherapyDesk Pro is $59/mo with AI notes, SMS reminders, and calendar sync all included. No add-ons, no per-message fees, no feature gating behind higher tiers.
Cash-Pay Focus
SimplePractice was built for the broad therapy market, which means insurance billing, ERA processing, claims management, and credentialing features take up significant UI real estate and development attention. If you don't bill insurance, roughly half the platform is irrelevant to you.
TherapyDesk is built exclusively for cash-pay solo therapists. Every feature in the platform is one you'll actually use. Superbills are there for clients who want to file for out-of-network reimbursement. Good Faith Estimates are built in for No Surprises Act compliance. There's no insurance billing module cluttering your workflow.
Modality Understanding
SimplePractice's AI doesn't distinguish between therapeutic modalities. Whether you practice CBT, EMDR, or IFS, you get the same generic note structure.
TherapyDesk supports CBT, DBT, IFS, EMDR, ACT, and psychodynamic frameworks at launch, with more modalities planned based on user demand. The difference shows up in the output: notes that use the correct clinical vocabulary for your specific approach, not a one-size-fits-all template.
What's Included
SimplePractice includes built-in telehealth, which is a genuine advantage — you don't need a separate Zoom or Doxy.me account. They also have the largest marketplace of therapist-facing integrations and a well-established client portal.
TherapyDesk takes a BYOV (Bring Your Own Video) approach to telehealth — you use your existing Zoom or Doxy.me setup. In exchange, you get AI notes, SMS reminders, and calendar sync included with no add-on fees, at a lower total price.
Who SimplePractice Is Best For
Be honest: SimplePractice is still the right choice for some therapists.
- •Therapists who bill insurance. SimplePractice's insurance billing infrastructure is mature and comprehensive. TherapyDesk doesn't do insurance billing at all.
- •Group practices. SimplePractice handles multi-clinician scheduling, permissions, and billing. TherapyDesk is built for solo practitioners.
- •Therapists who want built-in telehealth. If you don't already have a video platform and want everything in one browser tab, SimplePractice's integrated telehealth is convenient.
- •Therapists who need a large integration ecosystem. SimplePractice connects with more third-party tools than any other therapy EHR.
Who TherapyDesk Is Best For
- •Cash-pay solo therapists who don't want to pay for insurance features they'll never use
- •Therapists frustrated by SimplePractice price increases who want a platform with a price stability commitment
- •Therapists using a modality-specific approach (CBT, IFS, EMDR, DBT, ACT, psychodynamic) who want AI notes that actually understand their framework
- •Therapists currently paying for two tools (EHR + standalone AI notes) who want to consolidate into one platform at a lower total price
- •Therapists who value transparent pricing with no per-message SMS fees, no feature gating, no surprise add-on costs
Migration
Switching EHRs feels daunting, but it doesn't have to be. TherapyDesk offers migration support to help you bring over client records, notes, and scheduling data from SimplePractice. Your clients won't notice a gap in service.
See what modality-aware AI notes look like for your practice.
Try TherapyDesk free — no credit card required to explore. When you're ready, Pro is $59/mo with everything included.