INFORMED CONSENT FORM
Consent for Jungian Analysis and Psychotherapy
Please read this document in its entirety and complete the consent form prior to our first session.
By signing, you confirm that you have read, understood, and agree to the terms outlined below.
About Me
I am Jane Clapp, a Jungian Psychoanalyst and a Registered Psychotherapist with the College of Registered Psychotherapists of Ontario (CRPO).
Description of Services
Jungian Analysis is often an intensive process in terms of time commitment and emotional impact, yet it can lead to profoundly transformative changes in behaviour, quality of life, and self-understanding.
Jungian Analysis, developed by Swiss psychiatrist Carl Jung, is a form of psychoanalysis that seeks to bring balance and union between the conscious and unconscious parts of the mind. It is based on the belief that the human psyche, when provided with the proper conditions, has an innate tendency to heal and to move toward wholeness. While unconscious influences can distort our thoughts, feelings, and relational patterns, the unconscious can also serve as a wellspring of wisdom and guidance.
My approach includes, but is not limited to:
Jungian dream analysis
Somatic emotional awareness practices
Active imagination
Providing tools for improved self-regulation
Creative expression
Exploration of childhood histories and traumatic events
The overall aim is to create an opportunity for you to live more authentically and satisfyingly. Our work together may address developmental or mental health issues, resolve specific problems, support decision-making, assist with coping during crises, develop personal insight, work through inner conflict, and improve relationships.
You may be invited to engage with aspects of yourself that are uncomfortable, and this process may lead to unforeseen changes in your relationships or take you outside of your comfort zone to explore your “growing edge.” The potential benefits of our work include improved coping skills, relief or resolution of trauma symptoms, increased resilience, deeper self-understanding, and the cultivation of a healthier relationship with yourself and others.
Outcomes and Ethics
The outcomes of psychoanalytic work cannot be predicted or guaranteed. They depend on factors such as:
The fit between analyst and analysand
The presence of ongoing external stressors
Your readiness and willingness to engage with difficult truths in your life
I will do my best to help you work safely with the challenges that arise and to maximize the potential benefits of our time together. If you have any questions or concerns about the work at any time, you are encouraged to bring them into our sessions.
Confidentiality
I hold client confidentiality as a cornerstone of the work and comply with all applicable privacy and professional ethics standards. Without prior written authorization, I will not release your information to a third party. At any time, you have the right to withhold or withdraw consent to disclosure or to place conditions on it.
However, there are legal and/or ethical exceptions to confidentiality. These include my obligation to:
Inform a potential victim if you intend to cause them harm
Inform an appropriate party (e.g., family member, health care provider, police) if you intend to end your life
Comply with a court order to release your file
Report to the Children’s Aid Society if I suspect that a child is at risk of harm or in need of protection due to neglect, or physical, sexual, or emotional abuse
Report sexual abuse of a client by another regulated health professional
Report elder abuse of a resident in long-term care
While such circumstances are rare, they do occur. My aim is to make this a space in which you feel safe to share deeply. I may also consult with other professionals for guidance related to my therapeutic approach, but any shared information will be anonymized.
In the event of my sudden illness or death, you may be contacted by a designated representative who will be bound by the same confidentiality standards and will assist you in finding appropriate referral support.
Privacy and Record-Keeping
I retain client records for at least ten years from the date of our last interaction, or ten years from your 18th birthday, whichever is later. Records are stored securely in compliance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Personal Health Information Protection Act (PHIPA).
You may request a copy of your records. A reasonable fee will apply to cover the time spent preparing, copying, and, where applicable, mailing the file. Please note that:
Records containing the name of another person will be redacted to protect their confidentiality
Reports from other professionals cannot be released without their consent
Nature of the Therapeutic Relationship
Our work is professional and boundaried. I cannot have other roles in your life, such as being a friend or social contact. In public settings, I will not acknowledge you first to protect your confidentiality, although you are welcome to initiate greeting if you wish.
I will not see you and another family member or loved one for individual therapy at the same time. You may, however, choose to attend workshops or trainings that I facilitate. If so, we will discuss the differences in my role in that setting and the potential impact on our analytic work. If I am both your analyst and teacher/facilitator, I will never disclose your status as a client, though you are free to do so yourself.
Payment Policy
Full payment is required at the time of each appointment. Accepted payment methods include cash, eTransfer, PayPal, or QuickBooks. Invoices are sent in advance of sessions. eTransfer payments must be received before the start of session. Any outstanding balances must be settled before further appointments can be scheduled.
Cancellations and Missed Sessions
You will receive an email reminder 36 hours before your session.
Cancellations within 36 hours of your appointment and missed sessions will be billed at the full rate.
Three consecutive cancellations or missed sessions without response may result in the termination of your treatment, with referral information provided if desired.
Cancellation fees may be waived for compassionate reasons (illness, medical emergency, death in the family).
In the case of bad weather or unsafe travel, sessions can take place by phone or video.
Scheduling Changes
Four weeks’ notice is required to permanently change your regular session day and/or time.
Termination of Work
If you wish to end therapy, I request four weeks’ notice so we can conclude our work in a supportive and intentional way.
Emergencies
I do not provide emergency services outside of sessions. If you require immediate help, call 911, go to the nearest hospital emergency department, or contact a local crisis line.
How Jungian Analysis Differs from Other Approaches
Jungian analysis is a sustained, in-depth relationship exploring the interplay between the conscious and unconscious. It recognizes the healing potential of numinous experiences — moments of mystery and awe that may arise through dreams, synchronicity, or insight — as “medicine for the soul.”
This work addresses both personal history and shadow aspects unrelated to trauma, while also considering collective unconscious forces, including archetypes, myths, and symbolic images, that may shape one’s life.
Analysts undergo extensive training through internationally recognized institutes, including their own long-term personal analysis, in-depth study of archetypal psychology, and mastery of symbolic amplification, dream work, and collective unconscious dynamics.
The process is often long-term and requires tolerance for uncertainty, paradox, and the unknown. It is not aimed at restoring you to a pre-crisis state but at opening a deeper, more authentic way of living.
Who Might Jungian Analysis Not Be For
This approach is not suited for those in acute crisis who require immediate stabilization, those experiencing high emotional dysregulation, or those seeking short-term, directive, or symptom-focused therapy. It may not be appropriate if you are unwilling to explore the unconscious, dreams, or symbolic/archetypal material.
Consent
I have read and understood this document, had the opportunity to ask questions, and agree to the terms outlined above.