March 22, 2026
12 min read
By Albert Wong, PhD · Clinical Psychologist
You just finished your first real session. Not a role-play in practicum. Not a mock intake with your classmate pretending to have anxiety. An actual session with an actual person who sat across from you and told you things they haven't told anyone else. You held the space. You did the work. You felt, for the first time, like maybe you could actually do this.
Then your supervisor says, "Great. Now write a SOAP note."
And you sit there staring at a blank screen, realizing that four years of graduate school—thousands of pages of reading about attachment theory and cognitive distortions and multicultural competency—somehow never included a single lecture on how to actually document a therapy session. You know what a SOAP note is, vaguely. You've heard of DAP notes. Someone in your cohort mentioned BIRP once, and you nodded like you knew what they were talking about.
You don't. And that's okay. Almost nobody does at the start.
This guide is the one I wish someone had handed me on my first day. We're going to walk through the major note formats—SOAP, DAP, BIRP, and a few others—so you can understand what each one actually is, when each one makes sense, and how to pick the right one for your practice. No jargon. No textbook language. Just the real stuff.
Before we get into the specifics, let's talk about why this decision matters at all. Can't you just write down what happened in session and call it a day?
Technically, you can. Narrative notes—just writing a paragraph about the session—are legally acceptable in most states. But there are three reasons why a structured format is almost always better.
First, insurance. If you're paneled with any insurance company, they can audit your notes at any time. When they do, they're looking for evidence of medical necessity. They want to see that the client has a diagnosable condition, that you're providing treatment for that condition, and that you have a plan for continued care. A structured note makes those elements immediately visible. A narrative paragraph makes the auditor hunt for them. Auditors who have to hunt tend to deny claims.
Second, legal protection. If you're ever involved in a malpractice claim, a custody dispute, or a licensing board investigation, your notes are exhibit A. A structured format shows that you followed a consistent clinical process. It shows that you assessed, you intervened, you planned. It's harder to argue negligence when your documentation tells a clear clinical story in a recognizable format.
Third, clinical continuity. You will forget what happened in session. Not next year—next week. When a client comes back seven days later and references something you discussed, you need notes that help you remember quickly. A well-structured note lets you scan the assessment and plan sections in thirty seconds and pick up exactly where you left off. A narrative paragraph requires you to reread the whole thing and piece together what you were thinking.
SOAP stands for Subjective, Objective, Assessment, and Plan. It was developed in the late 1960s by Dr. Lawrence Weed, a physician who was frustrated that medical records were a mess. He wanted a universal structure that any clinician could read, regardless of specialty. It worked. SOAP became the dominant documentation format in medicine, and eventually spread to therapy, social work, occupational therapy, and pretty much every other healthcare profession.
Here's what each section means in a therapy context.
Subjective is what the client tells you. Their words. Their self-report. "I've been feeling more anxious since my mother moved in." "I tried the breathing exercise but it didn't work." "Things are a little better this week." You're capturing the client's perspective in their own language, or as close to it as you can get. This is where you record their reported symptoms, their concerns, their experience of the week since last session.
Objective is what you observe. This is the therapist's perspective—what you noticed during the session that the client didn't explicitly tell you. Their affect. Their body language. Whether they made eye contact. Whether their speech was pressured or their mood appeared congruent with their content. In a medical setting, this would include vital signs and lab results. In therapy, it's your clinical observations. Some therapists also include interventions used here—"Therapist utilized cognitive restructuring to address catastrophic thinking patterns."
Assessment is your clinical judgment. This is where you connect the dots. Given what the client reported (Subjective) and what you observed (Objective), what's your clinical impression? How is the client progressing toward treatment goals? Are symptoms improving, stable, or worsening? Is the current treatment approach working? This is the section that demonstrates your clinical reasoning—the part that separates your notes from a court reporter's transcript.
Plan is what happens next. Frequency of sessions. Homework assignments. Referrals. Changes to the treatment approach. Goals for next session. Medication considerations to discuss with a prescriber. This section shows that you're not just reacting to each session in isolation—you have a direction.
SOAP notes work well when you need maximum structure and when your notes might be read by professionals outside of therapy—physicians, psychiatrists, case managers. The medical community understands SOAP instantly. If you're in an integrated care setting or a hospital, SOAP is probably your best bet.
The downside? That Subjective/Objective split can feel awkward in therapy. In medicine, the distinction is clear: "The patient says their knee hurts" (Subjective) vs. "Range of motion is limited to 90 degrees" (Objective). In therapy, the lines blur. If a client says "I feel hopeless" while crying, is the crying Subjective or Objective? What about when a client describes a panic attack and you notice their hands shaking as they talk about it? You end up splitting observations that naturally belong together.
Many therapists also find that the Objective section feels forced. "Client appeared alert and oriented, dressed appropriately, mood anxious, affect congruent." You write the same mental status observations every session, and it starts to feel like a ritual rather than useful documentation. If that's your experience, you're not wrong. The format was designed for medicine, and therapy borrowed it. Sometimes borrowed things fit a little funny.
DAP stands for Data, Assessment, and Plan. It emerged as a response to exactly the problem I just described. Therapists kept struggling with the Subjective/Objective distinction, so someone said, "Why don't we just combine them?"
And that's essentially what DAP does.
Data is everything that happened. What the client said, what you observed, what interventions you used, what topics you covered. It's the full picture of the session in one section. "Client reported increased anxiety related to upcoming custody hearing. Affect was tearful and voice trembled when discussing potential outcomes. Therapist used grounding techniques and explored client's catastrophic thinking patterns. Client was able to identify two cognitive distortions and generate alternative thoughts by the end of the session."
See how much more naturally that flows? You're telling the story of the session the way it actually happened—client experience and therapist observation woven together. You're not artificially splitting your observations into two buckets.
Assessment works the same way it does in SOAP. Your clinical impression. Progress toward goals. Diagnostic considerations. Whether the treatment plan is working. This is still the section where you show your clinical reasoning.
Plan is also the same. Next steps, session frequency, homework, referrals.
DAP is increasingly the preferred format in therapy-focused private practices. It's simpler. It's more intuitive. It reduces the cognitive load of trying to categorize every observation as "Subjective" or "Objective." For a therapist documenting six or seven sessions a day, that cognitive load adds up. DAP lets you just document what happened and move on.
The trade-off is that the Data section can become a dumping ground. Without the Subjective/Objective structure forcing you to organize your thoughts, some therapists end up writing long, unfocused Data sections that read more like session transcripts than clinical documentation. The solution is discipline: keep your Data section focused on clinically relevant information. Not everything that happened in session needs to be documented. Document what matters for treatment.
DAP is also slightly less familiar outside of therapy. If you're sending notes to a psychiatrist or a primary care physician, they might need a moment to orient themselves. It's not a dealbreaker—the information is all there—but SOAP is the lingua franca of medicine. If interdisciplinary communication is a big part of your practice, keep that in mind.
BIRP stands for Behavior, Intervention, Response, and Plan. If SOAP was built for medicine and DAP was built for therapy, BIRP was built for accountability. It's the format that most directly answers the question insurance companies are asking: "What did you actually do in this session, and did it work?"
Behavior is what brought the client to the session and what you observed. It combines the presenting problem with the client's current presentation. "Client presented with increased depressive symptoms following the loss of employment. Reported sleeping 12-14 hours per day and skipping meals. Affect was flat. Eye contact was minimal." Behavior sets the stage—it's the clinical picture that justifies the intervention.
Intervention is what you did about it. This is the section that makes BIRP unique. While SOAP and DAP mention interventions as part of larger sections, BIRP gives interventions their own dedicated space. "Therapist utilized behavioral activation to identify small, achievable activities. Explored cognitive distortions related to self-worth and employment identity. Introduced sleep hygiene psychoeducation. Practiced progressive muscle relaxation in session." You're documenting every clinical tool you used, clearly and explicitly.
Response is how the client responded to your interventions. Did the behavioral activation planning engage them? Did they resist the cognitive restructuring? Were they able to do the relaxation exercise, or did they become more anxious? "Client was initially resistant to behavioral activation, stating 'nothing will help.' After exploring the connection between inactivity and mood, client agreed to try walking to the mailbox daily as a starting point. Client was able to complete progressive muscle relaxation and reported a decrease in physical tension from 8/10 to 4/10."
Plan is—you guessed it—what happens next.
The beauty of BIRP is that it creates a clear cause-and-effect narrative. Problem led to intervention. Intervention led to response. Response informs the plan. If an insurance auditor reads a BIRP note, they can immediately see the clinical logic. They can see that you identified a specific behavior, applied a specific intervention, measured the response, and planned accordingly. That's medical necessity, documented in four clean steps.
BIRP is especially popular in community mental health settings, substance abuse treatment programs, and any practice that deals heavily with managed care. If you spend a lot of time justifying sessions to insurance companies, BIRP does some of that work for you.
The downside? BIRP can feel reductive. Therapy isn't always a clean sequence of problem-intervention-response. Sometimes a session is about sitting with grief. Sometimes the most therapeutic thing you do is witness someone's pain without trying to fix it. BIRP's structure subtly pressures you to frame every session as an intervention with a measurable outcome, and not every session works that way. Experienced therapists sometimes feel like BIRP forces them to over-simplify their clinical work.
There's also the question of the "Behavior" section name itself. In therapy, "behavior" can feel limiting. A client's internal experience—their thoughts, their emotions, their relational patterns—are often more relevant than their observable behavior. Some therapists adapt the section to include broader clinical observations, but that's technically stretching the format beyond its original design.
SOAP, DAP, and BIRP are the big three, but they're not the only options. A few others come up frequently enough that you should know what they are.
GIRP stands for Goals, Intervention, Response, and Plan. It's similar to BIRP but starts with the treatment goals rather than the presenting behavior. Each note begins by referencing which treatment plan goals were addressed in the session, then documents the interventions used and the client's response. GIRP is popular with clinicians who want every session note to explicitly tie back to the treatment plan. It's excellent for demonstrating continuity of care and treatment plan compliance—but it can feel rigid if your sessions don't always map neatly to predefined goals. Therapy is sometimes messy, and clients sometimes need to talk about things that aren't on the treatment plan.
PIRP stands for Problem, Intervention, Response, and Plan. Very similar to BIRP, but "Problem" replaces "Behavior." The distinction is subtle but meaningful for some clinicians—"Problem" feels broader and more inclusive of internal experiences, while "Behavior" implies observable action. If your theoretical orientation is more psychodynamic or humanistic, you might find PIRP's language more comfortable than BIRP's.
Narrative notes are exactly what they sound like: unstructured prose describing the session. Some experienced clinicians prefer them because they allow for nuance and complexity that structured formats can't capture. The risk is that narrative notes can miss critical elements—medical necessity, treatment progress, intervention documentation—that structured formats require you to address. If you do narrative notes, you need the discipline to include all the essential elements even without a template prompting you.
Template-based notes are a hybrid approach where your EHR provides a custom template with specific fields and checkboxes. You might have dropdown menus for mood, affect, and risk assessment, combined with free-text fields for the session content. These can be fast to complete but sometimes produce notes that read more like a checklist than a clinical document. They also tend to lock you into your EHR's specific template design, which can make switching systems more painful.
Here's the honest answer: there's no universally "best" format. The right format depends on your specific situation. But there are some clear guidelines that can help you decide.
Start with your supervisor. If you're pre-licensed, this is simple. Use whatever format your supervisor requires. They're signing off on your notes, and they need to be able to read them in a format they're comfortable with. This isn't the time to innovate. Learn the format they want, get good at it, and save your preferences for when you have your own practice.
Check your insurance contracts. Some insurance companies and managed care organizations specify documentation requirements in their provider agreements. Most don't mandate a specific format, but some do require that certain elements be present in every note—diagnosis, interventions used, progress toward goals, plan for continued treatment. BIRP and GIRP formats naturally include all of these elements. SOAP and DAP require you to be more intentional about covering them.
Consider your setting. If you're in a hospital, integrated care clinic, or any setting where physicians and other medical professionals will read your notes, SOAP is probably the right call. They know it. They trust it. It reduces friction. If you're in a therapy-focused private practice where your notes are primarily for your own reference and the occasional audit, DAP gives you more freedom. If you're in community mental health or substance abuse treatment where insurance documentation is a constant battle, BIRP is built for exactly that fight.
Think about your clinical style. If you're a CBT therapist who uses specific interventions and measures outcomes, BIRP's structure might feel natural—it mirrors the way you already think about sessions. If you're more psychodynamic or relational, DAP's Data section gives you room to capture the nuance of the therapeutic relationship without forcing it into an intervention-response framework. If you do a lot of assessment and diagnostic work, SOAP's explicit Assessment section gives you space for that.
Think about your time. This is the factor that nobody talks about, but it matters enormously. You're going to write hundreds—probably thousands—of notes over your career. A format that takes you fifteen minutes per note versus ten minutes per note means the difference between finishing your notes during the workday and finishing them at home on the couch at 9 p.m. Most therapists find DAP fastest because it has only three sections and the Data section allows for natural, flowing documentation. BIRP can be slower because the Intervention and Response sections require you to be very specific. SOAP falls somewhere in between.
One last thing: whatever format you choose, be consistent. Switching formats mid-client is confusing for anyone who reads the chart—including you. Pick a format, commit to it, and give yourself at least a month to get comfortable before you decide it's not working. Most note formats feel clunky at first and become second nature with practice.
Everything I've written above is true, and it has been true for decades. Therapists have been agonizing over note formats since the 1970s. But something has changed in the last couple of years that genuinely alters the calculus: AI-generated notes.
Here's the old problem: you chose a format early in your career, you got good at it, and then you were stuck with it. Switching formats meant relearning how to write notes from scratch. Your EHR probably only supported one or two formats. If you wanted BIRP but your system only did SOAP, you either adapted the SOAP template (which always felt hacky) or you dealt with a system that didn't fit your brain.
Modern AI note tools change this because the format becomes a setting, not a skill. You record a session. The AI listens. Then it generates a note in whatever format you want—SOAP, DAP, BIRP, GIRP, or any custom template you've defined. Same session. Same clinical content. Different structure. You pick the format per note, per client, per insurance requirement. You can generate a BIRP note for the insurance company and a DAP note for your own records from the exact same session.
This doesn't mean format doesn't matter anymore. You still need to understand what each format is and what each section means, because you're reviewing and signing off on AI-generated notes, not just rubber-stamping them. You need to know if the AI put something in the wrong section, or missed a clinically relevant observation, or documented an intervention you didn't actually use. The clinical judgment is still yours. The format is just the container.
But it does mean you don't have to choose once and be locked in forever. It means the format can serve the purpose instead of constraining the clinician. Sending records to a new psychiatrist? Generate a SOAP note they'll immediately understand. Getting audited by an insurance company? Pull up the BIRP version that clearly documents medical necessity. Reviewing your own clinical thinking? Look at the DAP version that tells the story of the session the way you experienced it.
It's a small shift, but it's the kind of small shift that removes an entire category of stress from clinical practice. You stop worrying about picking the "right" format and start focusing on picking the right format for each specific situation.
Regardless of whether you use SOAP, DAP, BIRP, or anything else, there are a few principles that make notes good.
Be specific about interventions. "Therapist used CBT techniques" tells an auditor nothing. "Therapist used cognitive restructuring to address client's belief that 'I'll never find another job,' resulting in client identifying the cognitive distortion of fortune-telling and generating the alternative thought, 'I don't know what will happen, but I've found jobs before'" tells them everything. Name the technique. Describe what you did. Show the clinical reasoning.
Document progress toward treatment plan goals. Every note should reference the treatment plan, even if only briefly. "Client continues to make progress toward Goal 1 (reduce frequency of panic attacks from 3x/week to 1x/week). Client reports two panic attacks this week, down from three last week." This creates a longitudinal story of treatment that satisfies auditors and, more importantly, helps you track whether your treatment is actually working.
Avoid jargon without clinical backing. "Client was resistant" is a judgment. "Client declined to engage with the thought record, stating 'I don't think writing things down will help'" is an observation. The first one could get you in trouble. The second one documents what actually happened.
Write for the audience who might read this in five years. That audience might be you, trying to remember what was happening with a client who returns after a break. It might be a new therapist taking over the case. It might be an attorney. It might be a licensing board investigator. Would all of those readers understand what happened in this session from your note? If not, add more detail.
Finish your notes the same day. I know. I know. But memory degrades fast. A note written three days after the session is missing details, and those missing details are exactly the ones that matter in an audit or a legal situation. If you can't finish the note the same day, at least jot down the key clinical observations and interventions so you have something to work from later.
Here's what I've learned after years of writing notes and talking to therapists about notes: the format matters less than you think, and the content matters more than you think. A mediocre SOAP note and a mediocre DAP note are equally mediocre. A great BIRP note and a great narrative note are equally great. The format gives you structure. You give it substance.
If you're just starting out, pick a format—any format your supervisor approves—and commit to it for six months. Get comfortable with the structure until it becomes automatic. Then evaluate. Is it serving you? Is it protecting you? Is it helping you think clinically? If yes, keep going. If not, try a different format.
And if you're tired of agonizing over this, know that we're in an era where the technology can flex to fit your needs instead of the other way around. You don't have to get it perfect on day one. You just have to get started.
Practice Harbor's AI generates notes in SOAP, DAP, BIRP, and custom formats from a single session recording. Pick the format that fits—or switch anytime.
AI-powered notes. All major formats. Customizable templates. Always your choice.