I bill by the hour and spend almost all of my time at a computer. This program is ideal for tracking what I really do. It allows me to see what time I actually spend working versus doing nonsense, so that I can render accurate bills. This program is well worth the price of admission. The annual license fee is low (it's gone up a little bit in the last few years) and I have no qualms about paying it in order to take advantage of periodic updates. Review collected by and hosted on G2.com.
I don't see any downsides. For a detailed view of what you're doing, you can save screenshots automatically and frequently. I do it every 20 seconds, which eats up a lot of disk space, but I delete the screenshots after I render my bills. Review collected by and hosted on G2.com.