Articles

Deciding to go is the easy part. Finding a therapist for pilots who has read the FAA's rules is where most aviators stall out. Here is what the credentials mean, which questions to ask on the first call, and the answers that should end it.

You wake up, you are awake enough to know where you are, and your body will not move. Often there is a presence in the room. Sleep paralysis is a well-documented glitch at the border of REM sleep, it is common, and the things that make it more frequent are mostly things you can change. Here is the mechanism, who gets it most, and what helps.

Spoon theory gave people with invisible illness a way to say "I look fine and I am not fine," and it still does that job well. Then it left the diner. Here is what the metaphor gets right, where the internet version does harm, and who should keep counting anyway.

FAA psychiatric evaluations, psychological evaluations, and neuropsychological evaluations are three different credentials with three different specification documents behind them. Booking the wrong one is one of the most common and most expensive mistakes a deferred pilot makes. An aviation psychologist explains how to tell from your letter which one the FAA is asking for.

Some of the people I see would meet the criteria for borderline personality disorder, and I still do my best not to write it down. The label describes a recognizable kind of pain, but it explains very little of it, follows people for years, and outlasts the symptoms it names. This is what I do instead.

Clinicians who call me about burnout can usually define it, stage it, and name the research. What they have not done is get treated for it. Here is what the evidence says about how common this is, which part of burnout reaches your clients, and why supervision and self-care were never going to cover it.

The people who ask me about this have good performance reviews and an apology ready. Work is the last part of a life to go, which makes it a poor place to look for evidence. Here is what high-functioning depression turns out to be on examination, and what changes treatment when someone is still holding everything up.

A gender dysphoria assessment done well takes about six months, not one to six appointments. A licensed psychologist explains what the time is for, what gets ruled out, how capacity to consent is weighed, and what the findings can and cannot settle.

Most of the guilt people bring me is noise. Then there is the other kind, where you let something slide that mattered and you know it. Forgiving yourself for that kind follows a sequence, and skipping to the end does not work. Here is the order I use.