BIRP Note Example: Abandonment Trauma

Quill generated this note with AI from the summary that was provided. The therapist can then copy-and-paste the note into their current EHR platform.

Behavior:
Client presented as anxious and reported significant difficulty in her relationship. She stated, "Every time he doesn't text me back right away, I just panic." Client described intense fear of abandonment triggered by her partner's behaviors, such as not responding immediately, seeming distracted, or needing space. She acknowledged that these fears feel irrational but lead to behaviors that push her partner away, exacerbating the fear. Client shared a history of abandonment trauma, including her father leaving when she was very young and past relationships where partners disappeared without explanation. She expressed that these experiences have left her feeling as though people inevitably leave, keeping her in a heightened state of alert for signs of withdrawal.

Intervention:
The session lasted 60 minutes and took place in-office. Therapist explored the client's abandonment trauma and its impact on her current relationship patterns. Therapist introduced emotional regulation strategies, including the 5-4-3-2-1 grounding technique, self-soothing practices such as using a blanket, listening to calming music, or contacting a safe friend, and reality-testing to assess whether fears are rooted in the present or past. Therapist also discussed secure attachment strategies, emphasizing calm communication of needs to her partner.

Response:
Client engaged actively in the discussion and appeared to gain insight into the connection between her past trauma and current fears. She expressed understanding of how her reactions might contribute to relationship challenges. Client demonstrated interest in the emotional regulation strategies and expressed willingness to practice them. No changes to the diagnosis were discussed during the session.

Plan:
Client will practice grounding and self-soothing techniques when feelings of abandonment arise, as well as reality-testing before reacting. The next session is scheduled for next week in-office. Therapist and client will review her experiences with these strategies and continue exploring secure attachment approaches.

Client Session Summary:

Here's the summary of this client session. Remember, Quill does not record the client session. A therapist would provide a summary (like the one below) after the session is over, and then Quill would generate a note similar to the one above.

Today's session was 60 minutes, in-office. Vanessa came in looking anxious and said she's been having a really hard time in her relationship. She said quote 'Every time he doesn't text me back right away, I just panic' unquote. She described how even small things, like her partner not responding immediately, or seeming distracted, or needing space, trigger this intense fear that he's going to leave. She said she knows it's not rational, but in the moment it feels so real, and she ends up acting in ways that push him away, which makes the fear worse.

We talked about abandonment trauma and where these patterns might be coming from. She opened up about how her dad left when she was really young, and then later she had a couple of relationships where people just disappeared without explanation. She said she just learned that people leave, and she's always waiting for it to happen again. That wound is still really active, and her nervous system is on high alert for any sign that someone's pulling away.

We worked on some emotional regulation strategies she can use when that panic hits. First, grounding, I taught her the 5-4-3-2-1 technique to help bring her back to the present moment instead of getting lost in the fear. Second, self-soothing, we talked about what she can do to comfort herself in those moments, like wrapping herself in a blanket, listening to calming music, or calling a friend who's safe. Third, reality-testing, asking herself whether the fear is based on what's happening right now or what happened before. We also talked about secure attachment strategies, like communicating her needs to her partner in a calm way instead of reacting from the panic. Her homework is to practice grounding and self-soothing this week when the abandonment fear comes up, and to try reality-testing before she reacts. We'll meet again next week to see how it went.

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More About BIRP Notes:

From even more examples, to an overview of the format in general, to templates, to a cheat sheet, here's everything you need to know about BIRP notes.