AI BIRP Notes for PMHNPs Using AdvancedMD

BEHAVIOR: Client arrived on time for 50-minute session, appropriately dressed with adequate grooming. Made good eye contact throughout session. Appeared more relaxed than previous sessions - sat back in chair rather than perched on edge. Engaged actively in therapeutic exercises without prompting. Became tearful (crying for approximately 2 minutes) when discussing relationship with deceased parent. Voice trembled when stating "I never got to say goodbye." Demonstrated insight when reflecting on patterns, stating "I see how I push people away before they can leave me." Reported completing homework assignment. INTERVENTION: - Utilized empty chair technique from Gestalt therapy to facilitate expression of unspoken feelings toward deceased parent (15 minutes) - Validated complicated grief responses using empathic reflection - Normalized ambivalent feelings toward the deceased ("It's possible to miss someone and also feel angry at them") - Taught progressive muscle relaxation technique for managing acute distress - Assigned homework: Write unsent letter to deceased parent; practice PMR daily RESPONSE: Client initially hesitant with empty chair exercise ("This feels weird") but engaged fully after first minute. Successfully verbalized three statements to the empty chair: "I wish you had been there more," "I forgive you," and "I love you." Client reported feeling "lighter" after exercise and rated distress as 4/10, down from 7/10 at session start. Expressed gratitude for the opportunity to "finally say those things." Demonstrated correct PMR technique during session. Verbalized commitment to homework completion. PLAN: Continue weekly grief-focused therapy. Next session: process content of unsent letter. Review PMR practice and troubleshoot any barriers. Consider introducing meaning-making interventions if client ready. Monitor for complicated grief symptoms. Client to return in 1 week.