BIRP (Couple)
Created by
Michael Lee
Specialty
Therapist
Last edited
10/20/2026
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0 times
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About this template
A structured template for documenting couple therapy sessions, including the partners’ observed behavior, therapeutic interventions, responses, and follow-up plans. It supports organized recording of relationship dynamics, communication concerns, and ongoing treatment planning.
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Client Information
- Client Names: Marcus Vance (DOB: 14/08/1984, MRN: 492-810-33) & Elena Vance (DOB: 22/11/1986, MRN: 492-810-34)
- Provider Name: Dr. Jonathan Reynolds, MD
- Date of Service: 18/05/2024
- Session Duration: 50 mins (14:00–14:50 CST)
Behavior
Couple presented for joint relational therapy and psychiatric follow-up regarding marital discord secondary to Marcus's MDD. Elena reported feeling overwhelmed by household management and emotionally isolated, stating, "I feel like a caregiver, not a wife." Marcus exhibited psychomotor retardation, slumped posture, and poor eye contact, stating, "I'm already failing, I don't need reminders." Observed a classic pursue-withdraw dynamic: Elena's vocal tone escalated when seeking engagement, prompting Marcus to shut down and look away. Marcus reported adherence to sertraline (Zoloft®) 100 mg PO daily with mild improvement in anhedonia, though fatigue persists. Both denied SI/HI.
Intervention
Provided psychoeducation on the impact of depressive symptoms (anergia, avolition) on relational dynamics to externalize the illness and reduce mutual blame. Utilized Emotionally Focused Therapy (EFT) techniques to de-escalate the pursue-withdraw cycle, helping both identify primary underlying emotions (Elena's fear of abandonment; Marcus's shame and inadequacy). Facilitated a structured speaker-listener exercise using "I" statements to express needs without criticism.
Response
Both partners were receptive to psychoeducation. Elena's affect softened upon recognizing Marcus's withdrawal as a symptom of depression and shame rather than indifference. Marcus engaged during the structured exercise, maintaining eye contact and validating Elena's exhaustion without becoming defensive. Relational tension visibly decreased by session end.
Plan
Continue sertraline (Zoloft®) 100 mg PO daily for Marcus. Homework: Implement a daily 10-minute structured check-in focusing on emotional state rather than household logistics, utilizing the speaker-listener technique. Next session scheduled in 2 weeks (01/06/2024 at 14:00 CST) to review homework, assess depressive sx, and address equitable task division.
How to use this template
This template can be used to assist with various tasks in the medical field. You can use it to generate notes, manage patient information, or assist with diagnosis and the Assessment and Plan. To use this template, simply click the “Use Template” button above. If you have any questions or need assistance, feel free to reach out to the support team or refer to the description and example output provided above.