2026 GIRP note examples for therapists

Reduce depressive symptoms as measured by PHQ-9 from baseline 18 to ≤10 within 90 days (treatment-plan goal #2).

Reviewed the 7-day behavioral activation log with [Patient name]. Identified the Friday cancellation pattern (4 of 4 weeks). Used Socratic dialogue to surface the underlying thought ('I deserve a rest by Friday') and conducted cognitive restructuring focusing on the distinction between rest as recovery vs. rest as avoidance. Assigned a Saturday morning pleasure-activity replacement.

[Patient name] engaged collaboratively. Initial resistance to relabeling the Friday rest gave way to recognition after the third evidence-for/evidence-against round. Generated three alternative thoughts independently. PHQ-9 administered: 12 (last session 14; baseline 18) — continued movement toward goal.

Continue weekly individual sessions toward the same goal. Homework: Saturday morning low-effort pleasure activity (already chosen — gardening). Reissue the activity-monitoring log. Coordinate with ACT team prescriber [Provider] at next team meeting re: continued sertraline. Next session [Date].

Eliminate NSSI behavior — currently zero episodes in 60 days; target is 12 consecutive months (treatment-plan goal #1).

Reviewed diary card with [Patient name]; flagged Tuesday as the highest-emotion day (8/10). Conducted chain analysis on the Tuesday spike, identifying the prompting event (a difficult call with [Provider] about housing). Reinforced TIP skill usage — patient used cold-water-to-face within 10 minutes of the spike and prevented urge from escalating. Briefly reviewed DEAR MAN for the upcoming housing call.

Diary card complete and accurate. Patient self-identified that the TIP skill prevented the urge escalation. Engaged in the chain analysis without prompting — significant indicator of internalized skill. DEAR MAN review: patient identified two phrases she wants to use; agreed to write them on the bathroom mirror.

Continue weekly individual + weekly skills group toward zero-NSSI goal. Homework: practice DEAR MAN once with a low-stakes partner before next session. Diary card continued. Coach call available for the housing follow-up call. Next individual session [Date].

Process the index trauma memory (workplace assault, [Date]) to adaptive resolution, measured by SUDS ≤2 and VOC ≥6 (treatment-plan goal #1).

Phase 4 reprocessing of the index target. Tactile bilateral stimulation, 8 sets averaging 30 seconds. Used cognitive interweave on the responsibility theme ('It wasn't your fault') when processing stalled in set 5. Closed with safe place imagery and body scan.

[Patient name] stayed within window of tolerance throughout. SUDS trajectory across sets: 6 → 5 → 4 → 2 → 2 → 1 → 1 → 1. VOC for 'I am safe now': start 5 → end 6. Responsibility interweave produced visible relief and a clear shift in body sensation. Body scan completed clean.

Continue weekly EMDR toward goal completion. Expect one more reprocessing session followed by Phase 5 (installation) and Phase 6 (body scan re-check). Resourcing homework continued. Coordinate with PCP [Provider] re: sleep — patient reports improvement. Next session [Date].

Develop reliable Self-energy access across daily life, measured by patient self-report of Self-led functioning ≥7/10 in 4 of 5 weekly check-ins (treatment-plan goal #2).

Began with Self-energy check-in (5/10 today, lower than recent weeks). Used direct access to meet the protector that was activated this morning (an old 'manager' that flares around facility-mealtime conflict). Negotiated a brief retreat with the manager's permission, then invited Self to lead the conversation about the conflict. Brief unburdening was not attempted today given facility-level stressors.

Patient remained in Self for most of the session despite the lower starting Self-energy score. The manager part responded to validation and stepped back willingly. Patient ended session at Self-energy 7/10. Reported feeling 'more like me again.'

Continue weekly IFS toward Self-energy goal. Homework: daily 5-minute Self-energy check-in upon waking. Coordinate with milieu staff and prescriber [Provider] re: continued sertraline. Next session [Date].