Documenting a 45-minute therapy session is where psychiatric EMRs reveal their assumptions about what our work is. A medication visit can live comfortably inside a structured template. A therapy session cannot, or at least not without losing the things that made the note worth writing: the narrative arc, the interventions and how the patient responded to them, the observation that this week's affect was different from last week's in a way that matters. We documented the same scenario in five platforms, a 45-minute CBT session with an adult being treated for major depressive disorder and generalized anxiety, and paid attention to documentation time, note quality, and how each system's structure helped or fought us. Platforms appear in alphabetical order. Each one embodies a different theory of documentation, and your reaction to those theories will tell you more than any feature list.
Session Setup and Template Selection
Starting the documentation process and choosing a note format
| EMR | How It Plays Out |
|---|---|
| Hero EMR | The ambient scribe starts capturing when the encounter begins, and the system infers the visit type from the scheduling context, so there is no template decision to make unless you want structured documentation instead. The absence of setup is the point: the session starts and you attend to the patient. Clinicians who feel uneasy about ambient capture should note that structured templates remain available, and consent conversations with patients about the scribe are worth having regardless. |
| ICANotes | You select the therapy encounter type and the click-based content system loads the relevant behavioral health library. The setup routes you into the platform's structured universe of pre-written content, and everything downstream follows from that choice. It is quick, if slightly utilitarian. |
| Luminello | You choose from the available therapy templates within the encounter. The templates were designed with prescribers in mind, so a therapy-heavy practice will likely have customized them beforehand; once configured to your preferences, selection is a non-event. |
| SimplePractice | Template selection draws from a genuinely large library, DAP, SOAP, BIRP, and community-contributed formats, with your recent choices surfaced first. The form builder means your ideal structure probably exists or can be made. Of the traditional platforms, this is the most pleasant starting point. |
| TherapyNotes | You select the therapy note template from the encounter types, and the behavioral health focus of the platform means the structure is relevant out of the box. Simple, appropriate, unremarkable in the good sense. |
Clinical Content Documentation
Capturing the substance of the session: presenting concerns, interventions, responses
| EMR | How It Plays Out |
|---|---|
| Hero EMR | After the session, the scribe presents a draft that identified the CBT interventions used, cognitive restructuring, behavioral activation planning, homework review, along with the patient's engagement and the relevant observations of affect. The draft preserved narrative flow rather than reducing the session to bullets, and our editing pass typically ran a few minutes rather than the ten or fifteen a from-scratch note takes. Two honest caveats: the draft occasionally included historical material that belonged in a previous note rather than this one, and the prose sometimes states clinical impressions with more confidence than we actually felt. The review pass is not optional. |
| ICANotes | You assemble the note by clicking pre-written phrases from the behavioral health content library, organized by clinical category. It is the fastest non-AI approach here by a wide margin, and the resulting note is compliant and complete. It is also recognizably assembled. Capturing what was specific to this session with this patient means adding free text, and the more free text you add, the more the speed advantage erodes. Whether that trade sits well with you is close to a personality test. |
| Luminello | Documentation happens within the template's structured sections, with free-text areas for narrative. For the prescriber visits Luminello was designed around, this works efficiently; for a full 45-minute therapy narrative, the structure feels like it is holding its breath. Expect to spend a solid ten minutes or more writing, and expect the therapy note to be the place where you feel the platform's prescriber orientation most clearly. |
| SimplePractice | You write. The template sections provide organization, the free-text fields are spacious, autosave protects you, and the interface gets out of the way to a degree that is rarer than it should be. A thorough note for a 45-minute session took us eight to twelve minutes of actual writing. If you believe therapy documentation should be written by the person who was in the room, this is the best version of that experience among the five. |
| TherapyNotes | Structured fields cover therapeutic approach, interventions, patient response, and plan updates, and they accept narrative text within that organizational frame. The structure ensures completeness and imposes a particular shape on the note, which some clinicians find clarifying and others find constraining. Documentation time landed in the ten-to-fifteen-minute range for us, at the higher end when the session did not fit the frame neatly. |
Assessment and Treatment Plan
Documenting the clinical assessment and updating the plan
| EMR | How It Plays Out |
|---|---|
| Hero EMR | The draft assessment pulls from session content, including risk-relevant observations, and the plan section carries the existing treatment plan forward with the session's changes highlighted: homework, medication considerations, next-session focus. Review took a minute or two. The carry-forward is convenient and also worth watching, since inherited plan language from resolved issues occasionally survives into drafts where it no longer belongs. |
| ICANotes | Assessment and plan content comes from the click library, supplemented with free text for individualized planning. The pre-written content reliably covers the compliance-relevant elements, and the individualization is, as everywhere in ICANotes, the part you type yourself. |
| Luminello | Structured fields cover diagnostic impressions and plan components, and prior treatment plan elements carry forward with modifications, which genuinely speeds ongoing documentation. This section plays to the platform's strengths more than the narrative section does. |
| SimplePractice | You write the assessment and plan in the template sections, with as much narrative depth as you care to provide. Prior plans can be referenced but do not automatically pull forward, so updating means having last session's note open in another view. A few minutes of work, entirely manual, entirely yours. |
| TherapyNotes | The designated sections walk you through the essential plan components, and treatment goals from prior sessions are referenceable within the system. The guided structure is helpful for ensuring nothing is missed, particularly for clinicians earlier in practice. |
Finalization and Signing
Reviewing the completed note and signing it
| EMR | How It Plays Out |
|---|---|
| Hero EMR | Review the draft, adjust, sign. Our total post-session documentation time, including a genuinely careful read of the AI draft, ran three to five minutes for the 45-minute session. That number is the platform's strongest argument, and it holds up only if you actually do the careful read; the failure mode of ambient documentation is not bad drafts, it is clinicians who stop reading them. |
| ICANotes | Review the assembled note, add free-text customization where the clicked content reads too generic, and sign. Total time ranged from eight to fifteen minutes depending on how much individualization the session demanded. The floor is low and the ceiling depends on your standards for how personal a note should sound. |
| Luminello | Verify the sections, sign, done. Total documentation time for a comprehensive therapy note ran twelve to eighteen minutes. Adequate for clinical and billing purposes, with the ongoing sense that therapy notes are not what this platform gets up in the morning to do. |
| SimplePractice | Review in the template view, correct, sign electronically. Total time was twelve to eighteen minutes, all of it writing you chose to do, and the finished note reads like a clinician wrote it because one did. The honest cost of the traditional approach, at its best. |
| TherapyNotes | Review the sections, confirm completeness, apply the signature. Fifteen to twenty minutes total in our hands. The structure that guides you during writing also makes review straightforward, since every section is where you expect it to be. |
Conclusion
Three legitimate philosophies emerged from this comparison, and which one fits you is a question about your practice, not about the software. If you believe the clinician should write the note, SimplePractice offers the best writing experience of the five, and it is not particularly close; the platform respects the act of documentation in a way that shows. If raw speed is the constraint and you can live with structured language, ICANotes remains the fastest traditional approach, a position it has held for years for good reason. If you want the documentation burden to mostly disappear and are willing to trade it for a disciplined review habit, Hero's ambient scribe delivered the largest time savings in our testing, cutting post-session work to a few minutes, with the caveats we have described about reading drafts skeptically. Luminello and TherapyNotes both handled the task competently without distinguishing themselves, which for practices that chose them on other grounds is perfectly fine; nobody should switch platforms over therapy notes alone. For psychiatrists whose week includes substantial psychotherapy, our suggestion is to document one real session, with appropriate consent, on any platform you are seriously considering, because the feel of a documentation system across a full session is impossible to fake in a demo and impossible to convey fully in a review.
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