Note Examples
Example BIRP Note

Example BIRP Note

BEHAVIOR

Psychological Factors:

  • Symptom 1:
    • Symptom Description: Depressed mood most of the day, nearly every day.
    • Onset: Ongoing, no specific onset provided.
    • Frequency: Daily.
    • Ascendance: No improvements reported.
    • Intensity: Moderate to severe.
    • Duration: Several years per client report.
    • Quote (Symptom): "I’m always seeing things I know I can’t do. It feels heavy.”
  • Symptom 2:
    • Symptom Description: Low motivation and withdrawal from previously enjoyable activities.
    • Onset: Gradual, no specific onset provided.
    • Frequency: Daily.
    • Ascendance: No improvements reported.
    • Intensity: Moderate to severe lack of motivation.
    • Duration: Several years per client report.
    • Quote (Symptom): "I just go places where there's no one and sit there alone.”

Therapist Observations And Reflections: The client displays cognitive distortions like mental filtering that focus on negative aspects of situations. Increased awareness of these patterns through thought tracking will be beneficial. The client requires support and encouragement to challenge avoidance behaviors.

INTERVENTIONS

  • Therapeutic Approach Or Modality: Cognitive-behavioral therapy, interpersonal therapy
  • Psychological Interventions:
    • Validated feelings.
    • Encouraged challenge of automatic thoughts.
    • Assigned thought tracking.
  • Rationale: Increase awareness of cognitive distortions fueling depression. Begin the process of identifying and challenging automatic negative thoughts.

RESPONSE

Progress and Response:

  • Response To Treatment: The client displayed limited engagement and motivation for change.
  • Specific Examples Or Instances: Client keeps deflecting from talking about certain issues.
    • Quote (Progress): "I don't know, I don't think I can."
  • Challenges To Progress: Lack of motivation and avoidance of social connections will likely impede progress. Negative automatic thoughts and cognitive distortions will also pose a challenge.
  • Therapist Observations And Reflections: Client is fused with their negative thoughts, might need to introduce defusion techniques.
  • Therapeutic Alliance: The client showed some resistance. She was hesitant to talk about certain things related to her anxiety. The therapist processed that with her.

PLAN
Follow-Up Actions And Plans:

  • Homework: Complete thought records identifying automatic negative thoughts and labeling cognitive distortions. Engage in one social activity.
  • Plan For Future Session: Review thought records, continue cultivating motivation and self-efficacy, begin discussing behavioral activation steps.
  • Plans For Continued Treatment: Continue weekly therapy, consider psychiatric referral if lack of progress.
  • Coordination Of Care: No coordination of care indicated at this time.