OCD SOAP Note Example for Therapists

In obsessive-compulsive disorder, the note has its own challenge: recording the content of obsessions with the precision treatment needs, without a later reader mistaking it for intent or risk. This is especially important when the intrusive thoughts are about causing harm.

The example below is fictional and educational. It is not a diagnostic assessment or a risk assessment, and it does not replace professional judgement or applicable documentation requirements.

Fictional OCD SOAP note example

Context: Eighth session of cognitive behavioural therapy with exposure and response prevention (ERP). Presenting concern: intrusive thoughts of harming her partner, with avoidance of knives and reassurance seeking.

Subjective: The person reports that intrusive thoughts of harming her partner occur several times a day, especially when cooking. She describes them as unwanted, contrary to what she wants and very distressing. This week she chopped vegetables with a knife in her partner's presence three times, as agreed. On one occasion she again asked her partner to confirm that she is “not a dangerous person”. When this is explored, she reports no intent or plans to cause harm and has not engaged in any harmful behaviour. She rates distress at 7 out of 10 at the start of exposures and 3 out of 10 at the end. She estimates that she spends a little under an hour a day mentally checking “whether she would be capable of it”, compared with about three hours at the start of treatment.

Objective: Cooperative and well engaged. Brings the completed exposure record. During in-session exposure she holds a kitchen knife while writing down the intrusive thought; distress rises to 8 and falls to 4 out of 10 in about fifteen minutes. She makes two requests for reassurance to the therapist, which are named and not answered, as agreed.

Assessment: The harm thoughts retain the characteristics of ego-dystonic obsessions described in the OCD formulation: they cause distress, the person rejects them and responds with avoidance, mental checking and reassurance seeking. What was explored today regarding intent is consistent with the initial assessment. The reduction in mental checking time and the fall in distress during exposures indicate progress. Reassurance from her partner continues to function as neutralisation.

Plan: Move to daily exposure with knives in the kitchen and add peeling fruit while her partner is sitting nearby. Continue the record of exposures and mental checking time. Propose a joint session with her partner to agree how to respond to reassurance requests without reinforcing them. Review at the next session.

Why it is written this way

The note describes the thoughts as intrusive and unwanted, and records how intent was explored. Without that context, a phrase such as “thoughts of harming her partner” could be read very differently by anyone else who accesses the record, including the person receiving care.

It does not reproduce the content of the obsessions in more detail than necessary. For continuity, the theme and its function in the cycle are enough. In OCD, repeating the exploration of intent in every session can itself function as reassurance; it is best done when there is a clinical reason.

Reassurance is recorded as a neutralising behaviour, including when it appears in session, because the plan depends on it.

The reduction in checking time is the person's own estimate and is presented as such. If you use a standardised scale such as the Y-BOCS, record the score and the date so it can be compared over the course of treatment.

The same session as a progress note

Eighth ERP session. Intrusive thoughts of harm towards her partner, experienced as unwanted and distressing, with no intent or harmful behaviour in today's exploration. Three exposures at home (distress from 7 to 3 out of 10) and one in session (from 8 to 4). Mental checking reduced to under an hour a day. Reassurance seeking with her partner persists. Exposure is extended to daily practice and a joint session is proposed to address reassurance.

Questions to use during review

• Is it clear that the thoughts are intrusive and unwanted, and how intent was explored?
• Does the note avoid reproducing the content of the obsessions in more detail than necessary?
• Are avoidance, checking and reassurance recorded as parts of the same cycle?
• Is each exposure recorded with its level of distress and approximate duration?
• If there are genuine concerns about risk, are the assessment carried out and the subsequent action recorded?

See the SOAP notes guide and the guide to mental health progress notes. You can also compare this case with the panic attack example or the anxiety example.

Clara prepares a structured draft from the session. The clinician reviews how the obsessions are described, the exploration of intent and the plan before adding it to the record. See AI clinical notes with Clara.