If you trained in a graduate counselling or psychology program, chances are you learned one note format: SOAP. It is the default in most textbooks, the go-to in practicum sites, and often the only template supervisors hand out. But SOAP is not the only game in town, and depending on your setting, your payers, and your clinical style, it may not even be the best fit.
Choosing the right progress note format matters more than most clinicians realize. The format you use shapes how clearly your clinical thinking comes through on the page, how smoothly your notes pass insurance audits, and how much time you spend documenting after each session. A poor fit means you are either shoehorning your clinical work into categories that do not match or spending extra minutes rewriting sections that feel redundant.
This guide breaks down the three most common therapy note formats — SOAP, BIRP, and DAP — so you can make an informed choice for your practice.
SOAP Notes — The Industry Standard
SOAP is the most widely recognized progress note format in healthcare, originally developed for medical settings and later adopted across mental health disciplines.
S — Subjective: What the client reports. This includes self-described symptoms, mood, concerns, life events, and direct quotes when clinically relevant. Think of this section as the client's voice entering the record.
O — Objective: What the clinician observes. Affect, appearance, behaviour in session, mental status indicators, and any test results or measurement tools administered. This section is where your clinical eye does the talking.
A — Assessment: Your clinical interpretation. How do the subjective and objective data connect to the diagnosis, the treatment plan, and progress toward goals? This is the analytical heart of the note.
P — Plan: What happens next. Interventions planned for future sessions, homework assigned, referrals made, and any changes to treatment frequency or approach.
Best for: Medical and integrated care settings, insurance-heavy caseloads, practices where objective measurement is emphasized, and any context where interdisciplinary teams need to read your notes.
Example:
S: Client reported increased anxiety over the past week, describing "a constant knot in my stomach" related to an upcoming custody hearing. Endorsed difficulty sleeping (4-5 hours per night) and reduced appetite.
O: Client appeared fatigued with dark circles under eyes. Speech was rapid. Affect was anxious and constricted. PHQ-9 score: 14 (moderate). No suicidal ideation endorsed.
A: Symptoms consistent with exacerbation of Generalized Anxiety Disorder in the context of acute psychosocial stressor. Current coping strategies (avoidance, reassurance-seeking) are maintaining the anxiety cycle. Moderate progress toward goal of distress tolerance.
P: Continue weekly sessions. Introduce cognitive restructuring targeting catastrophic thinking about custody outcome. Assigned thought record for daily use. Will reassess sleep at next session and consider referral to PCP if insomnia persists.
BIRP Notes — Behaviour-Focused
BIRP notes shift the emphasis from the medical model toward observable behaviour and intervention outcomes. This format is especially common in community mental health centres, substance abuse treatment programs, and settings where demonstrating measurable behavioural change is a priority.
B — Behaviour: What the client presented with in session. Observable behaviours, presenting concerns, and the reason for the visit. Unlike SOAP's split between subjective and objective, BIRP combines everything into a behavioural snapshot.
I — Intervention: What the clinician actually did. This is where you document the specific techniques, modalities, and therapeutic strategies you employed during the session. BIRP gives intervention its own dedicated section, which many clinicians appreciate.
R — Response: How the client responded to the interventions. Did they engage? Push back? Show insight? Demonstrate a new skill? This section creates a direct line between what you did and what happened as a result.
P — Plan: Treatment plan continuation, goals for the next session, and any adjustments to the overall treatment approach.
Best for: Behavioural health settings, substance abuse and addiction treatment, community mental health, and practices using CBT, DBT, or other structured behavioural approaches where tracking intervention-response patterns is central.
Example:
B: Client arrived on time and appeared agitated. Reported three days of sobriety following a relapse last weekend. Described cravings as "8 out of 10" and expressed frustration with inability to maintain abstinence beyond two weeks. Fidgeted throughout the first portion of the session.
I: Clinician utilized motivational interviewing to explore ambivalence about sobriety. Conducted a decisional balance exercise comparing short-term relief of use versus long-term recovery goals. Reviewed and updated the client's relapse prevention plan, adding a new coping strategy (calling sponsor before entering high-risk situations).
R: Client engaged actively in the decisional balance exercise and identified three new consequences of continued use that he had not previously acknowledged. Affect shifted from agitated to reflective by mid-session. Client verbalized commitment to calling sponsor daily for the next week. Demonstrated improved ability to identify relapse triggers compared to prior sessions.
P: Continue weekly sessions focused on relapse prevention. Client will attend three support group meetings before next session. Will introduce urge surfing technique at next visit. Reassess craving intensity and track sobriety days.
DAP Notes — The Streamlined Option
DAP condenses the documentation process into three sections by merging SOAP's subjective and objective categories into a single "Data" section. For many therapists, particularly those in private practice, this feels more natural and less forced.
D — Data: Everything that happened in session. Client reports, clinician observations, topics discussed, interventions used, and any notable events. This section is flexible and allows you to write in a way that mirrors how you actually think about a session.
A — Assessment: Your clinical interpretation. Diagnostic impressions, progress evaluation, risk assessment, and how the session content connects to the bigger clinical picture.
P — Plan: Next steps, future interventions, homework, referrals, and any changes to the treatment plan.
Best for: Private practice, therapists who find the SOAP format too rigid or redundant, eclectic or integrative modalities, and situations where efficient documentation is a priority without sacrificing clinical quality.
Example:
D: Session focused on client's ongoing conflict with her mother regarding boundaries around childcare expectations. Client described a phone call earlier this week in which she attempted to set a limit but "froze and agreed to everything." Explored the freeze response in the context of her attachment history. Practised assertive communication using role-play; client rehearsed two boundary-setting scripts. Client appeared engaged and demonstrated increased confidence in the second role-play attempt compared to the first. No safety concerns.
A: Client shows growing awareness of the connection between her attachment patterns and difficulty with assertiveness. The freeze response in conflict situations remains a primary barrier to goal achievement. Role-play demonstrated that with rehearsal, client can access assertive communication skills, suggesting the issue is more about activation under stress than skill deficit. Progressing toward treatment goal of establishing healthy interpersonal boundaries.
P: Continue weekly sessions. Client will practise one boundary-setting conversation before next session and journal about the experience. Next session will focus on grounding techniques to manage the freeze response in real-time. Will revisit assertiveness progress in four sessions.
Side-by-Side Comparison
| Feature | SOAP | BIRP | DAP |
|---|---|---|---|
| Sections | 4 | 4 | 3 |
| Emphasis | Medical model | Behavioural outcomes | Flexible, integrative |
| Best setting | Medical, integrated care | CMH, substance abuse | Private practice |
| Insurance acceptance | Universal | Widely accepted | Widely accepted |
| Learning curve | Moderate | Low | Low |
| Modality fit | All modalities | Behavioural (CBT, DBT) | All modalities |
| Subjective/Objective split | Yes | No | No |
| Dedicated intervention section | No | Yes | No |
How to Choose the Right Format
There is no universally "correct" note format. The best choice depends on your specific circumstances. Here is a practical decision-making framework.
1. Check your payer requirements first. Some insurance panels and managed care organizations specify a preferred or required format. Medicaid programs in certain states, for example, may lean toward BIRP in behavioural health contracts. Before you commit to a format, review your credentialing agreements and ask your billing department.
2. Consider your setting. If you work in a hospital, medical clinic, or integrated care team, SOAP is likely expected because other providers on the team already use it. If you are in community mental health, BIRP may already be standard at your agency. If you are in private practice with full autonomy over your documentation, you have the freedom to choose whatever works best.
3. Match to your modality. Therapists using highly structured approaches like CBT or DBT often find that BIRP's intervention-response structure maps naturally onto their session flow. Psychodynamic, humanistic, or eclectic therapists may find DAP's flexibility a better fit. SOAP works across all modalities but requires more deliberate effort to separate subjective from objective in talk therapy contexts.
4. When in doubt, default to SOAP. It is the most universally recognized format, accepted by virtually every payer, and understood across disciplines. If you are unsure or if you work across multiple settings, SOAP is the safest bet.
Spending Less Time on Notes, Regardless of Format
Whichever format you choose, the documentation process itself can be a significant time drain. Many therapists spend 10 to 20 minutes per note, and that adds up quickly across a full caseload.
ConfideAI offers built-in templates for SOAP, BIRP, and DAP formats. Rather than writing every note from scratch, you can enter brief key phrases from your session — a few words about the presenting concern, the intervention you used, the client's response — and ConfideAI generates a structured, professional progress note in your chosen format. All processing happens with hardware-level encryption designed to protect client confidentiality, because documentation tools should never force you to choose between efficiency and privacy. ConfideAI is currently available in free beta if you want to try it with your own workflow.
The Bottom Line
The best note format is the one that captures your clinical thinking efficiently, satisfies your compliance requirements, and does not leave you dreading the end of every session. SOAP gives you structure and universal acceptance. BIRP gives you a clear intervention-to-outcome narrative. DAP gives you speed and flexibility.
Understand what each format offers, match it to your practice reality, and then write notes that actually serve their purpose: documenting good clinical care.