2026 BIRP note examples for therapists

[Patient name] attended on time. Reports 14 days continuous sobriety from alcohol. Mood mildly low; PHQ-9: 9 (last week 12). Identified two cognitive distortions in the past week (catastrophizing about a job interview; all-or-nothing thinking about a family relationship). Sleep 6 hrs; one craving episode Saturday managed by leaving the environment.

Reviewed the 3-column thought record from the week and identified the trigger-thought-behavior chain for Saturday's craving. Practiced cognitive restructuring on the catastrophic interview thought using evidence-for/evidence-against. Introduced the urge-surfing technique with a 10-minute in-session practice. Coordinated care with prescriber [Provider] regarding naltrexone titration.

Engaged collaboratively throughout. Demonstrated insight into the trigger-thought-behavior chain without prompting. Generated three alternative thoughts to the interview catastrophe independently. During urge-surfing practice, reported a craving intensity peak of 5/10 and a clear return to baseline within 6 minutes.

Continue weekly IOP + individual CBT. Homework: thought record daily; urge-surfing rehearsal twice per day regardless of craving presence. Confirm naltrexone titration with prescriber [Provider] this week. Next individual session [Date].

[Patient name] (adolescent) attended with parent for the family component. Reports two emotional dysregulation episodes this week: one resulted in target behavior (verbal aggression toward sibling); one was managed with skills (TIP). Diary card complete with parent co-signature. Mood at session start: 'tired and annoyed' (5/10 on the patient's scale).

Behavioral chain analysis on the verbal aggression incident, conducted jointly with the parent. Validated the patient's emotional experience while highlighting the consequence of the chosen behavior. Coached the parent in dialectical validation — practicing 'I see you're frustrated' before redirection. Reviewed PLEASE skills (treat physical illness, balance eating, avoid mood-altering substances, balance sleep, exercise) with both parties.

Patient engaged with the chain analysis after initial resistance (5 minutes). Showed insight into the prompting event (a perceived slight from the sibling) and the missing link (skipping the morning PLEASE check-in). Parent demonstrated improved validation in the session and committed to a family check-in protocol.

Continue weekly family DBT. Homework: morning PLEASE check-in for the patient; nightly validation practice for the parent (one validating statement per evening). Diary card to be reviewed by parent each morning. Next session [Date].

[Patient name] arrived calm and prepared. Reports stable mood, 7 hrs sleep, no nightmares this week (down from 2 last week). Identified that the target memory (workplace assault, [Date]) has felt 'farther away' between sessions. Beginning SUDS: 4 (last session: 6). Beginning VOC for 'I am safe now': 5.

Phase 4 reprocessing using tactile bilateral stimulation. Conducted 8 sets averaging 30 seconds each. Used cognitive interweaves twice when processing stalled — once on the responsibility theme ('It wasn't your fault') and once on the safety theme ('That moment is over now, you're here'). Closed with safe place imagery and a body scan.

Patient stayed within window of tolerance throughout. SUDS progression: 4 → 3 → 2 → 1 across sets. VOC progression: 5 → 6 → 7 by session end. The responsibility interweave produced visible emotional release (tears, then a deep exhale). Body scan completed clean with no residual somatic charge.

Phase 4 on this target appears complete. Next session: Phase 5 (installation of the positive cognition) and Phase 6 (body scan re-check). If clean, begin Phase 8 (re-evaluation) of subsequent target. Self-soothe homework continued. Next session [Date].

[Patient name] reports a momentous week: an unburdening of a long-held exile occurred between sessions. Patient describes feeling 'lighter' and 'more here.' A manager part has been reorganizing — uncertain about its new role. Some sadness present but described as 'clean grief,' not toxic shame.

Honored the spontaneous unburdening and worked to integrate it. Met with the manager part that has lost its old job (protecting the now-unburdened exile). Helped the manager identify a new, age-appropriate role with the patient's Self-permission. Used direct access briefly to thank the manager for its years of service.

Patient remained in Self throughout. The manager part was visibly relieved to be invited into a new role rather than retired. Patient cried during the thank-you to the manager and reported feeling 'whole' afterward. No blending observed; Self-energy score: 9/10 at session end.

Continue IFS, frequency tapering to biweekly given the integration phase. Homework: gentle daily check-in with the manager in its new role; allow grief to surface as it does. Watch for other parts that may have been clustered around the unburdened exile. Next session [Date].