How to Write a PIRP Note: A Practical Guide for Therapists
PIRP Notes (Problem, Intervention, Response, and Progress) offer a concise and structured way to capture the essence of each therapy session. The format helps clinicians readily link session content to prior and developing treatment goals and to demonstrate medical necessity, which is essential for compliance with insurance regulations (and for getting compensated).
The best way to approach any progress note writing is to ask ourselves some simple questions about the session. Below I offer some cue questions and examples to guide your clinical writing using a PIRP note approach and to ensure your notes reflect the therapeutic work and the ongoing need for care. At the end, you’ll also find an example of a completed PIRP note (using a fictitious case of course).
P: Problem
This section summarizes the client’s presenting issue and establishes the ongoing need for treatment (i.e., medical necessity). It should connect directly to the diagnosis, symptoms, or functional impairments that justify therapy.
💡 Clinician Cue Questions:
- What specific problem or symptom was the focus of today’s session?
- How does this problem continue to cause distress or impairment in daily functioning?
- What evidence supports the medical necessity for continued treatment (e.g., severity, risk, symptom frequency)?
- Are there new or ongoing psychosocial stressors impacting the client’s functioning?
Example:
Client reported persistent anxiety and racing thoughts interfering with sleep and concentration at work. Despite use of coping strategies, symptoms continue to cause significant distress, supporting the medical necessity of ongoing therapy.
I: Intervention
Describe the clinical interventions and techniques used to address the identified problem. Use professional terminology and specify the therapeutic rationale.
💡 Clinician Cue Questions:
- What interventions or modalities were used (e.g., CBT, DBT, EMDR, Psychodynamic)?
- How do these interventions target the client’s symptoms or functional goals?
- What skills, reframing, or behavioral strategies were introduced or practiced?
- Was between-session practice or follow-up work assigned?
Example:
Provided psychoeducation on the stress response and guided client through a progressive muscle relaxation exercise. Explored self-critical thought patterns and introduced daily mindfulness tracking as homework.
R: Response
This section captures how the client responded to interventions—emotionally, cognitively, or behaviorally—and provides evidence of engagement or insight.
💡 Clinician Cue Questions:
- How did the client respond to interventions or feedback?
- What affect, tone, or verbal indicators of change were observed?
- Did the client demonstrate new insight or motivation?
- Was there resistance, distress, or avoidance that needs further attention?
Example:
Client appeared calmer following grounding exercise and reported feeling “lighter.” Expressed understanding of connection between self-criticism and anxiety. Actively participated in identifying coping triggers.
P: Progress
Summarize progress since the last session and describe any remaining symptoms or functional impairments that justify continued care. This is another key place to reinforce medical necessity.
💡 Clinician Cue Questions:
- What measurable progress has occurred since the previous session?
- How is the client moving toward treatment goals?
- What symptoms or impairments remain that justify continued treatment?
- What are the next steps in care?
Example:
Client continues to show gradual improvement in emotion regulation, reporting fewer anxiety spikes and improved focus. However, ongoing sleep disturbance and work-related tension indicate continued medical necessity for therapy. Plan to reinforce coping strategies and introduce cognitive restructuring next session.
Documenting Medical Necessity in PIRP Notes:
To meet clinical and insurance documentation standards, ensure that medical necessity is clearly demonstrated throughout your note. This includes:
- Linking symptoms to functional impairment or distress.
- Showing how interventions address those symptoms.
- Documenting the client’s response and measurable progress.
- Indicating the need for continued care in the Progress section.
This not only supports ethical practice but also protects your documentation in case of an audit or insurance review.
How Note Designer Can Help 👩🏻💻
Note Designer makes writing PIRP notes simple and compliant. With built-in clinician prompts, editable templates, and optional AI assistance, you can ensure each note includes clear statements of medical necessity, measurable progress, and a professional tone. Whether you’re writing PIRP, SOAP, or DAP notes, Note Designer helps you stay organized, consistent, and audit-ready – so that you can focus on client care with less anxiety about your documentation.
Example PIRP Note
Client: John Doe. (pseudonym)
Date: October 10, 2025
Session #: 6 of 12 in current treatment plan
Session Type: Individual therapy, in-person
Duration: 50 minutes (Start 2:00 PM / End 2:50 PM)
Diagnosis: F41.1 Generalized Anxiety Disorder
CPT Code: 90834 (Psychotherapy, 45 minutes with patient)
Problem:
Client reported ongoing anxiety related to workload and interpersonal tension with supervisor. Described sleep disruption (averaging 4–5 hours/night) and difficulty concentrating during meetings. Symptoms continue to interfere with occupational functioning and emotional well-being, supporting medical necessity for ongoing treatment to reduce anxiety and improve daily functioning.
Intervention:
Provided CBT-based intervention focusing on identifying automatic thoughts linked to performance pressure. Guided client in replacing self-critical statements with balanced alternatives. Practiced brief breathing and grounding exercise to manage anxiety surges during work hours. Reviewed and adjusted between-session journaling to target situational triggers more effectively.
Response:
Client was engaged and reflective throughout session. Demonstrated insight into the role of self-criticism in maintaining anxiety. Stated, “I realize I’m holding myself to impossible standards.” Practiced breathing exercise in session and reported noticeable decrease in muscle tension. Appeared calmer, with improved affect by session end.
Progress:
Client shows moderate progress toward treatment goals, with reduction in symptom intensity and improved coping. Continues to experience residual worry and physiological anxiety symptoms under stress, indicating ongoing medical necessity for treatment. Plan to reinforce cognitive restructuring and introduce problem-solving skills next session to support generalization of gains.
Clinician Signature:
Virginia Woolf, Ph.D., C.Psych
Session electronically signed on October 31, 2025, 3:05 PM
How to Use This Example
When writing your own PIRP note, use each section to connect the clinical picture, intervention, and progress. Make sure the “Problem” and “Progress” sections explicitly demonstrate why therapy is medically necessary including how the client’s symptoms impair functioning and how continued treatment is expected to help. This not only supports ethical practice but also protects your documentation in case of an audit or insurance review.
Patricia C. Baldwin, Ph.D.
Clinical Psychologist
President
Note Designer Inc.
👩🏻💻 Author of Note Designer: A simple step-by-step guide to writing your psychotherapy progress notes (2nd Edition- updated and expanded); 2023
© 2025 Patricia C. Baldwin. All rights reserved.
For more guidance on how to write different types of progress notes and reports, check out my other blogs listed here:
