Architecture of Meaning
Cultivating Meaningful Engagement for the Highly Sensitive Person

Acknowledgment

Acknowledgment & Release Form

Before we begin our work together, I would like you to have this information about my background, approach and fee policies. If you have any questions, please don't hesitate to contact me.

Qualifications

The work I currently do, although drawing on years of formal training, is an innate gift that has been honed through years of energy work, body work and other experiential modalities. I have been working in private practice with bright, gifted and sensitive individuals since 1994.

I received a B.A. in Psychology and Philosophy from Pomona College in 1980. I received certification as an Educational Kinesiologist in 1993. Other areas of study and training include: environmental psychology, environmental studies, art therapy, play therapy and sensory integration.

Methods and Approach

I work with clients who have a sophisticated understanding of their emotional landscapes due to prior therapeutic work. My work consists of verbalizing subtle emotional, mental, energetic, spiritual and physical themes in a manner that resonates with a client's unique way of processing information. My work is not designed to diagnose, evaluate or cure any physical, mental or emotional ailments or conditions. I am not a psychotherapist, psychiatrist or mental health counselor.

The goals of our work include creating a vocabulary for your inner experiences and reframing your experiences of the world in a manner that validates your own wisdom. At any time during our work, we are each free to acknowledge that our work together is concluded.

Insight Dynamics, LLC makes no promises, claims or guarantees of diagnosing, treating or curing any physical, mental or emotional health challenges. You remain solely responsible for seeking and/or continuing with any necessary medical or psychological care.

All our sessions are strictly confidential. I will not discuss any information you give me, unless you provide written consent.

Fee Policies

My sessions are conducted over the telephone. I bill by the hour and quarter hour, at a rate of $150 an hour. (At any one time, I have several clients who I see on a sliding scale. If you can not afford my full fee, please speak to me about that option.) I expect payment for the first session in advance of the session. After that, I will bill you monthly, unless you prefer to pay by the session. I accept checks.

It is your responsibility to sense whether you are ready for our scheduled session at least 24 hours in advance of the session. If you cancel a session less than 24 hours before it is scheduled, I will need to charge you for that session.

Contact Information

All mail should be sent to:
Jessica Thayer
PO Box 1174
Charlottesville, VA 22902

All checks should be made out to: Insight Dynamics, LLC.

I can be reached at: 800-291-5576 nationwide,
and in Virginia at: (434) 977-6565.

I return calls within 24 hours. First-time callers should mention the state in which they reside and when I might reach them in person. Clients are always invited to leave messages during our work together.

If it is possible, I ask that you be on a land line when we speak. I ask that you not be near a computer that is on when we work. Ideally, you take some time to center before we speak. It is great if you can also give yourself some free time after we speak to integrate the work we have done.

Feedback Form
I request that if you discontinue our work without speaking to me, that you fill out the Feedback Form under "Contact". Since I care about all of my clients and also want to offer the highest level of work possible, your agreement to some kind of communication that provides closure is an important part of our agreement.

Background Questions
In order to save time in our initial work together, please help by giving me some background information.
Please answer the following questions:

Date of birth:
Are you on any medication? Yes
No
If yes, what and why?
Have you been diagnosed with PTSD? Yes
No
Have you ever been treated for PTSD? Yes
No
Do you suffer from chronic anxiety? Yes
No
Please describe the quality of your sleep.
Were you ever emotionally, physically or sexually abused? Yes
No
If yes, did you ever do any healing work around the abuse? Yes
No
Are you, or have you ever been, dependent on alcohol, drugs or tobacco? Yes
No
Do you suffer, or have ever suffered, from an eating disorder? Yes
No
Do you suffer, or have you ever suffered, from self harming behavior? Yes
No
Do you have, or have you ever had, suicidal thoughts? Yes
No
Have you ever attempted suicide? Yes
No
Do you ever feel crazy?
(many sensitives do) 		Yes
No
Have you ever been in a major accidents? Yes
No
Have you ever suffered from a life threatening illness? Yes
No
Have you ever suffered from a chronic medical condition? Yes
No
Have you ever been institutionalized? Yes
No
Do you suffer, or have you ever suffered, from depression? Yes
No
Did you have a traumatic birth? Yes
No
Was your mother exposed to toxins while you were in utero? Yes
No
Are you doing any kind of healing work at this time? Yes
No
Are you in therapy? Yes
No
Have you ever been in therapy in the past? Yes
No
If you do have a past therapist, could you rely on them if you needed to? Yes
No
What kind of healing work do you have access to if you needed it?
Is there anything else you would like me to know before we begin?

Acknowledgment by Client:

I,
acknowledge that Jessica Thayer has provided me with a copy of this disclosure and that I have read and understood the information.
address
city, state
zip code
phone
email

By clicking on submit, I am accepting the terms above and I am acknowledging that I have read this form.

You will be emailed a copy of this form. When you receive this form via email, you will be asked to send it back to Jessica. The action of sending it back to Jessica will constitute your signature.