How Therapy Notes Change by Format
On this page, you'll find side-by-side examples of different formatted notes using the same session to demonstrate how different formats emphasize or overlook key therapeutic elements. You'll also find quick comparisons of each format to show what each format does—and doesn't.
Full HEART Note
(Approx. 15 - 20 sentences—best for emotionally rich or relationally complex sessions)
H: Client arrived appearing worn down, with slow movements and minimal expression. They quietly asked if it was okay to "not have much to say today." Therapist responded with acceptance and paced the opening in silence. A subtle shift in facial expression when therapist commented, “Sometimes silence says everything,” seemed to invite a softening. Client later noted they felt “weirdly safe not needing to talk right away.”
E: As the session unfolded, the client described themselves as “a dusty book no one’s read in years.” This metaphor led to gentle exploration of what it means to feel forgotten, overlooked, or irrelevant. Themes of longing, grief, and existential fatigue emerged without clear narrative structure. The client occasionally paused and sighed, saying “I don’t even know what I’m feeling.” Therapist reflected, “You’re showing up exactly how you need to,” and the client nodded. They later mentioned wanting to “feel like a person again,” comparing themselves to an old tree still standing but hollowed.
A: Therapist provided minimal structure, intentionally avoiding directive strategies in favor of holding space for the symbolic process. Reflections, metaphor scaffolding, and presence-based attunement were primary tools. Therapist asked gentle questions to deepen image work and validated the experience of emotional disorientation without needing to reframe or redirect. Subtle cues (slowed breathing, uncrossing arms) guided the pacing.
R: Client expressed feeling lighter near the session’s close, saying “I feel like I emptied a little bit of whatever’s been stuck.” They also said, “Thanks for not rushing in to fix it.” Posture appeared more open, and they smiled faintly before leaving. Client did not express specific goals but stated they felt “curious about coming back.”
T: Therapist will continue to honor slow pacing and metaphor development, resisting the urge to structure prematurely. Will monitor the emotional window of tolerance and continue relational tracking. Focus remains on co-creating emotional safety and helping the client rediscover meaning through process-oriented unfolding rather than task-driven objectives.
HEART-Lite Note
(Approx. 5 - 10 sentences—best for time-efficient but clinically sound notes)
H: Client appeared fatigued, quiet, and emotionally distant at session start. Therapist slowed pacing and allowed silence.
E: Client used metaphors of a dusty book and hollow tree to describe emotional depletion and disconnection. Themes of irrelevance, grief, and longing emerged.
A: Therapist focused on emotional pacing and metaphor work; no directive interventions used.
R: Client reported feeling “lighter” and more curious about returning.
T: Continue process-based exploration with attunement to emotional tolerance.
DAP Note
(Structured, efficient format ideal for programs that prioritize behavior, insight, and planning)
Want to learn more about the differences between Full HEART and HEART-Lite notes? This guide should help!
D (Data): Client presented as quiet and emotionally subdued. Described feeling like “a dusty book” and “a hollowed tree.” Reported a sense of not feeling like a person. Themes of emotional depletion and existential fatigue were present.
A (Assessment): Therapist noted use of metaphor as central to client expression. No structured intervention applied; focus was on presence and attunement.
P (Plan): Continue process-focused work. Allow symbolic material to emerge organically. Track emotional tolerance and relational safety.
SOAP Note
(Insurance-friendly and widely used across settings—balances subjective and clinical data)
S (Subjective): Client reported feeling emotionally disconnected and described themselves with metaphors suggesting abandonment and depletion.
O (Objective): Presented as quiet and fatigued, with minimal eye contact and flat affect. Expressed appreciation for not needing to talk right away.
A (Assessment): Client is experiencing emotional fatigue and disconnection. Responds well to gentle, metaphor-focused exploration and relational pacing.
P (Plan): Maintain process-based, emotionally safe environment. Avoid premature structuring; follow client’s emotional rhythm.
BIRP NOTE
(Best for settings valuing behavior tracking, structured interventions, and measurable progress)
B (Behavior): Client arrived visibly fatigued and asked if it was okay to not speak much. Described themselves as “a dusty book” and “a hollow tree.” Tone was subdued, posture closed, affect flat.
I (Intervention): Therapist used reflective listening, silent co-regulation, and metaphor exploration. Avoided structured tools or tasks.
R (Response): Client expressed a sense of emotional release and curiosity about future sessions. Body language became more open.
P (Plan): Continue symbolic and process-oriented exploration. Focus on emotional safety and pacing.
PIE Note
(Best for settings prioritizing clinical formulation, diagnostic clarity, and case conceptualization)
P (Problem): Client expressed emotional exhaustion, disconnection from self, and a lack of desire to speak. Used metaphorical language to describe their state.
I (Intervention): Therapist engaged in attuned silence, symbolic reflection, and gentle presence. Minimal verbal intervention used.
E (Evaluation): Client noted feeling “lighter” and appreciated the space to not be rushed or fixed. Appeared more open by end of session.
What the Formats Do—and Don’t
Most note formats—like SOAP, DAP, and PIE—were built to meet insurance or medical documentation requirements. They help organize information, but often fall short when it comes to capturing emotional nuance, relational shifts, symbolic themes, or therapist presence.
This section breaks down what each format is designed to do—and what it tends to leave out.
Use this comparison to:
- Understand where HEART fills common gaps
- Identify what’s missing in your current note style
- Translate your notes between formats more intentionally
💡 Each format has its strengths—but HEART was designed to reflect the therapy you actually do.
DAP Format
SOAP Format
HEART Format
BIRP Format
PIE Format
🧠 Big Takeaway:
HEART isn’t just a different format—it’s a structurally more complete model that:
- Preserves human nuance (H)
- Tracks symbolic and thematic material (E)
- Captures therapist intent and pacing (A)
- Reflects internal shifts and subtle progress (R)
- Adds direction and future planning (T)
Traditional formats are serviceable—but they were built for systems.
HEART was built for therapy.