BIRP Notes Guide 2026
Master the BIRP format for mental health progress notes. Behavior, Intervention, Response, Plan - the structured approach that captures therapeutic work and client progress effectively.
Includes templates, real clinical examples, common mistakes to avoid, and best practices for efficient documentation.
The Four Components of BIRP Notes
Each section serves a specific purpose in documenting the therapeutic session and tracking client progress.
Behavior
Observable client behaviors, statements, and presentation during the session
Intervention
Clinical techniques and therapeutic interventions used during the session
Response
Client response to interventions and clinical impressions
Plan
Next steps including homework, referrals, and future session focus
Detailed BIRP Section Guide
What to include, real examples, and practical tips for each section.
Behavior
Observable client behaviors, statements, and presentation during the session
What to Include
- •Client affect and mood presentation
- •Verbal statements and self-reports
- •Observable behaviors during session
- •Body language and nonverbal cues
- •Mental status observations
- •Changes from previous sessions
Examples
“Client presented with constricted affect, avoided eye contact, and reported "I feel like giving up."”
“Client appeared well-groomed, maintained appropriate eye contact, and demonstrated improved mood compared to last session.”
“Client was tearful when discussing relationship conflict, clenched fists, and raised voice when describing spouse.”
Pro Tips
- →Use objective, observable language
- →Include direct client quotes when relevant
- →Note discrepancies between verbal and nonverbal
- →Avoid interpretations - save those for Response
Intervention
Clinical techniques and therapeutic interventions used during the session
What to Include
- •Therapeutic techniques applied
- •Evidence-based interventions used
- •Psychoeducation provided
- •Skills taught or practiced
- •Homework assigned
- •Crisis interventions if applicable
Examples
“Utilized CBT cognitive restructuring to challenge automatic negative thoughts. Practiced thought records with client.”
“Administered PHQ-9 (score: 14). Provided psychoeducation on depression symptoms and treatment options.”
“Implemented grounding technique (5-4-3-2-1) for anxiety management. Role-played assertive communication skills.”
Pro Tips
- →Name specific evidence-based techniques
- →Include any assessments administered with scores
- →Document homework/between-session assignments
- →Note treatment modality (CBT, DBT, MI, etc.)
Response
Client response to interventions and clinical impressions
What to Include
- •Client engagement with interventions
- •Receptiveness to techniques
- •Progress toward treatment goals
- •Clinical impressions and interpretations
- •Barriers to progress
- •Therapeutic alliance assessment
Examples
“Client engaged well with cognitive restructuring and was able to identify 3 cognitive distortions independently. Progress toward goal of reducing negative self-talk.”
“Client was resistant to grounding technique initially but demonstrated mastery by end of session. Reported feeling "more in control."”
“Limited progress this session due to crisis stabilization needs. Client unable to engage with planned skill-building interventions.”
Pro Tips
- →Connect response to treatment goals
- →Include your clinical impressions
- →Note any resistance or barriers
- →Document prognosis indicators
Plan
Next steps including homework, referrals, and future session focus
What to Include
- •Next session date and focus
- •Homework assignments
- •Referrals made or pending
- •Treatment plan modifications
- •Safety planning if indicated
- •Coordination with other providers
Examples
“Continue weekly sessions. Next session: practice assertive communication role-plays. Homework: complete daily thought records.”
“Refer to psychiatry for medication evaluation (PHQ-9 = 18). Safety plan reviewed. Next session in 3 days for crisis follow-up.”
“Transition to biweekly sessions as client demonstrates sustained improvement. Focus on relapse prevention and termination planning.”
Pro Tips
- →Be specific about homework assignments
- →Include timeframes when possible
- →Document any referrals with rationale
- →Note changes to treatment frequency
Complete BIRP Note Examples
Real clinical examples across different diagnoses and therapeutic modalities.
Depression - CBT Session
Diagnosis: Major Depressive Disorder, Recurrent, Moderate (F33.1)
Behavior
Client arrived 10 minutes early, casually dressed but well-groomed (improvement from previous sessions). Reported mood as "a little better, maybe 5 out of 10." Made intermittent eye contact. Discussed completing one thought record this week but "didn't feel like doing more." Stated, "I actually went to the grocery store for the first time in three weeks."
Intervention
Reviewed completed thought record and identified cognitive distortion (fortune-telling). Utilized Socratic questioning to examine evidence for/against automatic thought. Practiced cognitive restructuring with new thought. Introduced behavioral activation planning. PHQ-9 administered: 12 (down from 16 at intake).
Response
Client actively engaged with cognitive restructuring exercise and independently identified the distortion pattern. Expressed skepticism about behavioral activation but agreed to try. PHQ-9 reduction indicates meaningful symptom improvement. Client demonstrates growing insight into connection between thoughts and mood.
Plan
Continue weekly CBT sessions. Next session: expand behavioral activation schedule, practice additional cognitive restructuring. Homework: complete 3 thought records, engage in one pleasurable activity from list. Follow up on PHQ-9 progress at session 12. Consider transition to biweekly after 12 sessions if progress continues.
Generalized Anxiety Disorder - ACT Session
Diagnosis: Generalized Anxiety Disorder (F41.1)
Behavior
Client presented with elevated anxiety, fidgeting with hands throughout session. Reported GAD-7 score of 15 (moderate-severe). Stated, "I can't stop worrying about everything - work, health, my kids. I didn't sleep last night." Voice tremulous. Engaged readily with session activities.
Intervention
Introduced cognitive defusion technique "I'm having the thought that..." to create distance from anxious thoughts. Practiced leaves on a stream mindfulness exercise (5 minutes). Psychoeducation on acceptance vs. avoidance paradox. Values clarification exercise focusing on what matters beyond anxiety reduction.
Response
Client found defusion technique "weird but helpful" and reported slight anxiety reduction during mindfulness exercise. Expressed insight that avoidance maintains anxiety. Identified "being present for my kids" as core value. GAD-7 baseline established for progress monitoring.
Plan
Continue weekly ACT sessions. Focus next session on committed action aligned with values despite anxiety. Homework: practice defusion technique 2x daily, complete values worksheet. Consider adding mindfulness app (Headspace or Calm) for daily practice. Reassess GAD-7 at session 8.
Trauma - EMDR Processing Session
Diagnosis: Post-Traumatic Stress Disorder (F43.10)
Behavior
Client engaged in EMDR processing of index trauma (motor vehicle accident, 2 years ago). Initial SUDs: 8/10. Reported intrusive images of impact and sounds of breaking glass. Demonstrated physical tension in shoulders and rapid breathing at session start. Stated readiness to continue processing.
Intervention
Conducted EMDR bilateral stimulation (horizontal eye movements, 24 sets) targeting trauma memory. Installed positive cognition "I survived and I'm safe now." Utilized grounding between sets as needed. Body scan completed. Containment exercise (safe place visualization) for session closure.
Response
SUDs decreased from 8 to 3 during processing. Client reported memory felt "further away" and physical tension released. Positive cognition VOC increased from 2 to 6. Some residual distress related to secondary memory (hospital stay) emerged - marked for next session. Tolerated processing well with no dissociation.
Plan
Continue EMDR processing next session targeting hospital-related memory. Homework: use safe place visualization daily and PRN for distress. Journal any new trauma-related material that emerges. PCL-5 at session 15 to assess overall PTSD symptom reduction. Maintain weekly frequency during active processing phase.
Substance Use Disorder - Motivational Interviewing
Diagnosis: Alcohol Use Disorder, Moderate (F10.20)
Behavior
Client attended session appearing tired but sober. Reports 5 days without alcohol use (longest period in 6 months). Stated, "I want to quit but I don't know if I can do it." Discussed social pressure from drinking buddies. Ambivalent presentation - acknowledged problems caused by drinking but minimized frequency.
Intervention
Utilized motivational interviewing techniques: reflective listening, developing discrepancy between values (being a good father) and current behavior. Explored decisional balance (pros/cons of change). Elicited change talk through importance and confidence rulers. Provided affirmation for 5 sober days.
Response
Client's change talk increased throughout session. Identified parenting as primary motivation for change. Confidence ruler: 4/10, Importance ruler: 8/10. Recognized high importance but low self-efficacy. Expressed willingness to attend one AA meeting "just to see." Ambivalence remains but movement toward preparation stage observed.
Plan
Continue weekly MI sessions. Build self-efficacy through identifying past successes with behavior change. Homework: attend one AA meeting before next session (agreed to Wednesday night meeting). Develop list of alternative activities to replace drinking occasions. Consider referral to outpatient SUD program if client progresses to action stage.
Child/Adolescent - ADHD + Anxiety Session
Diagnosis: ADHD, Combined Type (F90.2); Generalized Anxiety Disorder (F41.1)
Behavior
Client (14-year-old male) attended with mother. Restless during session, difficulty remaining seated, interrupted multiple times. Reported SCARED-C score of 28 (elevated anxiety). Stated, "School is stressing me out - I can't focus and I'm falling behind." Mother confirmed declining grades and increased irritability at home.
Intervention
Psychoeducation on ADHD-anxiety overlap for client and mother. Introduced study skills organization system (color-coded folders, planner use). Practiced deep breathing technique adapted for adolescents (4-7-8 breathing). Collaborated with mother on homework structure. Coordinated with school counselor (consent signed).
Response
Client engaged well with breathing exercise, reported "actually feeling calmer." Receptive to organizational strategies but skeptical about follow-through. Mother committed to providing structured homework time. Strong therapeutic alliance with client. Parental involvement supportive of treatment goals.
Plan
Continue weekly sessions alternating individual and parent-included sessions. Next session: individual, focus on anxiety management skills for school. Homework: practice breathing daily, try planner for one week. Send letter to school for 504 accommodation consideration. Follow-up SCARED in 4 sessions. Consider consultation with prescriber regarding ADHD medication optimization.
BIRP vs. Other Note Formats
Understanding when to use BIRP compared to SOAP, DAP, GIRP, and other documentation formats.
| Format | Stands For | Best For | Strengths | Common Users |
|---|---|---|---|---|
| BIRP | Behavior, Intervention, Response, Plan | Mental health, behavioral health, counseling | Captures client response to interventions, documents therapeutic progress | Therapists, counselors, psychologists, social workers |
| SOAP | Subjective, Objective, Assessment, Plan | Medical, primary care, multi-disciplinary | Universal format, widely understood across disciplines | Physicians, nurses, NPs, PAs, mental health |
| DAP | Data, Assessment, Plan | Brief therapy, solution-focused, streamlined documentation | Efficient, combines subjective/objective into "Data" | Mental health professionals, brief therapy clinicians |
| GIRP | Goal, Intervention, Response, Plan | Goal-oriented therapy, outcome-focused treatment | Keeps treatment goals front and center | Therapists, rehabilitation professionals |
| PIRP | Problem, Intervention, Response, Plan | Problem-focused treatment, crisis work | Clearly links interventions to presenting problems | Social workers, crisis counselors |
Common BIRP Note Mistakes to Avoid
Learn from these frequent documentation errors and how to correct them.
Mistake #1: Confusing Behavior and Response sections
Problem: Putting client reactions to interventions in the Behavior section instead of Response
Solution: Behavior = what client presented WITH at session start. Response = how client REACTED TO your interventions.
B: Client practiced deep breathing and reported feeling calmer.
I: Practiced diaphragmatic breathing exercise. R: Client reported feeling calmer after exercise, demonstrated proper technique.
Mistake #2: Vague intervention documentation
Problem: Writing "processed feelings" or "provided supportive therapy" without specifics
Solution: Name the specific technique or modality used. Include what you actually did.
I: Processed trauma with client. Provided support.
I: Utilized prolonged exposure therapy - conducted 15-minute imaginal exposure to trauma memory. Practiced in-vivo exposure homework planning.
Mistake #3: Opinion in Behavior section
Problem: Including clinical interpretations or judgments in the Behavior section
Solution: Keep Behavior purely observational. Save interpretations for Response.
B: Client was clearly depressed and not motivated to change.
B: Client spoke slowly with flat affect, reported sleeping 12+ hours daily, and stated "nothing will help."
Mistake #4: No measurable progress indicators
Problem: Failing to include assessment scores, SUDs ratings, or other metrics
Solution: Include standardized measures, rating scales, or specific behavioral counts when possible.
R: Client seems to be improving.
R: PHQ-9 decreased from 18 to 12 over 4 weeks. Client reports 5 days without panic attacks (previously daily).
Mistake #5: Plan lacks specificity
Problem: Generic plans like "continue treatment" without concrete next steps
Solution: Include specific homework, session focus, referrals, and timeframes.
P: Continue weekly therapy.
P: Continue weekly CBT sessions (next: Thursday 3/15). Focus: exposure hierarchy step 3. HW: daily worry time logs. Reassess GAD-7 at session 10.
BIRP Note Best Practices
Follow these guidelines for efficient, compliant, and clinically useful documentation.
1Timeliness
- Complete notes within 24-48 hours of session
- Set aside dedicated documentation time
- Use templates to maintain consistency
- Consider voice-to-text for efficiency
2Clinical Content
- Link interventions to treatment plan goals
- Include standardized assessment scores
- Document risk assessment when indicated
- Use client quotes for behavioral evidence
3Legal/Ethical
- Write as if the client will read the note
- Avoid unnecessary personal opinions
- Document informed consent discussions
- Include safety planning when risk is identified
4Efficiency
- Use standardized phrase templates
- Pre-populate recurring information
- Consider AI documentation assistants
- Review and sign immediately after writing
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Frequently Asked Questions
Common questions about BIRP notes answered.
What does BIRP stand for?
BIRP stands for Behavior, Intervention, Response, and Plan. It is a structured documentation format commonly used in mental health and behavioral health settings to record psychotherapy progress notes. Each letter represents a section of the note that captures different aspects of the therapeutic session.
When should I use BIRP notes vs. SOAP notes?
BIRP notes are ideal for mental health settings where documenting specific therapeutic interventions and client responses is important. SOAP notes are more universal and commonly used in medical settings. Choose BIRP if you need to emphasize the intervention-response relationship in therapy; choose SOAP if you work in integrated care or need interdisciplinary communication.
What goes in the Behavior section of a BIRP note?
The Behavior section should include objective observations of the client at the beginning of the session: their appearance, affect, mood statements, presenting concerns, and any observable behaviors. Include direct quotes when relevant. This section should be factual and avoid clinical interpretations.
How detailed should the Intervention section be?
The Intervention section should be specific enough that another clinician could understand exactly what therapeutic techniques you used. Name the modality (CBT, DBT, MI), specific technique (cognitive restructuring, exposure), any assessments administered with scores, and homework assigned. Avoid vague phrases like "processed feelings."
What's the difference between Behavior and Response in BIRP notes?
Behavior captures how the client presented AT THE START of the session - their initial state, concerns, and presentation. Response documents how the client REACTED TO your interventions during the session - their engagement, progress, receptiveness, and any changes observed as a result of the therapeutic work.
How long should a BIRP note be?
A comprehensive BIRP note for a 45-60 minute therapy session typically ranges from 200-400 words. The goal is to be thorough enough for clinical and legal purposes while being efficient. Quality matters more than length - focus on clinically relevant information, treatment progress, and specific details rather than padding.
Can AI help write BIRP notes?
Yes, AI documentation tools like PatientNotes can significantly reduce BIRP note writing time. These tools can listen to sessions (with consent) and generate draft notes in BIRP format, which you then review and sign. This can save 10-15 minutes per session while maintaining clinical quality. The clinician always reviews and approves the final note.
What should I include in the Plan section?
The Plan section should include: next session date and planned focus, specific homework assignments, any referrals made or pending, changes to treatment frequency or approach, safety planning if indicated, and coordination with other providers. Be specific - "continue therapy" is not sufficient.
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