How to Write BIRP Notes (With Examples)
TEMPLATES
BIRP is popular method of writing progress notes in mental health. In this article we cover everything about writing BIRP notes, along with templates and examples .
We also discuss the latest AI therapy note tools that can write BIRP notes for you and how to use them
Understanding the BIRP Format
Before diving into the specifics of writing BIRP notes, let's break down each component:
B - Behavior: This section describes the client's observable behavior, affect, and self-reported symptoms or concerns.
I - Intervention: Here, you document the therapeutic techniques, strategies, or actions you employed during the session.
R - Response: This part details how the client responded to your interventions, including any changes in behavior, mood, or insight.
P - Plan: The final section outlines the next steps in treatment, including future session plans, homework assignments, or referrals.
Step-by-Step Guide to Writing BIRP Notes
1. Documenting Behavior
Start by describing the client's presentation, including:
Appearance and demeanor
Mood and affect
Reported symptoms or concerns
Any significant changes since the last session
Example: "Client arrived on time, appearing tired with slumped posture. Reported feeling 'overwhelmed' with work stress. Mood described as anxious, with congruent affect observed."
2. Describing Interventions
Detail the therapeutic techniques you used, such as:
Specific counseling approaches (e.g., CBT, DBT, motivational interviewing)
Coping skills taught
Psychoeducation provided
Example: "Utilized cognitive restructuring to challenge negative thought patterns about work performance. Introduced deep breathing technique for anxiety management."
3. Recording Response
Document how the client reacted to your interventions:
Changes in mood or behavior during the session
Insights gained or resistance encountered
Client's feedback on the interventions
Example: "Client demonstrated increased relaxation after practicing deep breathing. Expressed insight into the connection between negative thoughts and anxiety symptoms."
4. Outlining the Plan
Conclude with the next steps, including:
Date and time of the next appointment
Homework assignments or between-session tasks
Referrals or additional resources provided
Any changes to the treatment plan
Example: "Next session scheduled for 5/15/2023 at 2 PM. Client agreed to practice deep breathing daily and complete thought record worksheet. Will continue focus on stress management techniques."
BIRP Note Templates and Examples
BIRP Note Example - Depression
B: Client arrived 10 minutes late, dressed casually but neatly. Reported low mood and difficulty getting out of bed. Described feeling "hopeless" about the future. Affect appeared flat.
I: Conducted mood check using PHQ-9 scale. Utilized motivational interviewing to explore client's values and goals. Introduced activity scheduling as a behavioral activation technique.
R: Client engaged well in the motivational interviewing process, identifying career success as a core value. Showed interest in activity scheduling but expressed doubt about its effectiveness.
P: Next session scheduled for 5/22/2023 at 3 PM. Client to complete daily activity log and attempt one pleasurable activity per day. Will review progress and adjust approach as needed.
BIRP Note Example - Anxiety
B: Client arrived on time, visibly tense with rapid speech. Reported increased worry about health and frequent panic attacks. Sleep disturbances noted, averaging 5 hours per night.
I: Provided psychoeducation on the cognitive-behavioral model of anxiety. Taught progressive muscle relaxation technique. Challenged catastrophic thinking about health concerns.
R: Client actively participated in relaxation exercise, reporting decreased muscle tension afterward. Demonstrated understanding of CBT model but struggled to apply it to own thoughts in-session.
P: Next appointment set for 5/18/2023 at 11 AM. Client to practice progressive muscle relaxation daily and log anxious thoughts. Will continue working on cognitive restructuring skills.
Automating BIRP Notes with AI
Can you actually automate the writing of BIRP Notes? Yes. Thousands of therapists today save hours of note-time each day by using AI therapy note tools that automatically write insurance-ready notes, like Supanote. They can directly listen in to the session in a secure way and write the note. Here's a comparison of the top AI Therapy Note tools.
BIRP vs. SOAP Notes
While both BIRP and SOAP (Subjective, Objective, Assessment, Plan) notes are structured documentation formats, they have key differences:
Focus: BIRP notes emphasize observable behaviors and specific interventions, while SOAP notes provide a broader medical perspective.
Structure: SOAP notes include an Assessment section for diagnoses and clinical impressions, which is not explicitly present in BIRP notes.
Application: BIRP notes are often preferred in mental health settings, while SOAP notes are more common in medical and interdisciplinary contexts.
Choose BIRP notes when you want to highlight the therapeutic process and client's behavioral changes. Opt for SOAP notes in medical settings or when a more comprehensive health assessment is needed.
BIRP vs. DAP Notes
DAP (Data, Assessment, Plan) notes are another documentation format used in mental health. Here's how they compare to BIRP notes:
Components: DAP notes combine the Behavior and Response sections of BIRP into a single "Data" section.
Assessment: DAP notes include a distinct Assessment section, similar to SOAP notes, which is not present in BIRP notes.
Intervention focus: BIRP notes explicitly document interventions, while DAP notes may include interventions within the Data or Plan sections.
Choose BIRP notes when you want to emphasize the relationship between interventions and client responses. Use DAP notes when you need to include more detailed clinical assessments or interpretations.
Best Practices for Writing BIRP Notes
Be concise and specific: Use clear, direct language to describe behaviors and interventions.
Use objective language: Focus on observable facts rather than personal opinions or judgments.
Maintain confidentiality: Avoid including unnecessary identifying information.
Be timely: Complete notes as soon as possible after the session to ensure accuracy.
Focus on relevant information: Include details that are clinically significant and support the treatment plan.
Use professional terminology: Employ appropriate clinical language while avoiding jargon.
Proofread: Review your notes for clarity, completeness, and accuracy before finalizing.
FAQs
How long should a BIRP note be?
BIRP notes should be concise yet comprehensive. Aim for 1-2 paragraphs per section, focusing on the most relevant information.
Can BIRP notes be used for group therapy sessions?
Yes, BIRP notes can be adapted for group sessions. Focus on overall group dynamics in the Behavior section and individual responses in the Response section.
How often should I write BIRP notes?
Ideally, write BIRP notes after each client session to ensure accurate and timely documentation.
Are BIRP notes suitable for all types of mental health treatments?
While BIRP notes are versatile, they are particularly well-suited for behavioral and cognitive-behavioral approaches. Other note formats may be more appropriate for certain modalities or settings.
How can I ensure my BIRP notes are HIPAA compliant?
Use secure, HIPAA-compliant electronic health record systems, avoid including unnecessary identifying information, and follow your organization's privacy policies.
What's the best way to document client quotes in BIRP notes?
Use quotation marks for direct client quotes, ensuring they're brief and relevant. For example: Client stated, "I've been feeling much less anxious this week."
How do I handle sensitive information in BIRP notes?
Include only clinically relevant sensitive information. Use professional, objective language and consider the potential impact if the client were to read the notes.
Can I use abbreviations in BIRP notes?
Use widely accepted clinical abbreviations sparingly. Ensure that any abbreviations used are standardized within your organization and would be easily understood by other professionals who might review the notes.
How detailed should the Plan section be in BIRP notes?
The Plan should be specific enough to guide future treatment but concise. Include concrete action items, homework assignments, and the focus for the next session.
What if I forget to write a BIRP note immediately after a session?
Write the note as soon as possible, clearly indicating the date of the session and the date the note was written. Rely on any session notes or memory aids you may have used during the session to ensure accuracy.
How do I document a client's lack of progress in BIRP notes?
Objectively describe observed behaviors or reported symptoms that indicate lack of progress. In the Response section, note any resistance or challenges. Use the Plan section to outline adjustments to the treatment approach.
Can BIRP notes be used in court or legal proceedings?
Yes, BIRP notes can be subpoenaed for legal proceedings. This underscores the importance of maintaining professional, objective, and accurate documentation at all times.
How do I transition from another note-taking format to BIRP notes?
Start by creating a template or checklist for each BIRP section. Practice with a few past sessions to get comfortable with the format. Gradually implement BIRP notes in your practice, seeking feedback from supervisors or colleagues if needed.
Conclusion
Mastering the art of writing BIRP notes takes practice, but it's an invaluable skill for mental health professionals. By following the structure and best practices outlined in this guide, you can create clear, concise, and effective clinical documentation. Remember that the ultimate goal of BIRP notes is to support quality client care and facilitate communication among healthcare providers. As you gain experience, you'll develop your own style within the BIRP framework, allowing you to document efficiently while maintaining the highest standards of clinical care.
References
National Association of Social Workers. (2020). "Documentation in Social Work: BIRP Notes." https://www.socialworkers.org/Practice/Practice-Standards-Guidelines
Journal of Clinical Psychology. (2019). "Comparative Analysis of SOAP and BIRP Note Formats in Clinical Documentation." https://onlinelibrary.wiley.com/journal/10974679
Substance Abuse and Mental Health Services Administration. (2022). "Treatment Improvement Protocol (TIP) Series: Documentation and BIRP Notes." https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-01-004.pdf