Therapy asks us to listen beyond the surface of what is said. We are also holding shifts in affect, recurring patterns, risk, relational dynamics, therapeutic interventions and the direction the work may be taking. Documentation should support that attention—not divide it during the session or follow us into the evening.

Twofold and AirNote both aim to reduce this burden, and this is a closer comparison than many AI-scribe matchups.

Twofold is not merely a general medical scribe with a few mental health templates added. Its current product supports DAP, BIRP, GIRP and other therapy formats, private psychotherapy notes, treatment plans, client summaries, homework and longitudinal progress tracking. It is a credible, well-developed option for therapists.  

AirNote takes an even more focused approach. It is designed around the complete workflow of an individual therapist: recording and transcribing sessions locally on a Mac, creating separate Clinical and Process Notes, preserving prior context, preparing for future sessions, developing psychological formulations and producing carefully bounded client or professional documents.

For most solo therapists who work from a Mac, AirNote is the more compelling overall choice. It costs considerably less, keeps raw audio on the therapist’s device during transcription and connects documentation, reflection and preparation in one therapy-specific workflow.

Key takeaways

• AirNote costs $19.99 per month. Twofold costs $69 per monthly, after its current introductory offer.

• AirNote costs $588.12 less per year than paying for Twofold's monthly plan.

• Twofold has genuine mental health depth, including therapy-specific note formats, treatment plans, outcome tracking and support for separate private psychotherapy notes.

• AirNote makes the distinction between a formal Clinical Note and a reflective Process Note central to every session workflow. Process Notes can then contribute to Prior Context, preparation and multi-session formulations.

• Twofold securely processes session audio and says recordings are immediately deleted. AirNote transcribes the audio locally, so raw recordings do not have to be uploaded for transcription at all.  

• Twofold’s continuity tools emphasise goals, outcome measures, payer documentation and measurable progress. AirNote’s continuity tools are more formulation-led, helping therapists preserve themes, shifts, relational patterns and the wider thread of the work.

• Twofold is likely to suit group practices, cross-device users and clinicians who need coding or structured outcome reporting. AirNote is likely to suit individual therapists seeking a private, focused and affordable practice assistant.

Twofold vs AirNote at a glance

What is Twofold?

Twofold is an AI clinical scribe with a particularly strong mental health offering.

It can capture an in-person or telehealth session, accept dictated summaries or uploaded material and turn that information into a structured clinical note. Its behavioural health templates include DAP, SOAP, BIRP, GIRP, PIRP, intake assessments, treatment plans and formats for couples, family and group therapy.  

Twofold also allows clinicians to customise section order, terminology, tone and level of detail. Its style-learning functionality is intended to adapt to the clinician’s edits over time, including different preferences for different kinds of notes.  

Its wider feature set includes:

• Treatment-plan generation.

• Client letters and summaries.

• Homework suggestions.

• Risk and safety-plan documentation.

• ICD-10 and CPT suggestions.

• Progress and outcome tracking.

• Reports and payer-oriented documentation.

• EHR-friendly copy and paste.

• Mobile, browser and desktop access.

Twofold is therefore considerably more than a transcript-to-note tool. It is developing into a broader clinical documentation platform for individual clinicians and group practices.

It also serves far more than psychotherapy. Its current site addresses primary care, paediatrics, psychiatry, physical therapy, nutrition, nursing, speech therapy, dentistry and other clinical disciplines.  

That breadth is useful when one clinician works across different types of care or when a practice wants one tool for several professional roles. It also means that Twofold must balance the needs of therapists with coding, audit, medical-necessity and general healthcare workflows.

What is AirNote?

AirNote is a local-first macOS documentation and practice assistant designed specifically for therapists.

After recording and locally transcribing a session, AirNote can prepare two distinct drafts:

• A concise Clinical Note for the formal client record.

• A fuller Process Note for the therapist’s own reflection, continuity, formulation and planning.

AirNote links sessions to clients and can use previous Process Notes to create Prior Context: a compact therapist-facing summary of recurring themes, goals, changes, formulation ideas and relevant continuity points.

That context can support later notes, pre-session preparation and psychological formulations. It is not treated as a substitute for reviewing the underlying clinical record, and it does not independently create new clinical facts.

AirNote also includes:

• Ask AirNote for session-specific questions and reflection.

• Client summaries and homework.

• GP referrals.

• Provider progress letters.

• Work or school absence documents.

• Custom client and professional documents.

• Draft psychological formulations.

• Local search and practice analytics.

• Calendar-assisted upcoming-session workflows.

• Client data-access packs and exports.

AirNote is not designed to replace an EHR. It works alongside the therapist’s existing practice-management or record system, allowing reviewed material to be copied or exported as needed.

Pricing: AirNote is substantially less expensive

Twofold currently advertises a seven-day free trial and a $19 first-month promotion.

After that introductory period, its ongoing Personal plan costs $69 per month when billed monthly, equivalent to $828 per year.  

AirNote costs $19.99 per month, equivalent to $239.88 over twelve months.

This means AirNote saves:

• $348.12 each year compared with Twofold’s annual rate.

• $588.12 each year compared with Twofold’s monthly rate.

Put another way, AirNote is approximately 71% less expensive than Twofold.

Twofold includes meaningful capabilities for that higher price. Coding suggestions, broad device access, style learning, payer-focused progress tracking and group-practice tools may be valuable in the right setting.

For many solo therapists, however, the central needs are more specific:

• Finish notes promptly.

• Preserve useful clinical reflection.

• Remember the thread of the work.

• Prepare for the next session.

• Develop formulations.

• Create occasional client or professional documents.

• Keep highly sensitive audio exposure to a minimum.

AirNote provides those functions at a price that is easier to absorb alongside supervision, insurance, professional memberships, scheduling, video platforms, accounting, room costs and continuing education.

Which product is better for therapy-specific notes?

Twofold is genuinely strong here.

Its website describes formats for major behavioural health documentation styles, including DAP, BIRP, GIRP, PIRP, intake, treatment plans and group or family work. It also recognises interventions, client responses, affect, mental status and risk-related material.  

Importantly, Twofold now supports a richer private psychotherapy note alongside a briefer progress note. Its site explicitly describes keeping reflective psychotherapy material separate from payer-facing documentation when the therapist’s setting permits it.  

This corrects an important limitation in the older comparison: AirNote is not the only product that recognises the difference between formal documentation and private reflection.

The distinction is nevertheless more deeply embedded in AirNote.

AirNote’s Clinical Note and Process Note are first-class, linked parts of the standard session workflow. The therapist does not simply choose between two templates. Each note has a distinct purpose:

The Clinical Note supports the record.
The Process Note supports the therapist’s thinking.

The Process Note can then contribute to Prior Context and later formulations. This gives the reflective note an ongoing role in the treatment workflow rather than leaving it as a separate document that may or may not be revisited.

For therapists who primarily need a polished DAP, BIRP or SOAP note that follows their preferred phrasing, Twofold is highly capable.

For therapists who want documentation and reflective continuity to work together automatically, AirNote has the more coherent structure.

Templates: Twofold offers breadth; AirNote offers a focused system

Twofold’s template library is extensive.

It includes standard therapy formats, psychotherapy notes, intake assessments, treatment plans, safety plans, modality-specific documentation and templates for many non-mental-health specialties. Twofold also allows extensive customisation and learns aspects of the clinician’s preferred writing style.  

This is one of Twofold’s strongest areas.

AirNote’s library is smaller and more deliberately curated. Its templates are designed with therapists around common, valuable therapeutic use cases. The focus is not simply on selecting DAP rather than SOAP. It is on how the note fits into a larger process involving:

• Formal record-keeping.

• Therapist reflection.

• Prior Context.

• Formulation.

• Preparation for the next session.

• Client-facing or provider-facing communication.

Therapists can still modify templates or create their own. The advantage is that the starting point is already therapy-specific, with less need to navigate a library designed for many unrelated clinical disciplines.

The fairest distinction is this:

Twofold offers more format breadth and personalisation. AirNote offers a more integrated therapy-documentation architecture.

Clinical Notes and Process Notes

A progress note and a reflective note solve different problems.

The formal record should usually be factual, concise and proportionate. It may need to document presenting concerns, risk, interventions, client response, progress and a plan without including every tentative impression or relational observation.

The therapist’s working reflection may need more space for:

• Emerging formulation.

• Emotional tone.

• Relational patterns.

• Avoidance or protective processes.

• Therapeutic stance.

• Countertransference considerations.

• Rupture and repair.

• Questions to hold in mind.

• Possible directions for future work.

Twofold allows clinicians to generate both private psychotherapy notes and formal progress notes. That is a meaningful strength.  

AirNote’s advantage is what happens next.

Its Process Notes can be used to build Prior Context for the client. Rather than simply archiving the reflection, AirNote can distil clinically relevant continuity from previous work and make it available when generating later notes, preparing for sessions or drafting formulations.

This creates a connected workflow:

Session → Clinical Note and Process Note → Prior Context → preparation → next session

The purpose is not to have AI “interpret” the client independently. It is to help the therapist recover themes already present in their reviewed records without rereading every previous note before an appointment.

Which product is better for continuity across therapy?

Both products now offer meaningful longitudinal tools, but they emphasise different kinds of continuity.

Twofold focuses strongly on measurable progress. It can connect treatment goals with progress notes, compare sessions, track interventions and outcomes, carry forward measures and produce documentation suitable for payers or supervisors.  

That may be particularly helpful for practices that regularly use:

• PHQ-9, GAD-7 or other outcome measures.

• SMART treatment goals.

• Utilisation review.

• Insurance authorisation.

• Structured treatment-plan reviews.

• Organisation-wide reporting.

AirNote’s continuity is more qualitative and formulation-led.

Prior Context is intended to preserve recurring themes, changes over time, goals, formulation ideas, risks explicitly present in the record and important points the therapist may want to revisit. AirNote can also prepare a pre-session summary and generate a draft psychological formulation based on multiple reviewed Process Notes.

For example, a therapist may need to remember not only that an outcome score has improved, but that:

• A familiar withdrawal pattern appeared after a moment of closeness.

• The client used a new form of self-advocacy for the first time.

• A previously intellectualised topic carried more emotion.

• A recurring rupture was repaired differently.

• A formulation hypothesis is becoming more or less plausible.

Twofold’s progress tools are strong when the central question is, “What measurable change is occurring?”

AirNote is particularly useful when the question is, “What is developing in the therapy, and what might be important to hold in mind next?”

For many psychotherapists, both questions matter. AirNote places the second one closer to the centre of the product.

Psychological formulations

Formulation is one of the areas where AirNote has a clearer specialist advantage.

AirNote can generate a separate draft psychological formulation from selected Process Notes, relevant Prior Context, session metadata and a chosen formulation template. The result remains tentative, source-limited and fully editable by the therapist.

This is different from placing a short case-conceptualisation paragraph inside a progress note.

A dedicated formulation can help the therapist organise:

• Predisposing influences.

• Precipitating events.

• Maintaining processes.

• Protective factors and strengths.

• Relational or attachment patterns.

• Core beliefs and assumptions.

• Behavioural cycles.

• Systemic context.

• Possible therapeutic priorities.

Twofold can capture formulations within psychotherapy notes and assessments, and it supports treatment plans that connect goals, objectives and interventions. Its current public materials place more emphasis on treatment-plan structure, outcome tracking, medical necessity and measurable progress.  

For therapists whose work is guided substantially by evolving case formulation, AirNote offers a more explicit and reusable formulation workflow.

AI support beyond the note

Twofold has a broad collection of supporting tools.

It can generate treatment plans, letters, client summaries and homework, assist with risk and safety documentation, provide coding suggestions and create reports. Its homework functionality can connect suggested tasks with goals and interventions, subject to therapist review.  

AirNote provides many comparable therapy-practice outputs:

• Client summaries.

• Client homework.

• GP referrals.

• Provider progress letters.

• Work or school absence documents.

• Custom documents.

• Psychological formulations.

It also provides Ask AirNote, which allows the therapist to ask questions grounded in the selected session and relevant client context.

A therapist might use Ask AirNote to:

• Retrieve what was agreed for the next session.

• Identify themes present in the transcript.

• Review interventions and client responses.

• Develop possible homework.

• Consider questions for the next appointment.

• Begin structuring a formulation.

• Draft a carefully bounded client summary.

These responses remain drafts. They do not replace supervision, assessment or professional judgement.

The practical appeal is that AirNote’s broader AI functions are not separate additions around a generic note writer. They are connected to the same client, sessions, Process Notes and Prior Context.

Privacy: secure deletion versus local transcription

Both products have serious privacy protections, but their architectures are different.

Twofold states that it is HIPAA compliant, signs a Business Associate Agreement, uses US-based Azure and Google Cloud infrastructure, encrypts data in transit and at rest and does not use clinical data to train AI models. Its site says recordings are processed to create the transcript and note, then immediately deleted without being written to server disk. Its SOC 2 Type II certification is currently described as in progress.  

That is a strong security position for a cloud clinical scribe.

AirNote’s approach is local-first.

Raw session audio is transcribed on the therapist’s Mac using an on-device model. It is not sent to AirNote, OpenAI, AWS, Google or another provider for transcription. The recording is deleted following successful transcription under AirNote’s retention workflow.

Clinical records are stored locally by default.

When the therapist chooses to generate a note, document, Prior Context, formulation or Ask AirNote response, the relevant text is securely sent for AI processing. The raw audio is not included. Optional Cloud Sync can synchronise clinical records, but raw recordings remain excluded.

The practical distinction is:

• Twofold processes the audio securely and immediately deletes it.

• AirNote transcribes the audio on the therapist’s own Mac, avoiding that upload for transcription altogether.

This matters because a therapy recording is unusually sensitive. It contains not only factual information, but the client’s voice, hesitations, emotion, names, relational context and disclosures that may never appear in the final clinical note.

Some therapists will be comfortable with Twofold’s secure processing and immediate-deletion model.

Others will prefer AirNote’s more restrictive principle: where raw audio can remain on the clinician’s device, it should.

Local-first records versus cloud convenience

Twofold stores clinical notes and progress information within encrypted US cloud infrastructure. That supports browser access, mobile workflows and synchronised use across devices.  

AirNote keeps the primary clinical record on the therapist’s Mac. AirNote staff do not have default access to records that remain only on the device. Cloud Sync is optional rather than the starting point.

Neither model is universally right.

Cloud access may be important for clinicians who move between several devices or practice locations. A local-first design may feel more proportionate for a solo therapist who works from one secured Mac and wants to reduce the number of systems retaining clinical records.

The relevant question is not simply whether data is encrypted. It is also:

Where does the full record need to exist for this particular practice to function well?

For many solo Mac-based therapists, AirNote’s answer is reassuringly simple.

Which product is more likely to save time?

There is no independent head-to-head study showing that one product universally produces a faster or more accurate note.

Both are likely to save considerable time compared with writing every note from scratch.

Twofold may be particularly efficient for therapists who want:

• Strong DAP, BIRP or payer-ready formats.

• Automatic style adaptation.

• Treatment-plan and goal tracking.

• Outcome measures.

• Coding suggestions.

• Documentation from a phone or browser.

• Shared templates across a group.

AirNote aims to reduce work across a broader reflective cycle:

• Transcribing the session.

• Drafting the formal Clinical Note.

• Drafting the therapist-facing Process Note.

• Preserving client context.

• Preparing for the next session.

• Developing formulations.

• Creating homework or client summaries.

• Drafting referrals and progress letters.

• Retrieving information through Ask AirNote.

For therapists, the documentation burden is not limited to writing a progress note. It also includes reconstructing the previous session, recalling agreements, preparing resources, producing letters and rebuilding the clinical thread after a busy week.

AirNote is designed to shorten that whole sequence.

Which product is more likely to support quality of care?

No AI scribe can guarantee better therapy. Quality of care depends on the therapist’s competence, ethical practice, judgement, supervision and relationship with the client.

A well-designed tool can nevertheless support the conditions in which thoughtful care is more likely.

When we are not preoccupied with writing everything down, we can attend more fully to the client. When notes are completed promptly, they may be more accurate. When previous themes are easier to retrieve, clinically meaningful continuity is less likely to be lost.

Twofold supports this through structured progress tracking, treatment-plan linkage and consistent documentation.

AirNote supports it through a combination of presence, reflection and preparation:

• Local transcription reduces the need to take extensive notes during the conversation.

• Process Notes preserve material that may be clinically useful but unsuitable for the formal record.

• Prior Context helps retain the thread of the work.

• Formulations help organise understanding across time.

• Session preparation brings reviewed context back into view before the client returns.

The AI remains an assistant. The therapist remains responsible for what is recorded, what is inferred and what happens next.

Who should choose Twofold?

Twofold may be the better fit when:

• You need browser and mobile access across several devices.

• You work in a group practice requiring shared templates and administration.

• DAP, BIRP, GIRP and payer-oriented formats are your main priority.

• You rely heavily on structured goals and outcome measures.

• CPT or ICD coding support is valuable.

• You want the system to learn your preferred wording from edits.

• You work across mental health and other clinical disciplines.

Twofold is a strong therapy scribe. Its mental health functionality deserves to be taken seriously, and its progress-tracking and customisation tools are genuine strengths.

Who should choose AirNote?

AirNote is likely to be the stronger fit when:

• Your work is primarily psychotherapy, counselling or psychological treatment.

• You practise independently and work mainly from a Mac.

• You want the formal record and reflective note kept distinct.

• You want Process Notes to support later context and formulation.

• You regularly prepare formulations, homework, summaries, referrals or professional letters.

• You want session-grounded AI questions and preparation support.

• You prefer raw session audio to remain on your device during transcription.

• You want clinical records to remain local by default.

• You want the full therapy-specific workflow for $19.99 per month.

AirNote’s case is not simply that it costs less.

Its notes, context, formulations, documents and preparation tools are arranged around the way a therapeutic relationship develops over time.

Final verdict

Twofold and AirNote are both credible AI therapy scribes.

Twofold has evolved into a sophisticated mental health documentation platform. It supports therapy-specific formats, private psychotherapy notes, treatment plans, client communication, outcome tracking, style learning and group-practice workflows. Therapists who need broad device support, strong payer documentation or structured progress analytics may find it well worth its price.

AirNote is the more focused and economical product for individual therapists.

It makes Clinical and Process Notes part of the core session workflow. It uses reflective material to support Prior Context, preparation and dedicated psychological formulations. Its raw audio is transcribed locally. Its primary records remain on the therapist’s Mac by default.

The price difference is also substantial. At $19.99 per month, AirNote costs $348.12 less each year than Twofold’s annual plan and $588.12 less than Twofold’s monthly plan.

For a group practice needing mobile access, shared templates and outcome reporting, Twofold may be the better operational fit.

For a solo therapist who wants to remain present during sessions, protect sensitive audio, preserve the deeper thread of the work and spend less time and money on documentation, AirNote is the more compelling choice in 2026.

Frequently asked questions

Is Twofold designed for therapists?

Yes. Twofold has a substantial behavioural health product with DAP, SOAP, BIRP, GIRP, PIRP, intake, treatment-plan, couples, family and group formats. It also serves many non-mental-health specialties.  

How much does Twofold cost?

Twofold advertises a seven-day trial and a current $19 introductory first month. Its ongoing Personal price is $49 per month when billed annually or $69 per month when billed monthly.  

How much does AirNote cost?

AirNote costs $19.99 per month after a seven-day trial. Its plan includes the core therapy note, client-context, document, formulation and Ask AirNote workflows.

Can Twofold create separate psychotherapy and progress notes?

Yes. Twofold says clinicians can prepare a richer private psychotherapy note and a separate, briefer progress note, depending on their setting and policies.  

What is different about AirNote’s Process Note?

AirNote’s Process Note is a standard part of its session workflow alongside the Clinical Note. Previous Process Notes can contribute to Prior Context and later formulation or preparation workflows, giving the reflective note an ongoing role across therapy.

Does Twofold track progress across sessions?

Yes. Twofold connects goals, interventions and session outcomes, offers session-to-session comparisons and supports structured outcome reporting.  

Does Twofold store therapy-session recordings?

Twofold says session recordings are not stored on its servers. Audio is processed to create the transcript and note and is then immediately deleted.  

Does AirNote upload session audio for transcription?

No. AirNote transcribes raw session audio locally on the therapist’s Mac. Relevant text is securely processed only when the therapist triggers an AI generation feature.

Which product is better for psychological formulations?

AirNote has the clearer dedicated formulation workflow. It can produce a separate draft formulation from reviewed Process Notes, Prior Context and a selected formulation structure. Twofold supports formulation material within psychotherapy notes and assessments, but publicly emphasises treatment plans, measurable goals and progress tracking.

Which product is better for larger practices?

Twofold has the stronger group-practice offering, including shared templates, centralised administration, team onboarding and volume pricing.  

Which product is better for solo therapists?

For therapists who require cross-device access or extensive outcome and payer tools, Twofold may fit well. For Mac-based solo therapists who prioritise local audio transcription, reflective continuity, formulations and lower cost, AirNote offers the stronger overall value.

Pricing and publicly described Twofold features checked on June 22, 2026. Subscription details and promotional offers may change.