CBT Progress Note Examples

Client: [identifier your setting uses]
Date of service: [date]   Start and end time: [00:00 to 00:00]
Session type: [individual / couple / family / group; in person or telehealth]
Telehealth (optional): [client's location this session; video or audio only]
Service code: [if you bill]   Clinician: [name, credentials]

Goal addressed: [treatment-plan goal this session worked on]
Measures: [questionnaire scores, with the previous score]
Homework review: [what was assigned, what the client did, what they noticed]
Session focus: [the problem or situation the client chose to work on]
Intervention: [the CBT technique by name, and what it was applied to]
Response: [what the client did or said, with ratings before and after]
Risk: [what you asked, what the client reported, risk level and reasoning]
Assessment: [your interpretation and progress toward the goal, with evidence]
Plan: [new homework, next session focus, next appointment]

Signature, credentials, date: [ ]

Telehealth: video; client confirmed they were at home.
Goal addressed: Goal 1, testing anxious predictions about work with a
thought record on at least four days a week.
Measures: GAD-7 13, moderate range (16, severe range, at intake).
Homework review: Thought records on 3 of 7 days. Client noticed the same
prediction ("I'm going to lose my job") in two of them.
Session focus: Client chose the manager cancelling their weekly check-in.
Intervention: Cognitive restructuring with a thought record. Automatic
thought: "She's building a case to let me go" (belief 90%; anxiety 80 on a
0 to 100 scale). Used Socratic questioning to weigh the evidence for and
against; client named the patterns as mind reading and fortune-telling.
Alternative thought, in the client's words: "She cancelled three people's
check-ins this week and my last review was good, so it's probably her
schedule, not me."
Response: Belief in the original thought fell to 40% and anxiety to 45.
Client found evidence against the thought with two prompts (five last
session).
Risk: Denies thoughts of suicide, self-harm or harm to others.
Assessment: Partial progress toward goal 1 (3 of the target 4 days).
Client is using the thought record more independently. The job-loss
prediction recurs and is still rated 40% after restructuring, so it suits
a behavioral experiment. Risk judged low: denies suicidal ideation.
Plan: Behavioral experiment: ask the manager about the review timeline by
Friday; client predicts "she'll dodge the question" (70%). Record what
happens. Thought records on four days. Next session in one week.

Goal addressed: Goal 1, at least four scheduled, valued activities a week.
Measures: PHQ-9 14, moderate range (18, moderately severe, at intake);
item 9 (thoughts of death or self-harm): 0.
Homework review: Activity and mood log kept daily. Did 2 of 4 planned
activities (a walk with a neighbor, a call with their sister). Mood 5 on
those days and 3 on the others (0 to 10). Skipped the library visit and
gardening: "I was waiting to feel like it."
Session focus: The library visit.
Intervention: Behavioral activation. Reviewed the log to link activity and
mood. Revisited the client's values (staying connected, being useful).
Used graded task assignment to break the library visit into steps (check
the hours, walk there, return one book). Discussed acting on the plan
rather than waiting for mood to lift. Scheduled four activities with days
and times.
Response: Client pointed out the mood difference on activity days without
prompting and chose Tuesday for the first library step.
Risk: Denies thoughts of suicide, self-harm or harm to others.
Assessment: Partial progress toward goal 1 (2 of 4 activities). The log
shows higher mood on activity days, which supports continuing behavioral
activation. Waiting to feel motivated is the main barrier. PHQ-9 has moved
from the moderately severe to the moderate range. Risk judged low: denies
suicidal ideation and PHQ-9 item 9 is 0.
Plan: Four scheduled activities, starting with the first library step on
Tuesday. Keep the activity and mood log. Next session in one week.

Goal addressed: Goal 2, handwashing fewer than 10 times a day.
Measures: Y-BOCS, repeated today: 22, moderate range (27, severe, at
intake). Handwashing log: average 18 a day this week (30 at intake).
Homework review: Did the agreed home exposure (touch the kitchen trash
lid, then no washing until the next planned wash) on 5 of 7 days. Washed
early once.
Session focus: Next hierarchy item, a public restroom door handle.
Intervention: Exposure and response prevention (ERP). Before starting,
client predicted "I'll have to wash within 10 minutes or the anxiety will
keep climbing" (90% sure). Client touched the clinic's restroom door
handle, then their phone and face, and did not wash for the remaining 40
minutes. Client asked once whether the handle was clean; therapist did
not give reassurance, as agreed in the plan.
Response: The predicted outcome did not happen: client did not wash, and
distress did not keep climbing (SUDS 80 at the start, 50 at the end).
Client re-rated the prediction at 30%: "It was bad, but I could stand it."
Risk: Denies thoughts of suicide, self-harm or harm to others.
Assessment: Progress toward goal 2: washing down from 30 to 18 a day, and
Y-BOCS down 5 points. Client held back the ritual and their prediction
did not come true, which supports moving up the hierarchy. Avoidance of
public restrooms remains. Risk judged low: denies suicidal ideation.
Plan: Daily home exposure: touch the front door handle and the trash lid,
then no washing until the next planned wash; write down the prediction and
what happened each time. Next session in one week: a coffee shop restroom
door handle.