BIRP Notes for Mental Health: Template and Examples
BIRP notes make the movement of a therapy session easy to see. They show how the client presented, what the therapist did, how the client responded, and what comes next.
BIRP stands for Behavior, Intervention, Response, and Plan. It is a useful format when you want the actual work of therapy to stand out instead of getting lost inside a long session summary.
The BIRP format at a glance
| Section | Main question |
|---|---|
| Behavior | What did the client report or demonstrate? |
| Intervention | What did the therapist do? |
| Response | How did the client respond? |
| Plan | What happens next? |
The best BIRP notes form a simple chain:
Behavior: Client avoided difficult conversations.
Intervention: Therapist modeled and practiced an assertive opening.
Response: Client completed the role-play and identified where they usually withdraw.
Plan: Client will try the opening in one low-stakes conversation.
B: Behavior
Behavior describes the client’s current presentation and the treatment-relevant concern. Despite the name, this section is not limited to visible behavior. It can include reported symptoms, thoughts, feelings, functional changes, and relevant observations.
Client reported increased irritability and two arguments with their partner this week. Client described shutting down when conflict begins and appeared tense while discussing the most recent argument.
Useful Behavior content includes:
- Current symptoms or concerns
- Observable presentation
- Changes since the previous session
- Effect on daily functioning
- Progress or setbacks related to the treatment goal
- Relevant risk information
Keep it focused. The Behavior section should set up the clinical work that follows.
I: Intervention
Intervention records what you did as the therapist. Name the approach or technique, the action you took, and what it targeted.
Therapist used emotion identification to slow the conflict sequence, then modeled an assertive opening and guided the client through two role-play attempts.
Strong intervention verbs include:
- Assessed
- Clarified
- Challenged
- Practiced
- Modeled
- Taught
- Rehearsed
- Reviewed
- Explored
- Developed
“Provided support” may be accurate, but it is hard to picture. “Used reflective listening to help the client identify grief beneath anger” makes the work clearer.
R: Response
Response shows what the client did with the intervention. This is where many notes become vague.
Instead of:
Client responded well.
Try:
Client completed both role-play attempts, noticed an urge to apologize before stating the concern, and created a shorter opening that felt realistic to use at home.
A response can show:
- Participation or hesitation
- Insight gained
- Skill performance
- Change in distress
- Feedback about usefulness
- Progress toward a goal
- Barriers that emerged
Not every response needs to be positive. “Client had difficulty staying with the exercise and asked to pause” can be clinically important.
P: Plan
Plan captures the next step in treatment.
Continue weekly sessions focused on emotion regulation and assertive communication. Client will use the revised opening during one low-stakes conversation and record what happened. Review the interaction next session.
A useful Plan may include session frequency, next-session focus, practice, referrals, care coordination, measures, or treatment-plan changes.
Copy-and-use BIRP note template
Reusable template
Complete BIRP note example: anxiety and avoidance
The following example is fictional.
Behavior: Client reported avoiding three work emails because they feared receiving criticism. The delay increased anxiety and led to difficulty concentrating on other tasks. Client appeared restless and repeatedly checked their phone during the first part of the session.
Intervention: Therapist used CBT-based guided discovery to examine the prediction that any corrective feedback would lead to dismissal. Therapist helped the client rate the likelihood of several possible outcomes and broke the email task into smaller steps. Practiced opening one non-urgent message in session while using paced breathing.
Response: Client identified catastrophizing and estimated the feared outcome as less likely after reviewing the evidence. Client opened the message, read it fully, and reported anxiety decreasing from 8/10 to 5/10. Client stated that separating “opening” from “replying” made the task feel manageable.
Plan: Client will open the remaining two emails using the same steps and draft responses before the next session. Continue weekly CBT sessions focused on avoidance and tolerance of uncertainty. Review anxiety ratings and outcomes next week.
BIRP note example: depressed mood
B: Client reported low motivation and spending most of Saturday in bed. Client completed one planned walk but canceled lunch with a friend. Affect was constricted at the start of session.
I: Therapist reviewed behavioral activation, explored the pattern between isolation and mood, and helped the client schedule two small activities connected to pleasure and accomplishment.
R: Client identified that waiting to “feel motivated” usually led to more avoidance. Client selected a 15-minute walk and preparing one simple meal as realistic steps and entered both into their calendar.
P: Continue weekly therapy. Client will complete the two activities and record mood before and after each. Review barriers and adjust the plan next session.
BIRP note example: group therapy
B: Client attended a skills group on managing strong emotions. Client was quiet at first but maintained attention and later described a recent situation in which anger led to leaving work early.
I: Facilitator taught the STOP skill, provided a short example, and guided members through applying it to a recent trigger.
R: Client completed the worksheet, identified early physical signs of anger, and shared one possible pause strategy with the group. Client reported that the exercise felt practical.
P: Client will practice the STOP skill once before the next group and note the trigger and outcome. Continue weekly group participation.
Common BIRP mistakes
Describing a topic instead of behavior
“Session focused on family” is too broad. Describe the treatment-relevant pattern: “Client reported avoiding calls from a parent after recent criticism.”
Naming a modality but not an action
“Used CBT” does not show what happened. “Used cognitive restructuring to examine the belief that setting a boundary would end the relationship” does.
Writing “receptive” for every response
Show what receptiveness looked like. Did the client identify a pattern, practice a skill, ask questions, or agree to a step?
Losing the treatment goal
The four sections should relate to the same clinical direction. If the Behavior concerns panic, the Intervention, Response, and Plan should not drift into unrelated time management.
When BIRP is a good fit
BIRP may work especially well when:
- Your setting emphasizes behavioral health interventions.
- You want the therapist’s action and client response to be easy to review.
- You document skills-based, goal-oriented, community, or group work.
- SOAP’s subjective/objective split feels less useful.
- Your supervisor, organization, or payer already uses BIRP.
The best format is still the one that meets your actual requirements. See SOAP vs. DAP vs. BIRP for a side-by-side comparison.
How to write BIRP notes faster
- Capture four quick words after the session: presentation, action, response, next.
- Start each Intervention with a strong verb.
- Make the Response observable whenever possible.
- Keep a small set of templates for individual, couples, and group sessions.
- Dictate a short recap while the session is fresh.
Apollo Notes can turn a spoken, typed, recorded, or handwritten session summary into a BIRP draft for you to review. Try Apollo Notes for free.
Frequently asked questions
What is the difference between Behavior and Response?
Behavior is the presentation or concern that brings the session into focus. Response describes what happened after the therapist’s intervention.
Can symptoms go in the Behavior section?
Yes. Behavior can include reported symptoms, thoughts, feelings, functioning, and observations—not only visible actions.
Is BIRP only for behavioral therapy?
No. The structure can document cognitive, relational, trauma-focused, supportive, and other approaches. The Intervention section should accurately name what you did.
Are BIRP notes accepted by insurance?
BIRP is widely used in behavioral health. Acceptance depends on the content, billed service, treatment plan, setting, and payer requirements rather than the acronym alone.