How do I document the eye position without overcomplicating the note?

Document the method used to find the brainspot (Outside Window, Inside Window, or Gazespotting), the general location of the eye position (e.g., 'lower right visual field'), and the activation level at the identified brainspot. You do not need to document exact coordinates. For example: 'Brainspot identified using Outside Window technique — therapist observed reflexive eye blink and pupil dilation at a point in the lower right visual field. Client confirmed activation at this position (SUDS 7/10).' This captures the essential clinical information without unnecessary detail.

How is Brainspotting documentation different from EMDR documentation?

While both modalities use eye position and target trauma, their processes differ significantly. EMDR uses bilateral stimulation with structured protocols (desensitization, installation, body scan phases), while Brainspotting uses a fixed eye position with focused mindfulness and relies on the client's natural processing capacity. Your BSP notes should emphasize: the method of brainspot identification, the client's somatic and emotional activation at the brainspot, the processing that unfolded (which is less structured and more client-led than EMDR), the use of BioLateral sound if applicable, and the therapist's dual attunement observations. BSP notes tend to document a more organic, less protocol-driven process.

Should I document everything the client says during processing?

No. Brainspotting processing can be largely internal, and the therapist's role is to hold space rather than direct the content. Document the themes, somatic shifts, emotional content, and key insights that emerged, but not a transcript. For example: 'During 20 minutes of focused processing at the identified brainspot, client moved through layers of activation: initial anger (jaw clenching, heat in the chest), then grief (tearfulness, heaviness in the chest), then a memory of the incident surfacing with associated body tension in the right shoulder. Processing settled with client reporting a sense of relief and lightness.' This captures the clinical arc without unnecessary detail.

How do I justify Brainspotting to insurance when the evidence base is newer than EMDR?

Brainspotting's evidence base is growing, with published studies demonstrating effectiveness for PTSD, anxiety, and performance issues. When documenting for insurance, focus on: (1) clear diagnosis and medical necessity, (2) specific treatment goals with measurable outcomes, (3) session-by-session documentation of interventions and observable changes, and (4) standardized outcome measures (PCL-5, PHQ-9). Your notes should demonstrate structured, goal-directed treatment. If questioned, you can reference the published research and note that BSP is a specialized trauma processing modality with emerging empirical support, developed from EMDR and informed by neuroscience research on subcortical processing.

Brainspotting Session Notes Template: Eye Position, Processing & Dual Attunement

By Modality|12 min read|Updated 2026-03-20|Clinically reviewed

What Is Brainspotting Documentation?

Brainspotting (BSP) documentation captures the process of using specific eye positions to access and process traumatic material stored in the subcortical brain. Developed by David Grand, Brainspotting is based on the principle that where you look affects how you feel — and that specific eye positions correspond to specific areas of neural activation related to traumatic or emotionally charged experiences. By maintaining a fixed gaze at a "brainspot" while in a state of focused mindfulness, the client accesses deep brain processing that can resolve trauma, anxiety, and other conditions.

BSP documentation must convey a process that is both structured (there is a specific method for identifying the brainspot and setting up the processing) and organic (the processing itself is client-directed and often largely nonverbal). Your notes should capture the brainspot identification method, the client's activation level, the processing that occurred, the role of dual attunement, and the session outcome — while acknowledging that much of the therapeutic action happens beneath conscious awareness.

The documentation challenge is that Brainspotting processing can look deceptively simple from the outside — the client stares at a point while the therapist observes. Your notes must convey the clinical sophistication of the intervention: the precise identification of a neurobiologically significant eye position, the therapist's attunement to subtle somatic and affective cues, and the measurable shifts in activation and symptom presentation.

When You Need BSP-Specific Notes

Use Brainspotting documentation when:

Brainspotting is the primary intervention in the session
You are identifying and processing at a specific brainspot — using Inside Window, Outside Window, or Gazespotting
BioLateral sound is being used as an auditory enhancement to the processing
The session involves focused, sustained processing at a fixed eye position
BSP is listed on the treatment plan as the therapeutic modality
You are using BSP within a broader treatment and need to document the BSP-specific components

Key Components — What to Document in BSP Sessions

Pre-Processing Assessment

Document the client's baseline state before identifying the brainspot:

Target issue — What is the focus of today's processing? (A specific trauma, a recurring symptom, a body sensation, a performance block)
SUDS rating — Subjective Units of Distress (0-10) when thinking about the target issue
Body activation — Where does the client notice activation in their body when considering the target?
Emotional tone — What is the predominant emotion associated with the target?

Brainspot Identification

Document the method used to locate the brainspot:

Outside Window — Therapist uses a pointer to slowly scan the client's visual field while observing reflexive responses (eye blinks, facial twitches, swallowing, pupil changes, shifts in breathing). The brainspot is the eye position where the greatest reflexive response is observed. Document the reflexive cues that indicated the brainspot.
Inside Window — Client reports where in their visual field the activation feels strongest as the therapist guides the pointer. Document the client's self-reported activation.
Gazespotting — The client's natural gaze direction when focused on the issue is used as the brainspot. Document the observation.
One-Eye Brainspotting — Using one eye (with an eye patch on the other) to access deeper material. Document which eye was used and why.
Eye position — Note the general location (upper left, lower right, midline, etc.)

Dual Attunement

Dual attunement is the hallmark of the therapist's role in BSP — simultaneously attuning to the client's external presentation and the client's internal processing. Document:

External attunement observations — What did you observe in the client's body, face, breathing, skin color, micro-movements?
Relational attunement — How did the therapeutic relationship support the processing? Was the client able to stay in connection with the therapist?
Therapist interventions — When and why did you intervene (e.g., to slow the processing, to deepen it, to check in, to offer a resource)?

Processing Content and Shifts

Document the arc of the processing:

Somatic shifts — Changes in body sensation during processing (location, quality, intensity, movement)
Emotional shifts — Changes in the emotional content (e.g., from anger to grief to relief)
Cognitive content — Any memories, images, thoughts, or insights that emerged
SUDS changes — How did the distress rating change during and after processing?
Processing duration — How long was the client at the brainspot?

BioLateral Sound

If BioLateral sound (bilateral auditory stimulation through headphones, typically nature sounds alternating between ears) was used, document:

That it was used and the type of sound
Whether it facilitated or deepened processing
Any client observations about the sound's effect

Post-Processing State

Document the client's state at the end of the session:

Final SUDS rating — Compared to the beginning
Body sensation check — What does the client notice in their body now?
Emotional state — How does the client feel?
Cognitive shifts — Has the client's perspective on the target issue changed?
Orientation and grounding — Is the client grounded, present, and safe to leave?

Filled-In BSP Progress Note Example

Brainspotting Progress Note — Trauma Processing Session

Client: S.M., Age 29, Female | Date: 03/17/2026 | Session: #8 (53 min) | Modality: Brainspotting | CPT: 90837

Diagnosis: F43.10 — Post-Traumatic Stress Disorder (related to physical assault, 14 months ago)

Subjective: Client reports continued intrusive images of the assault, occurring 3-4 times per week (down from daily at intake). Hyperstartle response persists, particularly to unexpected sounds or someone approaching from behind. Reports that "the image of his face right before it happened" is the most distressing element. SUDS for this image: 8/10. Sleep improved to 6 hours/night with one nightmare this week (previously 2-3 nightmares/week). PCL-5 score: 42, down from 56 at intake.

Pre-Processing Setup: Target: The intrusive image of the assailant's face in the moment before the assault. Client identified activation in the chest (tightness, "like something pressing down") and the throat (constriction). Emotional tone: fear with underlying anger. BioLateral sound (ocean waves) introduced through headphones. Client reported the sound as calming and was comfortable proceeding.

Brainspot Identification: Outside Window technique used. Therapist slowly guided pointer across the client's visual field, left to right, at eye level, then below eye level. Reflexive cues observed: at a point in the lower left visual field, client exhibited involuntary eye blink, a swallow, slight nostril flare, and a visible increase in chest movement (breathing rate increased). Client confirmed heightened activation at this position: "It's right there — my chest just got tighter." SUDS at brainspot: 8/10. Pointer secured at this position.

Processing (22 minutes of focused processing): Client maintained gaze at the brainspot with BioLateral sound. Therapist maintained dual attunement — tracking client's breathing, facial micro-expressions, skin color, and body movements while holding relational presence.

Minutes 1-5: Client's breathing was shallow and rapid. She reported chest pressure increasing to 9/10. Tears began. She stated, "I can see his face. It's right there." Therapist offered minimal verbal intervention: "Just notice what's happening. Your body knows what to do." Client's hands gripped the armrests.

Minutes 5-10: Processing shifted. Client's jaw clenched and she reported heat rising from her chest to her face. "I'm angry. I'm so angry. I froze that night and I couldn't fight back." Hands moved from gripping to fists. Therapist observed increased sympathetic activation — flushed skin, rapid pulse visible in the neck. Therapist checked in: "Stay with it if you can. What's happening now?" Client: "I want to push him away. My arms want to move." Therapist: "Let them."

Minutes 10-15: Client's arms pushed forward from the chest — a slow, deliberate extension, pushing away from her body. She repeated the movement three times, each one stronger. On the third push, she exhaled forcefully and stated, "Get off me." After this, her body visibly settled — shoulders dropped, breathing slowed, hands unclenched. She reported the chest pressure dropped from 9/10 to 4/10. Therapist recognized this as a completion of the thwarted fight response.

Minutes 15-22: Processing continued with the client's gaze maintained at the brainspot. Emotional tone shifted from anger to grief. Client cried quietly for several minutes. She stated, "I lost something that night. I don't feel safe in my own body anymore." Therapist held space without intervening. After the grief, client reported a sense of "something opening" in her chest. The tightness shifted to warmth. She stated, "It's like the image is still there but it's further away. It doesn't have the same grip." Final SUDS at the brainspot: 3/10.

Post-Processing Integration (10 minutes): Client was oriented and grounded after processing. Body scan revealed: chest warmth (described as "calm, not the anxious kind"), throat constriction resolved, mild heaviness in the limbs ("like after a good cry"). Client stated, "I didn't know my body wanted to fight back. I've been carrying that frozen feeling for over a year." She described the image of the assailant's face as "still there but like a photograph, not a movie — it lost its intensity."

SUDS for the target image: 3/10, down from 8/10 at the start of the session. Client was oriented to the present, made good eye contact, and reported feeling "tired but lighter."

Objective / Behavioral Observations: Client demonstrated capacity to sustain focused processing at the brainspot for 22 minutes without dissociation or overwhelm. Autonomic shifts were visible throughout: initial sympathetic hyperactivation (rapid breathing, flushing, muscle tension) transitioning to parasympathetic settling (slowed breathing, relaxed posture, warm skin tone) after the completion of the defensive response. Tearfulness during grief processing was appropriate and self-limiting. No dissociative episodes observed — client maintained eye contact with the brainspot and responded coherently to brief check-ins throughout.

Assessment: Clinically significant session. The brainspot accessed a specific neural network associated with the traumatic memory, facilitating the completion of a thwarted fight response (pushing the assailant away) that had been frozen since the assault. The 5-point SUDS reduction within the session (8 to 3) for the most distressing intrusive image is substantial. The client's description of the image shifting from "a movie" to "a photograph" suggests reduced limbic activation and increased cortical processing of the memory.

PCL-5 reduction of 14 points from baseline (56 to 42) represents clinically meaningful progress toward Treatment Plan Goal #1 (reduce PTSD symptoms to subclinical range, PCL-5 below 31). The thwarted fight response completion may contribute to reduced hyperstartle and body-based hypervigilance in coming weeks — this will be monitored.

Plan:

Continue weekly Brainspotting sessions, 53 minutes
Next session: assess for any activation or processing that continued between sessions (processing can continue for 24-72 hours post-BSP); check whether the intrusive image intensity held at the reduced level or returned
Potential targets for upcoming sessions: the body sensation of "not feeling safe in my own body" (may represent a separate brainspot); nighttime hypervigilance; the freeze response itself
Client to practice self-care in the 24-48 hours following the session — adequate sleep, hydration, gentle activity; avoid processing or discussing the session content extensively
Readminister PCL-5 at session 10
Next appointment: 03/24/2026 at 1:00 PM

Risk Assessment: Client denies SI/HI. No self-harm history. Reports occasional alcohol use (2-3 drinks/week, social), no increase since treatment began. Protective factors: supportive roommate, stable employment, close relationship with sister. Risk level: low.

This is a sample for educational purposes only — not real patient data.

Clinical Language and Terminology

Brainspot — A specific eye position that correlates with neural activation related to a particular issue. Document the eye position and the method used to identify it.

Dual attunement — The therapist's simultaneous attunement to the client's external presentation (body, face, autonomic cues) and the relational/neurobiological process occurring within the client. Document what you observed and how your attunement informed the session.

Outside Window — Brainspot identified by therapist observation of reflexive cues. Document the specific reflexes observed.

Inside Window — Brainspot identified by the client's self-reported activation. Document the client's report.

Gazespotting — Using the client's natural gaze as the brainspot. Document the observation leading to this choice.

BioLateral sound — Bilateral auditory stimulation, typically alternating nature sounds through headphones. Document its use and observed effect.

SUDS — Subjective Units of Distress Scale (0-10). Document pre-processing, during processing (if checked), and post-processing ratings.

Focused mindfulness — The client's state during processing — focused on the brainspot while maintaining open, nonjudgmental awareness of internal experience. This is not meditation; it is a specific processing state.

Common Mistakes

Documenting BSP as if it were EMDR. These are different modalities with different processes. BSP uses a fixed eye position (not bilateral eye movements), relies on focused mindfulness (not a structured protocol with specific phases), and emphasizes the therapist's dual attunement. If your notes describe desensitization phases, installation, and body scan as distinct steps, you are documenting EMDR, not BSP.

Failing to document the brainspot identification process. The method used to find the brainspot is a core clinical intervention, not a trivial setup detail. Document the method, the reflexive cues or client reports, and the eye position.

Writing overly brief notes because the processing was internal. Just because the client was largely silent during processing does not mean your note should be sparse. Document your observations from dual attunement, the somatic and emotional shifts you witnessed, and the pre-to-post changes.

Not using standardized outcome measures. BSP's evidence base is strengthened when clinicians track outcomes with validated instruments. Administer the PCL-5, PHQ-9, GAD-7, or other relevant measures regularly and document the scores.

Skipping post-processing assessment and safety. Always document the client's state at the end of the session — grounding, orientation, and readiness to leave. BSP can access deep material, and clients need to be adequately resourced before departing.

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