Family/Couples CBT Session Note

Date: [Session date]

Session Time: [Total minutes or start–stop times]

Modality/Location: [telehealth / in-person / hybrid] [Platform or site if required]

Provider: [Name, credentials]

Client Unit: [couple / family / co-parents / other relationship system]

Identified Patient: [Name; patient of record]

Participants Present: [Each attendee with name and role/relationship; note participation level if relevant] (Do not leave blank; prompt to complete if incomplete.)

Consent/Confidentiality: Reviewed previously; no changes. (Replace with any framework updates, limits discussed, or confidentiality events this session.)

Session Focus

Primary focus: [Presenting focus and connection to CBT-informed treatment goals]

Agenda:

• [Agenda item]
• [Agenda item]
• [Agenda item] (Include 2–5 items total.)

Interval update: [Changes since last session; homework completion and key learning; notable events or stressors] (Omit elements that do not apply rather than inserting placeholders.)

Safety Screening

[SI/HI status] [Relational or environmental safety concerns: escalation severity, intimidation, coercive control, ability to safely do conjoint work] [Abuse/neglect concerns if any] [Actions taken if applicable: safety plan updated, resources provided, mandated report filed] (Attribute each finding to patient report, partner report, or clinician observation. If no concerns identified: "Denies SI/HI; no relational safety concerns observed; safe for conjoint work.")

CBT Formulation & Interventions

Target relational pattern: [Neutral name of pattern being addressed]

Functional chain:

• Trigger: [Activating event or situation]
• Partner A: [Key interpretations/thoughts → emotions → observable behaviors]
• Partner B: [Key interpretations/thoughts → emotions → observable behaviors]
• Consequences: [Immediate outcomes, maintaining factors, longer-term relationship impacts]

Interventions delivered:

• [Technique, target, participants involved; outcome of in-session practice if applicable]
• [Technique, target, participants involved; outcome if applicable]
• [Technique, target, participants involved; outcome if applicable] (List each intervention used.)

Behavioral observations (identified patient): [Affect, engagement, regulation, communication patterns relevant to formulation]

Response & Progress

[Participant engagement, insight demonstrated, alliance dynamics, and emotional tolerance] [Progress indicators: symptom or relationship functioning changes, reduced escalation, improved repair attempts] [Standardized measures with score and interpretation, if used] [Barriers or maintaining factors observed: avoidance, ongoing stressors, inconsistent practice]

Plan

Agreements: [Concrete agreements reached with behavioral specifics]

Home practice: [Assignments with owner(s), frequency, anticipated barriers and workarounds]

Contingency: [Instructions if escalation risk arises] (Include only if escalation risk is present.)

Next session: [1–3 focus items; timing and modality]

Diagnosis: [Diagnosis relevant to identified patient]

Medical Necessity: [Link session content to treatment plan goals and functional impairment]

Provider Signature: [Name, credentials, date]