BIRP Note Format Guide
BIRP — Behavior, Intervention, Response, Plan — is a structured format built for mental health sessions. Learn what goes in each section, copy the template, and see real examples.
The four parts
Understanding BIRP notes
BIRP is a structured documentation format designed specifically for mental health and therapy sessions. It ties what you did in session directly to how the client responded.
BBehavior
Observable client behaviors, mood and presentation.
Examples
- Client appeared anxious, fidgeting with hands throughout session
- Maintained good eye contact, spoke clearly and coherently
- Exhibited flat affect, minimal spontaneous speech
- Demonstrated improved posture and engagement compared to last session
- Showed signs of agitation when discussing family relationships
Tips
- Focus on observable behaviors only
- Avoid interpretations or assumptions
- Include mood and affect observations
- Note changes from previous sessions
IIntervention
Therapeutic techniques and interventions used.
Examples
- Applied cognitive restructuring techniques to address negative thought patterns
- Utilized mindfulness breathing exercises to manage anxiety symptoms
- Implemented behavioral activation strategies for depression
- Conducted EMDR processing of traumatic memory
- Practiced assertiveness training through role-playing exercises
Tips
- Be specific about techniques used
- Include theoretical framework when relevant
- Document duration of interventions
- Note the client's participation level
RResponse
The 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
- Demonstrated good understanding of coping strategies discussed
- Expressed skepticism about homework assignments but agreed to try
- Showed emotional breakthrough when processing childhood trauma
Tips
- Document both verbal and non-verbal responses
- Include the client's own words when relevant
- Note resistance or engagement levels
- Record any insights or breakthroughs
PPlan
Treatment goals, homework and next-session plans.
Examples
- Continue CBT for anxiety, assign thought record homework
- Continue weekly sessions; reduce to bi-weekly if symptoms improve
- Refer to psychiatrist for medication evaluation
- Practice relaxation techniques daily, review progress next session
- Complete trauma processing, transition to maintenance phase
Tips
- Set specific, measurable goals
- Include homework assignments
- Plan the focus of the next session
- Consider referrals when appropriate
Copy or download
BIRP progress note template
Copy it into your EHR or notes app and adapt it to your practice, or download the PDF to print.
BIRP note template
BIRP PROGRESS NOTE TEMPLATE Client: [Client Name] Date: [Session Date] Session #: [Number] Duration: [Minutes] 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]
Worked examples
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 use
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.
Best practices
Writing BIRP notes that hold up
Guidelines for effective mental health documentation.
Best practices
- Use objective, behavioral language in the B section
- Be specific about the therapeutic interventions used
- Document the client's actual responses and engagement
- Include measurable goals in treatment planning
- Connect interventions to treatment goals
Common mistakes
- Including interpretations in the Behavior section
- Vague descriptions of interventions
- Assuming client responses without documenting them
- Generic or copy-paste treatment plans
- Failing to connect sessions to overall treatment
Your BIRP notes, written for you.
ReasonNotes listens to the session and drafts a complete BIRP note in your format — ready to review about a minute after you finish. HIPAA compliant, with a BAA on every plan.
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