PIRP Note Example: Acceptance and Commitment Therapy (ACT)

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.

Problem:
Client presented feeling stuck and reported feeling trapped between anxiety and avoidance. Client stated, "I know what I should be doing, but I just can't make myself do it." Client discussed wanting to apply for new jobs due to dissatisfaction in his current role but described experiencing a wave of anxiety when attempting to work on his resume or look at job postings, leading to avoidance and subsequent feelings of guilt, which exacerbates the anxiety. Client identified values of growth, challenge, and contributing something meaningful.

Intervention:
The session lasted 45 minutes and took place in-office. Therapist introduced ACT defusion exercises to help client gain distance from anxious thoughts, including noticing the thought, saying it in different ways, singing it, using a cartoon voice, and repeating it until it lost intensity. Therapist facilitated values clarification work, helping client identify meaningful values and connect job application efforts to value-aligned actions.

Response:
Client laughed during defusion exercises and reported that the anxious thoughts felt less heavy afterward. Client appeared more willing to try value-aligned actions by the end of the session. Client demonstrated understanding of the connection between anxiety and avoidance and how anxiety does not necessarily indicate a misaligned action but rather reflects care and importance.

Plan:
Client will complete homework of taking one small value-aligned action, such as updating one section of his resume, and practicing defusion techniques when anxious thoughts arise. Therapist and client will meet again next week to review progress and continue working on value-aligned actions and anxiety management strategies.

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 45 minutes, in-office. Ravi came in looking stuck and said he's been feeling trapped between his anxiety and his avoidance. He said quote 'I know what I should be doing, but I just can't make myself do it' unquote. He talked about how he's been wanting to apply for new jobs because he's unhappy in his current role, but every time he sits down to work on his resume or look at job postings, this wave of anxiety hits and he just shuts down. Then he feels terrible about avoiding it, which makes the anxiety worse.

We talked about how anxiety and avoidance feed into each other, and that trying to get rid of the anxiety first isn't really the answer, it's about learning to move forward even with the discomfort present. I introduced some ACT defusion exercises to help him get some distance from the anxious thoughts. We practiced noticing the thought and then saying it in different ways, singing it, saying it in a cartoon voice, repeating it over and over until it lost some of its power. He laughed a little, which was good, and said it felt less heavy when he did that.

Then we did some values clarification work. I asked him what really matters to him, beyond just escaping the anxiety. He said growth, challenge, and feeling like he's contributing something meaningful. We talked about how applying for jobs is actually a value-aligned action, even if it brings up anxiety. The anxiety doesn't mean he's doing the wrong thing, it just means he cares. His homework is to pick one small value-aligned action this week, like updating one section of his resume, and to practice defusion when the anxious thoughts show up. He doesn't have to feel ready or confident, he just has to take the action.

Actually, one more thing, he seemed a little more willing to try by the end. We'll meet again next week to see how it went.

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More About PIRP 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 PIRP notes.