How to Write BIRP Notes: Template, Examples & Tips

What is a BIRP Note?

BIRP notes are an effective means of clinical documentation that has been helping behavioral health experts and mental health professionals note down their clients’ histories in an effective manner. BIRP notes are a means of taking away all the added ‘mental stress’ from a professional and helping them keep a perfectly curated record of their clients’ clinical background and medical history. With BIRP notes, a mental health professional can ensure that they are on the same page with their clients when making decisions related to their progress or further management.

1. Behavior

This section is meant to note any perceived changes in the client’s behavior during the session, their physical appearance, emotional status, and any particular statement or words used by the client, focusing on complaints.

Tips for Writing:

• Instead of focusing on objective observations, it is better to focus on subjective interpretations.
• Include specific examples of what the client reported or the behavior they displayed during the session.
• Behavior changes compared to previous sessions can also be provided. For instance, ‘during the current session, the client was quiet compared to previous sessions and would spend most of the time looking at his phone.’

2. Intervention

This section includes the methods or approaches the therapist employs to meet or respond to the client’s needs or issues. It is important to mention any particular interventions, such as cognitive restructuring, relaxation techniques, or stress management methods in this section. This not only leaves a great impression on your client, but also showcases how aware and learned you are when it comes to dealing with clients of your speciality.

Tips for Writing:

• Maintain the context to explain the intervention and why it is being used.
• Connect your intervention to the client’s identified problems or objectives. This helps connect the dots and reach toward possible interventions or diagnostic tools for the treatment.
• Document the therapy offered with creativity. For example, ‘encouraged the client to use art to draw what their current mood looked like. They created a drawing that “felt exactly how they were feeling”, as per their words.’

3. Response

The Response section captures the client's reactions to the interventions used during the session. It focuses on whether the interventions were effective and whether the client’s response indicated progress, regression, or no change. Open‑ended observations, such as the client’s level of engagement, emotional shifts, or behavioral patterns, are documented here, offering valuable insights into their progress and the effectiveness of the therapeutic approach.

Tips for Writing:

• Describe the client’s verbal or non-verbal communication accurately.
• Avoid using ambiguous statements such as ‘client responded well’ without quantification. Statements like these not only create confusion, but may also hinder your future interventional plans.
• Adding details about behavioral changes can strengthen this section, for example, ‘At first, the client rolled their eyes at the mindfulness exercise. However, after the session, she said, “You know, maybe I could take this home when I get all worked up.”’

4. Plan

The Plan section describes the future treatment course or the further sequence of actions in the treatment process. It covers follow‑up actions and homework assignments, and helps answer the question ‘What is next?’ for both the client and you as their therapist.

Tips for Writing:

• Make sure that the plan is practical and addresses the identified needs of the client.
• Stipulate specific objectives for recording the treatment outcomes.

BIRP Notes Template

How to Write a BIRP Note: Mental Health Therapy Example

Writing BIRP notes involves breaking the session into four key sections: Behavior, Intervention, Response, and Plan. Below is an example from mental health therapy to illustrate each component in detail:

Behavior (B):

Document the client’s demeanor, actions, and emotional state during the session. Focus on noting specific symptoms, observable behaviors, and key statements made by the client. Capture any relevant verbal cues that reflect their current mental or emotional condition. Ensure accuracy in describing their behavior to provide a clear snapshot of their progress or concerns.

• Example: The client appeared anxious, fidgeting with their hands and maintaining minimal eye contact. They stated, ‘I can’t stop overthinking about work and feeling overwhelmed.’

Intervention (I):

Specify the methods, strategies, and action plans implemented to address the client’s issues. Focus on the specific techniques employed, such as therapeutic exercises, discussions, or other interventions aimed at addressing the client’s concerns.

• Example: The therapist guided the client through a 10-minute breathing exercise to reduce anxiety. Cognitive Behavioral Therapy (CBT) techniques were introduced to challenge irrational thoughts about work performance.

Response (R):

Observe and record the client’s immediate reaction to the intervention. Capture verbal, emotional, and physical cues that reflect their response. Identify any changes in their mood, behavior, or attitude as they engage with the intervention.

• Example: The client reported feeling calmer after the breathing exercise, stating, ‘I feel a bit more relaxed now.’ They were open to exploring CBT techniques and began identifying specific thought distortions.

Plan (P):

Outline the next steps for the client, including any homework, goals, or action items for follow‑up. Set clear objectives for the upcoming sessions and specify any areas of focus for continued treatment, ensuring a structured path forward for both the client and the therapist.

• Example: The client will practice the breathing exercise twice daily and write down three recurring negative thoughts to discuss at the next session. The next appointment is scheduled for next Wednesday.

This structure helps therapists create clear, comprehensive, and easy‑to‑understand BIRP notes that include all relevant information needed for future reference while adhering to documentation guidelines.

How to Write BIRP Notes Faster

Here are some tips to streamline the process of crafting detailed and well‑structured BIRP notes more quickly and efficiently:

Benefits of BIRP Notes

Several convincing reasons make mental health professionals opt for BIRP notes as an important means of documentation for their clients. Some key benefits include:

• Streamlined Format for Efficiency: BIRP notes provide a structured, step-by-step format, enabling mental healthcare professionals to document key details quickly and effectively without unnecessary complexity.

• Simplifies Billing and Documentation: BIRP notes provide a structured format that aligns with insurance and billing requirements, streamlining reimbursements and reducing administrative burdens.

• Enhances Session-to-Session Progress Tracking: By promoting consistent and electronic documentation, BIRP notes make it easier to monitor client progress, identify trends, and evaluate improvements or setbacks across sessions.

• Focus on Client-Therapist Relationship: The simplified documentation process frees up therapists to focus more on their clients, fostering trust, building confidence, and enhancing the therapeutic relationship.

• Emphasizes Client Response to Interventions: BIRP notes emphasize tracking client reactions to therapeutic strategies, helping professionals refine their approaches and align treatment with client needs more effectively.

• Applicable Across Diverse Healthcare Settings: BIRP notes are adaptable for use in diverse environments such as mental health clinics, hospitals, addiction treatment centers, and private practices, ensuring broad applicability.

• Ease of Use for Various Professionals: With a simple and universally understood structure, BIRP notes are easy to use for professionals at all experience levels, including those new to the field, eliminating barriers to effective documentation.

Common Mistakes When Writing BIRP Notes

Writing BIRP notes requires attention to detail and adherence to structure, but common mistakes can undermine their effectiveness. Below are key pitfalls to avoid:

1. Overloading with Subjective Information

Conversing with people overloads subjective information to the extent that one is hopelessly consumed with it. Adding too many of the writer’s opinions or emotions defeats the purpose of writing notes because it can quickly make them choppy and harder to reference.

2. Misalignment Between Plan and Interventions

Ensure the ‘Plan’ section is in harmony with the interventions you applied during the session. If CBT was the primary technique, it should include related approaches, such as journal writing or thought tracking. Plans and interventions have the potential to interfere with treatment direction because of the various, and often rather contradictory directions.

3. Omitting Critical Client Responses

The omission of how the client reacted to the carried‑out intervention makes the notes less informative. Always give verbal, emotional, or behavioral feedback to assess milestones and feed forward in another session.

Best Practices for Writing BIRP Notes

To create effective and professional BIRP notes, it’s essential to follow best practices that ensure accuracy, clarity, and adherence to ethical guidelines. Below are key principles to keep in mind:

Advanced Techniques for Effective BIRP Notes

To elevate the quality and precision of your BIRP notes, consider employing advanced techniques that enhance clinical relevance and ensure consistency with therapeutic standards:

Using Evidence-Based Interventions

Ensure that the BIRP notes accurately reflect evidence‑based interventions that align with formal standards for treating specific conditions. For instance, incorporate approaches like Cognitive Behavioral Therapy (CBT), mindfulness, and exposure therapy, and clearly outline how these methods were applied during the session. This practice not only strengthens the clinical validity of the notes but also ensures their reliability and relevance to treatment goals.

Documenting Progress Over Long-Term Therapy

Emphasize client relationship building by mentioning past meetings. For instance, compare the present response or behavior with the past one to demonstrate the improvement or the stagnation that may have occurred.

Incorporating Feedback Into BIRP Notes

Integrate clients’ satisfaction feedback as a way of promoting the therapeutic process. For example, take notes of their worries or of their satisfaction if the client stated that something useful was done for him/her in the “Response” and “Plan” fields. Such information helps plan further sessions and work on improving a therapeutic alliance between the client and the therapist.

BIRP vs Other Note Formats

When it comes to clinical documentation, different note formats are used for various purposes. Below is a concise comparison of BIRP, SOAP, and DAP notes to help you understand their key differences and applications in mental health therapy:

BIRP Notes with Twofold

Twofold Health streamlines the process of writing BIRP notes for therapists, offering specialized templates designed to save time and enhance accuracy. With its pre‑built BIRP format, therapists can efficiently document sessions by focusing on the key sections—Behavior, Intervention, Response, and Plan—without worrying about missing critical details. Twofold’s customizable note templates allow clinicians to modify existing structures or create entirely new ones, catering to unique therapeutic styles and client needs. By leveraging AI‑driven automation, therapists can quickly populate notes, ensure compliance with documentation standards, and maintain focus on client care. This innovative approach simplifies the documentation process while ensuring high‑quality, professional BIRP notes tailored for mental health practice.

Conclusion

BIRP notes are valuable since they are structured, efficient, and accurate and provide a comprehensive way of documenting the client’s progress, treatment plan, and interventions. These notes are easy to use, making therapy sessions more productive, simplifying billing procedures, and improving progress monitoring compared to traditional note‑taking methods. Specifically, BIRP notes help therapists build a stronger client‑therapist relationship by focusing on the clients’ responses to therapeutic interventions, enhancing the quality of care.