Understanding BIRP Notes
BIRP is a structured documentation format specifically designed for mental health and therapy sessions
B - Behavior
Observable client behaviors, mood, and presentation
Examples:
- • Client appeared anxious, fidgeting with hands throughout session
- • Maintained good eye contact, spoke clearly and coherently
Tips:
- • Focus on observable behaviors only
- • Avoid interpretations or assumptions
I - Intervention
Therapeutic techniques and interventions used
Examples:
- • Applied cognitive restructuring techniques to address negative thought patterns
- • Utilized mindfulness breathing exercises to manage anxiety symptoms
Tips:
- • Be specific about techniques used
- • Include theoretical framework when relevant
R - Response
Client's reaction to interventions and progress
Examples:
- • Client responded positively to CBT techniques, reporting decreased anxiety
- • Initially resistant to mindfulness exercises but engaged by session end
Tips:
- • Document both verbal and non-verbal responses
- • Include client's own words when relevant
P - Plan
Treatment goals, homework, and next session plans
Examples:
- • Continue CBT for anxiety, assign thought record homework
- • Schedule weekly sessions, increase to bi-weekly if symptoms improve
Tips:
- • Set specific, measurable goals
- • Include homework assignments
BIRP Note Template
Copy and customize this template for your therapy practice
BIRP Progress Note Template
BEHAVIOR:
Appearance: [Physical presentation, grooming, dress]
Mood/Affect: [Observed emotional state]
Behavior: [Observable actions, mannerisms, engagement level]
Speech: [Rate, volume, coherence]
Cognitive: [Thought process, concentration, memory]
INTERVENTION:
Therapeutic Approach: [CBT, DBT, psychodynamic, etc.]
Techniques Used: [Specific interventions employed]
Topics Addressed: [Main themes or issues discussed]
Skills Taught: [Coping strategies, techniques introduced]
Homework Assigned: [Between-session tasks]
RESPONSE:
Engagement: [Level of participation and cooperation]
Understanding: [Comprehension of concepts discussed]
Emotional Response: [Reactions to interventions]
Progress: [Movement toward treatment goals]
Insights: [Client realizations or breakthroughs]
PLAN:
Next Session: [Date and focus for next meeting]
Treatment Goals: [Ongoing objectives]
Homework: [Specific between-session assignments]
Referrals: [Other services or providers needed]
Frequency: [Session schedule going forward]
BIRP Note Examples
Real-world examples from different therapy modalities
Individual Therapy - Anxiety
Behavior:
Client presented with visible signs of anxiety including rapid speech, restlessness, and frequent sighing. Reported sleep difficulties and racing thoughts. Mood appeared anxious and somewhat overwhelmed.
Intervention:
Utilized cognitive behavioral therapy techniques focusing on identifying and challenging catastrophic thinking patterns. Introduced progressive muscle relaxation and taught diaphragmatic breathing exercises. Explored connection between thoughts, feelings, and physical sensations.
Response:
Client engaged well with CBT concepts, able to identify several negative thought patterns. Initially struggled with relaxation techniques but showed improvement by end of session. Expressed relief at having 'tools to use' and appeared more calm when leaving.
Plan:
Continue weekly CBT sessions focusing on anxiety management. Homework: practice breathing exercises twice daily and complete thought record for anxious episodes. Next session will review homework and introduce additional coping strategies.
Couples Therapy - Communication
Behavior:
Both partners present, sitting apart with minimal eye contact. Partner A appeared defensive with crossed arms, Partner B seemed withdrawn and tearful. Tension evident in room from start of session.
Intervention:
Facilitated structured communication exercise using 'I' statements. Implemented active listening techniques with reflection and validation. Addressed defensive communication patterns and introduced time-out strategies for heated discussions.
Response:
Initial resistance from both partners, but gradually engaged in exercises. Partner A showed decreased defensiveness by mid-session. Partner B became more verbal and made eye contact. Both expressed appreciation for 'new way of talking.'
Plan:
Continue weekly couples sessions focusing on communication skills. Homework: practice daily check-ins using techniques learned today. Next session will address conflict resolution strategies and explore underlying relationship dynamics.
Group Therapy - Substance Abuse
Behavior:
Client participated actively in group discussion, sharing personal struggles with sobriety. Appeared motivated and engaged. Other group members were supportive and offered encouragement. No signs of intoxication observed.
Intervention:
Led group discussion on relapse prevention strategies. Facilitated role-playing exercises for high-risk situations. Reviewed 12-step principles and discussed importance of sponsor relationships. Encouraged peer support and accountability.
Response:
Client demonstrated strong commitment to recovery, sharing specific triggers and coping strategies. Accepted feedback from group members positively. Expressed gratitude for group support and committed to attending AA meetings.
Plan:
Continue weekly group participation. Individual session scheduled to address specific relapse triggers. Client to maintain daily contact with sponsor and attend minimum 3 AA meetings per week. Progress review in 2 weeks.
BIRP Note Best Practices
Guidelines for effective mental health documentation
Best Practices
- Use objective, behavioral language in the B section
- Be specific about therapeutic interventions used
- Document client's actual responses and engagement
- Include measurable goals in treatment planning
- Connect interventions to treatment goals
Common Mistakes
- ✗Including interpretations in behavior section
- ✗Vague descriptions of interventions
- ✗Assuming client responses without documentation
- ✗Generic or copy-paste treatment plans
- ✗Failing to connect sessions to overall treatment