How to Write a BIRP Note: A clear and clinically meaningful approach

BIRP notes have steadily gained popularity as a structured, yet flexible format for psychotherapy documentation (preferred by many mental health providers, including myself). The acronym — Behavior, Intervention, Response, Plan — guides clinicians to capture the key elements of a session in a way that supports clinical thinking, treatment continuity, and professional accountability.

Unlike more rigid documentation systems, BIRP notes allow clinicians to reflect on both the content and process of the session while maintaining compliance with agency and insurance standards. In this post I offer a practical breakdown of how to write each section, complete with reflective prompts and sample statements, along with some tips on where to incorporate medical necessity – a crucial consideration in today’s clinical landscape.

B — Behavior

The Behavior section captures what the client presented during the session — emotionally, cognitively, and behaviorally. It includes both what the client reported and what you observed through tone, affect, posture, eye contact, speech, and other non-verbal cues. You might also include information from assessments or third-party sources when relevant. The goal is to paint a clinically relevant picture of how the client is functioning today.

Clinician Prompt:

💡 What did the client bring into the session, and what did I observe that reflects their emotional, cognitive, and functional state?

Example Statements:

• The client arrived on time, appearing somewhat disheveled and fatigued. They reported experiencing increased irritability, describing recent outbursts at home and feelings of guilt afterward. Affect was constricted; speech was soft but coherent.
• Reported “feeling like I’m walking through fog most of the time,” and described difficulty concentrating at work. Although the client stated they were “fine,” they appeared distracted and tearful at multiple points during the session.
• Oriented to person, place, and time. Mental status consistent with moderate depressive symptoms. Endorsed ongoing insomnia, low appetite, and social withdrawal. No suicidal ideation reported, but persistent hopelessness noted.

I — Intervention

This section outlines what you did during the session. That includes therapeutic techniques used, major themes explored, and any assessments or clinical tools administered. Whether you’re working from a particular theoretical model or integrating techniques from multiple approaches, the focus is on how you responded to the client’s presentation in a clinically grounded way.

Clinician Prompt:

💡 What therapeutic strategies or interventions did I use in response to the client’s presentation? What themes were central to the work today?

Example Statements:

• Guided the client through a review of recent interpersonal conflict using cognitive-behavioral techniques, identifying distorted thinking patterns and introducing strategies for cognitive reframing.
• Provided psychoeducation on trauma responses, normalized dissociative experiences, and initiated a grounding technique (5-4-3-2-1) to reduce in-session distress.
• Explored themes of identity and role loss related to recent job transition. Used a strengths-based narrative approach to help the client reconnect with previous coping resources and values.

R — Response

This is where you describe the client’s reaction to the session. It includes their immediate verbal and emotional responses, as well as any noticeable shifts in engagement, affect, insight, or resistance. You may also document progress toward goals, emerging themes, or areas where difficulties persist. This section helps illustrate the dynamic nature of the therapeutic relationship and the unfolding clinical process.

Clinician Prompt:

💡 How did the client respond to today’s session — emotionally, behaviorally, or in terms of insight and therapeutic progress?

Example Statements:

• The client was receptive to the cognitive reframing exercise and expressed surprise at how often negative self-talk shows up in daily life. They committed to practicing thought tracking over the coming week.
• Appeared overwhelmed when exploring grief-related content; became tearful but remained engaged. Noted that this was the first time they had shared these memories out loud.
• Expressed frustration with the pace of therapy, stating, “I feel like I should be further along by now.” Clinician validated the feeling and explored possible unrealistic expectations the client holds for their healing process.

P — Plan

The final section outlines next steps in the therapeutic process, including clinical goals, treatment focus, scheduling, and any assigned homework. This is also the section where you explicitly address medical necessity — articulating why ongoing treatment is appropriate given the client’s diagnosis, symptoms, or level of impairment. When done clearly, this protects both the clinician and client by justifying the clinical need for continued care.

Clinician Prompt:

💡 What are the next steps in treatment, and how do they support this client’s progress based on their current clinical needs? What is the medical necessity of the treatment at this point?

Example Statements:

• Treatment remains medically necessary due to the client’s persistent depressive symptoms, which continue to interfere with daily functioning and occupational performance. Focus will remain on behavioral activation and emotional regulation strategies.
• The client will complete a values clarification worksheet before next session to support work around meaning and motivation. Next appointment scheduled for Thursday, July 4th at 2:00 PM.
• Will continue weekly sessions to support trauma processing via EMDR. Current symptoms of re-experiencing, hypervigilance, and emotional numbing remain severe and clinically significant.
• Psychotherapy is indicated to reduce the intensity and frequency of trauma-related symptoms that impair the client’s ability to maintain safety, regulate affect, and engage in daily tasks.
• The client exhibits ongoing difficulty managing mood, maintaining employment, and sustaining relationships, necessitating continued weekly sessions focused on evidence-based treatment strategies.
• Due to the chronic nature of the client’s mental health condition and risk of decompensation without support, ongoing psychotherapy is essential to maintain current gains and promote further recovery.

A Reliable Format That Respects the Clinical Process

The BIRP format offers a thoughtful, organized approach to documenting therapy sessions while respecting the complexity of clinical work. It doesn’t reduce the session to a formula — rather, it helps clinicians express the process of therapy with clarity, depth, and precision. Whether you’re working in private practice, a hospital, or a training setting, BIRP notes can be adapted to suit your style and meet professional standards.

The level of detail, tone, and content may vary depending on your clinical setting, licensing requirements, or documentation policies. When in doubt, refer to your regulatory body’s guidelines and any applicable organizational policies. If you’re billing to insurance or working with third-party payers, ensure that your BIRP notes clearly demonstrate medical necessity and document treatment progression.

At Note Designer, we offer a thoughtfully structured BIRP note template designed specifically for mental health providers. It includes customizable sections, built-in drop-downs, and a rich library of professionally written content to help you document efficiently and thoroughly—including clear, editable statements that support medical necessity. Whether your approach is CBT, psychodynamic, trauma-focused, or integrative, Note Designer has you covered (we support over 20 different treatment approaches), and you can tailor the template to fit your clinical style and workflow with ease. In addition to our standard BIRP note for individual therapy, our platform also offers content variations to support different modalities and client populations. Note Designer also includes an optional AI-Rewrite feature that can help polish your note once it’s drafted. Whether you want to refine the phrasing, improve flow, or ensure a more professional tone, the AI-Rewrite offers gentle editing support—always keeping your clinical voice intact. It’s there when you need it, and completely optional.

Note Designer also offers an AI-Auto Note option: simply enter a few key statements or select from our built-in content drop-downs, and the AI will generate a complete progress note based on your specifications—whether SOAP, BIRP, DAP, SIRP, GIRP, or other formats. You can customize note style, pronouns, and level of elaboration to match your clinical voice and workflow.

By Patricia C. Baldwin, Ph.D.

Clinical Psychologist

Co-Founder Note Designer Inc.

Author of

Note Designer: A simple step-by-step guide to writing your psychotherapy progress notes (2^nd Edition – updated and expanded); 2023.

👩🏻‍💻 This blog post is derived from Chapter 5 of Note Designer: A simple step-by-step guide to writing your psychotherapy progress notes (2^nd Edition- updated and expanded); 2023

© 2025 Patricia C. Baldwin. All rights reserved.
This blog post is the intellectual property of Patricia C. Baldwin and may not be reproduced, distributed, or transmitted in any form or by any means without the prior written permission of the author. Brief quotations may be used with appropriate citation and link to the original source.