Topic · AI notes for TheraNest
AI therapy notes for TheraNest — drafted on your Mac, pasted into the chart, even if your EHR offers its own cloud scribe
TheraNest is the EHR that grew up with group practices. It also now ships its own cloud AI scribe — the AI Session Assistant — as a $35-per-provider add-on. That makes the question for TheraNest clinicians a different one than it is for SimplePractice or TherapyNotes users: it's not "where is the AI?" but "do I want my session audio to leave the building, given there's an in-product way to make it leave?" TherapyDraft is the answer when the answer is no.
TL;DR
TheraNest (now branded under Ensora Health, but still the same product clinicians know) is one of the largest EHRs serving the solo-to-mid-size mental-health market and the strongest of the three major US therapy EHRs at group-practice tooling. As of 2026 it offers an in-product cloud AI scribe — the AI Session Assistant — at $35 per provider per month on top of an Essentials/Advanced/Premier seat ($29/$59/$89 per month per therapist). The AI Session Assistant is telehealth-focused and routes session audio through TheraNest's cloud and its AI subprocessors. TherapyDraft is the alternative path: each clinician records and drafts on their own Mac, the audio never opens a network socket, and the finished note pastes cleanly into TheraNest's progress-note forms — including the custom shapes built in TheraNest's Dynamic Form Builder. For group practices that want session audio to stay decentralized across their clinicians' own machines instead of pooled in an EHR vendor's cloud, this is the architecturally honest path.
The state of AI in TheraNest as of 2026
TheraNest is now the rare EHR in the therapy market that has shipped its own AI scribe rather than punting to integrations. The AI Session Assistant generates structured SOAP-style drafts from telehealth sessions, scopes its assistance to telehealth-recorded encounters, and ships with explicit "client data is not used to train AI models" language in the product copy. It's a real feature and it's a competent one for clinicians whose practice is fully telehealth and whose comfort with cloud subprocessors is intact.
What it does not change is the underlying architecture. The AI Session Assistant captures audio in the TheraNest browser/app, ships it through TheraNest's cloud, runs inference at TheraNest's AI subprocessor of choice, and stores the resulting transcript and note artifacts in TheraNest's tenant of that subprocessor's storage. That's three vendors in the data path before the note lands in the chart: TheraNest, the audio-handling subprocessor, and the LLM-inference subprocessor. Each is covered by TheraNest's BAA — and each is also a new line in your subprocessor inventory and a new breach surface. None of that is wrong, but none of it is invisible to clinicians who chose their EHR with subprocessor minimalism in mind.
It also doesn't help clinicians whose practice is mixed or fully in-person. AI Session Assistant is designed for telehealth — sessions held inside TheraNest's video product, not sessions held in your office where the audio is captured by an external recorder. For a private practice that does both, the in-product AI scribe covers half the caseload at best.
The TherapyDraft → TheraNest workflow
- Record or import audio. Use the Mac's built-in microphone, a USB lavalier, or an exported audio file from any session-recording app. Telehealth or in-person — TherapyDraft doesn't care which, because it doesn't depend on the audio coming through a particular video product. The file is stored in TherapyDraft's local Application Support directory and is deleted when you delete it.
- Draft locally. Click "Draft," choose SOAP, DAP, BIRP, or GIRP, and wait 2–5 minutes while whisper.cpp transcribes and Qwen 2.5 14B drafts on your Mac. The macOS network-sandbox entitlement on the recording, transcription, and inference paths is set to deny by design — there is no socket for audio or text to leave through.
- Choose the TheraNest export preset. The export menu has a "TheraNest-paste" option that emits the note as labeled paragraphs aligned to TheraNest's standard SOAP/DAP/BIRP/GIRP form layouts. If your practice has built a custom form in the Dynamic Form Builder — and many TheraNest practices have — switch to "Custom-form-aware paste," which lets you point TherapyDraft at the field labels you actually use so the output matches them.
- Paste into the progress note. Open the appointment in TheraNest, open its progress-note form, paste section-by-section into the matching fields. Standard SOAP/DAP/BIRP/GIRP forms take roughly fifteen seconds to fill; a complex custom form with eight to ten labeled fields takes a minute. TheraNest accepts plain-text paragraphs and short labeled headings without mangling them.
- Review, sign, submit. The note is yours to review and sign in TheraNest. The audit trail records you as the author of every field, because every field was edited by you while logged in. TheraNest's billing flow, treatment-plan linkage, and e-prescribing integrations operate on the signed note exactly as if you had typed it.
Typical end-to-end time on a 50-minute session: two to three minutes of local drafting, one to three minutes of clinical review and editing inside TheraNest. That's the same 15–25-minute typing burden displaced as with the AI Session Assistant — without the audio leaving your machine.
Why this is structurally different from the AI Session Assistant
The AI Session Assistant and TherapyDraft solve overlapping problems with very different threat models. Three differences that matter for a TheraNest practice deciding between them:
- Where the audio lives. AI Session Assistant: TheraNest's cloud and its AI subprocessor's cloud. TherapyDraft: the Mac on the clinician's desk. The first arrangement is fine if you trust both vendors to keep their tenants and their employees away from your audio. The second arrangement makes that trust unnecessary, because the audio is never in either vendor's reach.
- What modality it covers. AI Session Assistant is telehealth-first. In-person sessions, hybrid sessions, intake calls held over the phone, and supervisory sessions are not its core use case. TherapyDraft works on any audio file — telehealth recording, in-person recording, phone-call export — because it's a Mac app, not a feature of a telehealth product.
- Where the trust boundary is for groups. In a group practice on TheraNest, the AI Session Assistant pools every clinician's session audio in the practice's TheraNest tenant. That tenant is administered by the practice owner or a designated admin. In some practices that's exactly right. In others — particularly partnerships and supervised-clinician arrangements — clinicians feel sharper about who at the practice can in principle reach their session audio. TherapyDraft makes that question moot: each clinician's audio lives on their own Mac, with no central pool, regardless of practice structure.
The pricing math, for solo and group practices
TheraNest pricing as of early 2026 (per clinician, monthly, tiered for cumulative feature scope): Essentials $29, Advanced $59, Premier $89. The AI Session Assistant is a $35-per-provider monthly add-on available on every tier. TherapyDraft is $39 per clinician per month (or $349 per year, ~$29 effective monthly) for the Solo plan, with no add-ons.
The configurations that matter:
- Solo on Essentials. Essentials + AI Session Assistant = $64/mo per clinician. Essentials + TherapyDraft Solo = $68/mo per clinician (or $58/mo with the annual TherapyDraft plan). The dollar delta is small; the architectural delta is the entire wedge.
- Group on Advanced. Advanced + AI Session Assistant = $94/mo per clinician for a five-seat practice = $470/mo on note assistance alone. Advanced + TherapyDraft Group ($29/seat for 3+) = $88/mo per clinician = $440/mo for the same five-seat practice — and the audio for all five clinicians stays distributed across their own machines.
- Premier on a larger practice. The $35 add-on compounds with seat count more aggressively than the EHR seat itself; ten Premier seats with the AI Session Assistant adds $4,200/year just for note drafting. Ten TherapyDraft Group seats add $3,480/year ($29/seat × 12 × 10) — and again, no central audio pool.
The pricing math is rarely the deciding factor; the threat-model math usually is. But for practices that are genuinely indifferent to architecture, TherapyDraft is at worst a few dollars more than the in-product add-on and at best a few hundred dollars cheaper at scale.
Working with TheraNest's Dynamic Form Builder
One of TheraNest's strongest features is the Dynamic Form Builder, which lets a practice define its own progress-note shape rather than commit to a vendor-defined SOAP/DAP layout. Many established TheraNest practices have done exactly this — a custom intake form, a custom progress note with eight labeled fields, a custom risk-assessment form. The downside is that an in-product AI scribe optimized for vendor-default SOAP doesn't necessarily map cleanly to those custom fields.
TherapyDraft's "Custom-form-aware paste" handles this case directly. The first time you use it for a TheraNest custom form, you copy the field labels — for example: "Presenting Concern / Mental Status / Risk / Interventions / Client Response / Plan / Homework / Next Session" — into TherapyDraft's preset. From then on, TherapyDraft drafts the note as labeled paragraphs aligned to those exact labels, in that order. Pasting into the corresponding TheraNest fields is one paste per field, no re-parsing. The same preset works for the practice's whole team — share the preset configuration as a small JSON file alongside the practice's clinical-templates documentation.
This is the kind of work that's structurally easier on a local-first tool. A cloud AI scribe has to centrally know about every customer's custom form schema or punt to a generic format. A local tool just reads a config file from your own Application Support directory.
What to paste for each note type in TheraNest
TheraNest's standard progress-note layouts and TherapyDraft's matching exports:
- SOAP — four labeled paragraphs (Subjective, Objective, Assessment, Plan). Paste into the four matching fields of TheraNest's standard SOAP form.
- DAP — three labeled paragraphs (Data, Assessment, Plan). For TheraNest's standard DAP form, the Data paragraph pastes whole; Assessment and Plan are short.
- BIRP — Behavior, Intervention, Response, Plan. Common for insurance-billing-heavy caseloads on TheraNest's group plans, well-aligned to TheraNest's intervention-tracking fields.
- GIRP — Goals, Intervention, Response, Plan. Pairs naturally with treatment-plan goals if your practice links progress notes to treatment-plan objectives in TheraNest.
- Custom Dynamic Form Builder layout — labeled paragraphs in your practice's defined order, configured once in TherapyDraft's preset and reused per clinician across the practice.
All five output modes are in every TherapyDraft plan, including the free trial.
For clinicians on other EHRs
The same workflow applies to SimplePractice, TherapyNotes, Jane, Valant, and anything else with a rich-text or plain-text progress-note editor. Each EHR has its own export preset; paste fidelity is tested quarterly against each editor's web interface so an editor update doesn't quietly mangle the formatting.
Related questions
Can I use TherapyDraft alongside TheraNest's AI Session Assistant?
Yes — they don't conflict. The AI Session Assistant is enabled per provider as a TheraNest add-on; TherapyDraft is a Mac app. Some practices keep both for a transitional period: AI Session Assistant for telehealth sessions where the audio's already in TheraNest's cloud anyway, TherapyDraft for in-person and phone sessions where there's no reason to upload audio to a vendor that wouldn't otherwise have it. Most practices that fully adopt the local-first approach end up dropping the add-on after a few weeks; the modality coverage of TherapyDraft is sufficient and the per-provider $35 isn't worth carrying.
How does this work for a group practice with shared documentation standards?
TherapyDraft's per-clinician licensing means every clinician installs and runs the app on their own Mac. The practice's documentation standards travel as a shared TherapyDraft preset (JSON config) — same field order, same custom labels, same SOAP-vs-BIRP convention — that every clinician imports once. Audio doesn't pool because there's no central server to pool into; this is the architectural property the page is about, and it's load-bearing for practices that explicitly chose decentralization. For per-seat pricing, the Group plan is $29/seat for 3+ seats — see the pricing page.
Will TheraNest's audit log show the AI as a contributor?
No. TheraNest records you as the author of each field you edit. The AI did not author the note in any chart-of-record sense — it produced a draft you reviewed, edited, and signed. That's the correct legal posture, the same one TheraNest's own AI Session Assistant takes (the assistant produces a draft; the clinician signs).
Does this work with TheraNest's billing and claim flow?
Yes, transparently. Once the note is signed in TheraNest, the billing-and-claim flow operates on the signed note exactly as it would on a typed note. TherapyDraft does not write directly to claims, does not auto-code, and does not touch the CPT/ICD-10 code pickers in TheraNest. Coding is a clinical-judgment decision that belongs in TheraNest's billing surface where you can see TheraNest's own validation rules.
What happens to the audio file after the note is drafted?
The audio file lives in TherapyDraft's local Application Support directory until you delete it. There's a per-session "Delete after sign-off" toggle that, when enabled, removes the audio file the moment you mark the corresponding note as signed in TheraNest (you confirm in TherapyDraft, the file is shredded). For practices with a written records-retention policy, the toggle's behavior is configurable to match — see the subpoena-and-discovery primer for the records-retention discussion.