SOAP vs DAP vs BIRP notes: the same session written in each format

Why structure your session notes

A session note has three jobs. It helps you pick up the thread at the next session. It keeps a trace of the patient’s progress over several months. And, if needed, it shows what was done and why.

Without a structure, notes tend to drift. Some sessions are written up in detail, others in a single line. Six months later, it becomes hard to tell what was suggested, what worked and what still needs work.

A fixed format solves this in a simple way. The same sections come back at every session, so you know what to write and where to find the information. That is the whole point of SOAP, DAP, BIRP and the others. They are memory aids, not obligations.

If you first want the general framework for psychologists’ notes (what is worth including, their status, their confidentiality), our article Psychologists’ session notes: framework, content and template covers the basics. Here, we focus on the form.

Each format in one sentence

• SOAP. Subjective, Objective, Assessment, Plan. The oldest and most widely used, it comes from medicine.
• DAP. Data, Assessment, Plan. A shortened SOAP where what the patient says and what you observe are grouped together. See our DAP note template, with a filled-in example.
• BIRP. Behaviour, Intervention, Response, Plan. It highlights what you did in the session and how the patient reacted to it.
• GIRP. Goal, Intervention, Response, Plan. Same logic as BIRP, but each note starts from the goal of the treatment.
• PIE. Problem, Intervention, Evaluation. A short format used mainly in nursing documentation, focused on one problem at a time.
• Narrative note. Free text, written as a short account of the session, with no set sections.

In France, staff working in hospitals and care facilities also know the transmissions ciblées (focused handover notes, close to focus charting). Each note starts from a “target” (a specific patient problem) and is then sorted into Data, Actions, Results. We come back to this below for allied health practitioners.

One session, five ways to write it

To compare formats, nothing beats an example. Here is a fictional, ordinary session. Ms L. has been coming for two months for work-related anxiety, with difficulty falling asleep. This is session 6, in person at the practice, 50 minutes. The treatment follows a cognitive behavioural approach, but the notes would be built the same way with another approach.

What happened in the session, in brief. Ms L. falls asleep more easily 4 nights out of 7 since she started the evening routine set up in session 4. She dreads a presentation to her team next Thursday and says “I’m going to stumble over my words and everyone will see it”. She arrives on time, speaks fast at first, then settles. You go over her thought diary, you examine the thought “everyone will see it” with her, then you role-play the first two minutes of the presentation. On the second run-through, she speaks more calmly and says she feels “a bit less tense”. You agree that she will rehearse twice out loud before Thursday, and the next session is in two weeks.

As a SOAP note

• S, subjective. Falling asleep more easily 4 nights out of 7 since the evening routine was put in place (session 4). Strong apprehension before a presentation to her team next Thursday. Says “I’m going to stumble over my words and everyone will see it”.
• O, objective. On time, neatly dressed. Fast speech at the start of the session, calmer afterwards. Smiles when talking about her colleagues. Thought diary filled in 5 days out of 7.
• A, assessment. Clear progress on sleep, the routine seems to be holding. The anxiety now centres on how others see her when she has to speak in public. “Mind reading” type thought clearly identified by the patient when we examine it together. Well engaged.
• P, plan. Rehearse the presentation twice out loud before Thursday, rate anxiety before and after (0 to 10). Session 7 in two weeks, review how the presentation went.

As a DAP note

• D, data. Falling asleep more easily 4 nights out of 7 since the evening routine. Apprehension before a presentation to her team on Thursday, “I’m going to stumble over my words and everyone will see it”. Fast speech at first, calmer afterwards. Thought diary filled in 5 days out of 7. Examination of the thought “everyone will see it” and role-play of the first two minutes of the presentation.
• A, assessment. Sleep improving. Anxiety now centred on how others see her. Patient able to put her thought into perspective in the session, calmer speech on the second run-through.
• P, plan. Two rehearsals out loud before Thursday, anxiety rated before and after (0 to 10). Session 7 in two weeks.

As a BIRP note

• B, behaviour. Arrives on time, fast speech at first. Reports falling asleep more easily (4 nights out of 7) and strong apprehension before her presentation on Thursday.
• I, intervention. Review of the thought diary. Examination of the evidence for and against the thought “everyone will see it”. Role-play of the first two minutes of the presentation, two run-throughs.
• R, response. Finds two counter-examples herself. Calmer speech on the second run-through. Says she feels “a bit less tense”.
• P, plan. Two rehearsals out loud before Thursday, with anxiety measured before and after. Session 7 in two weeks.

As a GIRP note

• G, goal. Treatment goal no. 2, being able to speak up in meetings without avoiding it. (Goal no. 1, sleep, on track with 4 easy nights out of 7.)
• I, intervention. Examination of the thought “everyone will see it”. Role-play of the first two minutes of Thursday’s presentation.
• R, response. Two counter-examples found. Calmer speech on the second run-through, says she feels “a bit less tense”.
• P, plan. Two rehearsals before Thursday, anxiety rated before and after. Session 7 in two weeks to review goal no. 2.

As a narrative note

Session 6, 50 min, at the practice. Ms L. arrives on time, speaks fast at first, then settles. Sleep is better, she falls asleep easily 4 nights out of 7 since the evening routine. What is on her mind today is her presentation to her team on Thursday. She is convinced she will stumble over her words and that “everyone will see it”. We go over her diary, examine this thought together and she finds two counter-examples herself. Role-play of the first two minutes, calmer on the second run-through, she says she feels “a bit less tense”. She will rehearse twice out loud before Thursday, rating her anxiety before and after. Next session in two weeks.

What the example shows

• The content is the same everywhere. What changes is where the emphasis falls.
• SOAP clearly separates what the patient says from what you see. This helps when someone else has to read the note.
• DAP is quicker to write, but the “Data” section soon becomes a catch-all.
• BIRP and GIRP make the work done in the session and its effect visible. That is handy in structured therapy, less natural when the session is mostly a time for reflection and working through.
• The narrative note is the most pleasant to reread, but nothing guarantees that the plan or the assessment will be there every time.

Comparison table

• SOAP
  • Sections. Subjective, Objective, Assessment, Plan
  • What it brings out. The difference between the patient’s account and your observation
  • Strength. Known to all clinicians, readable by a third party
  • Weakness. The line between S and O is blurry in psychotherapy
• DAP
  • Sections. Data, Assessment, Plan
  • What it brings out. Your assessment and the next steps
  • Strength. Quick, suited to regular follow-up
  • Weakness. The data gets mixed together
• BIRP
  • Sections. Behaviour, Intervention, Response, Plan
  • What it brings out. What you did and the effect it had
  • Strength. Clearly shows the therapeutic work
  • Weakness. Less room for your clinical reflection
• GIRP
  • Sections. Goal, Intervention, Response, Plan
  • What it brings out. The link between the session and the treatment goals
  • Strength. Tracking progress towards a goal
  • Weakness. Assumes goals were set at the start
• PIE
  • Sections. Problem, Intervention, Evaluation
  • What it brings out. One problem at a time
  • Strength. Very short
  • Weakness. Too thin for a psychotherapy session
• Narrative
  • Sections. None set
  • What it brings out. The course and tone of the session
  • Strength. Natural, suits less structured approaches
  • Weakness. Uneven from one session to the next, plan often forgotten

Where these formats come from

SOAP, born in American medicine in the 1960s

SOAP is associated with the “problem-oriented medical record” of the American physician Lawrence Weed. The idea was to organise the record by patient problem rather than by date or by source. Weed published on the subject as early as 1964 in the Irish Journal of Medical Science, then in a better-known 1968 article in the New England Journal of Medicine, titled “Medical records that guide and teach”. In a 2009 interview, he describes setting up this record as medical director of a hospital in Maine. At Case Western Reserve University, where he taught, students wrote a full SOAP note for each of the patient’s problems.

The format is now used well beyond general medicine, including in mental health, where the variants below also circulate.

DAP, BIRP, GIRP, variants with no clear origin

For DAP, BIRP and GIRP, we found no identifiable founding publication. These formats circulate mainly in documentation guides and software used in mental health in the United States. Be wary of articles that give them a precise date or author without citing a source.

Note also that the American Psychological Association (APA) does not require any format in its record keeping guidelines adopted in 2007. It states that some hospitals, clinics or organisations set a format. These guidelines are now archived by the APA.

Which format for which practice

There is no single right answer. Here are some pointers drawn from the logic of each format. Adapt them to your work.

• CBT and structured therapies
  • Format that fits. BIRP or SOAP
  • Why. Exercises, homework between sessions and their effect each have their own place.
• Brief, solution-focused therapy
  • Format that fits. GIRP
  • Why. Each session is linked to a goal set at the start, which helps measure progress over a small number of sessions.
• Long-term work, psychodynamic or integrative approach
  • Format that fits. Short narrative or DAP
  • Why. The “intervention” and “response” sections fit poorly with a session spent reflecting and working through. A brief text with one line of assessment and one line on next steps is often enough.
• Psychiatry
  • Format that fits. SOAP
  • Why. Close to the medical record, it makes room for the clinical examination, treatment and adjustments.
• Allied health (physiotherapy, speech and language therapy, psychomotor therapy, occupational therapy)
  • Format that fits. SOAP
  • Why. Measurements and tests have their own section, and the format is familiar to referring doctors.
• Team work, hospitals and care facilities
  • Format that fits. The facility’s format
  • Why. A note must be readable by colleagues. In France, many departments use transmissions ciblées.

For a concrete allied health example, see our osteopathy session tracking sheet template. For psychiatry, see our psychiatric consultation report template.

The case of transmissions ciblées

If you work in a hospital or care facility in France, you will often come across transmissions ciblées. You start by naming the target in one or two words (a symptom, a behaviour, a change in health). You then note the related data, the actions taken, then the results. The target is neither a medical diagnosis nor a care procedure. It is close to PIE in spirit, and it is often the shared language of the care team.

What the law requires (and does not)

An important point before going into detail. None of the texts we consulted in France, Belgium or Switzerland requires SOAP, DAP, BIRP or any other format. They sometimes set the content, a retention period or the patient’s right of access. The structure is up to you.

In France

• Psychologists. The « Code de déontologie des psychologues » (French psychologists’ code of ethics, 2021 version) asks psychologists to collect, file and archive their personal notes while protecting privacy and professional confidentiality (article 23). It also requires documents issued by the psychologist to be dated and to state their identity (article 18). It sets no format. This code currently has no regulatory force, but professional organisations point out that judges use it as a reference.
• Doctors, including psychiatrists. Article R4127-45 of the « Code de la santé publique » (French Public Health Code) requires doctors to keep a record for each patient. The commentary by the Ordre des médecins (French Medical Council), written on the previous version of the article, stated that writing it “is not subject to any formal requirements”. Until July 2026, the same article set apart the doctor’s personal notes, which could not be passed on and were not accessible to the patient. Decree no. 2026-691 of 27 July 2026 removed this wording.
• Patient access. Article L1111-7 of the Code de la santé publique gives everyone access to the information about their health held by health professionals and facilities. According to service-public.fr (the French government’s official information site), documents are provided no later than 8 days after the request, or 2 months if the information is more than 5 years old. What a patient can obtain from a psychologist has its own nuances, which we cover in our article on patient access to a psychologist’s records.

In practice, and this is a recommendation more than a rule, write your notes as if the patient might read them one day. Dated facts, quotes in quotation marks when they matter, an assessment phrased as a hypothesis. SOAP helps precisely to separate what was said, what was observed and what you make of it.

For retention periods in France, see our article on patient record retention periods.

The pitfalls of a format

• Filling in sections for the sake of it. An empty section is better than a hollow sentence. “Cooperative patient” in the O section tells nobody anything.
• Forgetting the assessment. It is the most useful section and the one most often rushed. One or two sentences on what you understand from the session are enough, as long as they are written.
• Mixing up account and interpretation. “She is in denial” is an interpretation. “She says everything is fine although her sleep has got worse” is a fact. The first goes in A, the second in S or O.
• Noting what concerns third parties. Patients talk about their partner, their colleagues, their children. Note only what serves the treatment.
• Changing format every month. An average format kept up for a year is better than an ideal format dropped after three weeks. Comparing one session with the next is exactly what makes notes useful.

A short outline, whatever the format

If you are not sure where to start, here is a base that works with every format. Keep it in front of you for the first few weeks.

• Date, session number, length, setting (practice or video).
• What the patient reports since the last session, with one or two useful quotes.
• What you observe (presentation, apparent mood, homework done or not).
• What you did during the session.
• Your reading of the session, phrased as a hypothesis.
• Where relevant, what you assessed in terms of risk and your conclusion.
• Next steps (homework, next date, point to come back to).

If you sort these lines under S, O, A and P, you have a SOAP note. Under D, A and P, a DAP note. The clinical work is the same.

How Delta works

Delta is an AI assistant for mental health professionals and allied health practitioners. During the session, Delta transcribes what is said, then prepares a session summary that you review. You can also dictate your observations just after the session. The summary takes your specialty and your therapeutic approach into account, and it is added to the patient’s file. You then find the whole course of treatment and its progress in one place, which is exactly what you expect from a structured note.

On security, data is hosted in France on infrastructure certified for health data (HDS, the French certification for health data hosting). AI processing takes place on servers located in France, after the patient’s name and identifying information have been pseudonymised. No audio file is kept, the data is never used to train models, and it is encrypted in transit and at rest. For informing your patients, see our article on consent and AI note-taking. Delta also drafts your assessment reports, letters and certificates.

Frequently asked questions

Sources

• Code de la santé publique, article R4127-45 (Légifrance)
• Code de la santé publique, article L1111-7 (Légifrance)
• Weed L.L., “Medical records, patient care, and medical education”, Irish Journal of Medical Science, 1964
• Takeda H., “What has changed after Dr. Lawrence Weed’s paper in 1968?”, Yearbook of Medical Informatics, 1999 (reference for Weed L.L., “Medical records that guide and teach”, N Engl J Med 1968;278:593-600, 652-7)
• Jacobs L., “Interview with Lawrence Weed, MD”, The Permanente Journal, 2009
• Case Western Reserve University, tribute to Larry Weed, 2017
• American Psychological Association, Record Keeping Guidelines (2007, archived)
• Code de déontologie des psychologues, 2021 version
• CERéDéPsy, position paper on the code de déontologie des psychologues, 2024
• Conseil national de l’Ordre des médecins, article 45 of the code de déontologie médicale (R4127-45 CSP) and commentary
• AP-HP, Legal Affairs Department, « Accès au dossier médical » (article L1111-7 CSP)
• Service-public.fr, « Accès au dossier médical » (checked on 28 February 2025)
• Commission des psychologues (Belgium), « Le dossier patient à la loupe », Courrier déontologique, April 2025
• CMS, overview of the Belgian law of 22 April 2019 on the quality of healthcare practice
• Canton of Geneva, Loi sur la santé (K 1 03), articles 52 to 57
• Canton of Bern, Ordonnance sur les patients et les professionnels de la santé (OPat, RSB 811.011)
• FSP, Code de déontologie (professional ethics guidelines), articles 20 and 21
• FMH, Guide pratique des bases juridiques, Le dossier médical
• Éditions Foucher, Les transmissions (transmissions ciblées), 2022