How to find a therapist who understands pilots
Pilots ask me two questions, usually in that order. The first is whether they can see a therapist at all without it costing them a medical, which I have written about at length. The second one sounds simpler and is harder to answer in a sentence: how do I find someone who knows what any of this means?
That second question is where a lot of aviators quit. You open a directory, filter to your state, and get four hundred therapists. Six mention aviation somewhere in a bio. Two of those six turn out to be coaches rather than clinicians, one is licensed in a state you do not live in, one has a waitlist into next year, and the sixth never calls back. Meanwhile your next flight physical is four months out and you would like this handled before then.
I am a licensed psychologist, an FAA/HIMS trained aviation psychologist, and a former pilot, and I have worked with pilots since the start of my career in mental health. The sad truth is that many of them first came to me at low-cost clinics, so they could pay in cash and keep a diagnosis out of the picture. These were not only private pilots. Some were naval and Coast Guard aviators. That should not be how anyone who flies has to get help. So here is what I would look for, in the order I would look for it.
"Aviation therapist" covers three different jobs, and only one of them is therapy
The phrase gets used for work that has almost nothing in common, and sorting that out first saves you weeks.
A treating clinician is a therapist. The work is ongoing, the relationship is confidential, and nothing goes to the FAA, your AME, your chief pilot, or your union without a release you sign. This is what most pilots are looking for when they start searching.
An FAA evaluator writes a report. An ADHD Fast Track evaluation, a Gender Dysphoria Mental Health Status Report, a psychological evaluation for certification: in all of those, the product is a document that goes to Aerospace Medicine. The evaluator's obligation runs to the question the FAA asked, not to your preferences about the answer. That work can be done well and fairly, and it is a different job from treatment, even when the same clinician does both.
A coach or peer supporter is neither. Aviation coaching can be useful for a career decision or a performance habit, and airline and union peer programs have pulled plenty of pilots back from a bad place. But a coach cannot diagnose, cannot treat a condition, and is not practicing under a psychology license, which means the protections and the limits are both different. I have written separately about what a coach cannot do for an aviator who needs clinical care.
Decide which of the three you need before you start calling. Pilots who skip this step tend to spend a month interviewing people for the wrong job.
HIMS training is the credential that tells you someone has read the FAA's rules
"Aviation" in a directory bio can mean the therapist has read about pilot mental health, or that their spouse flies, or that they like airplanes. None of that tells you whether they understand what a chart note does to a medical application.
The credential worth asking about is HIMS training. HIMS stands for Human Intervention Motivation Study, and it is the FAA's framework for evaluating and monitoring aviators with substance use and certain mental health histories. I have described the program in detail elsewhere. For your purposes here, what matters is the training behind it: it covers how the FAA thinks about fitness to fly, what gets reported, what a special issuance involves, and how a case moves through Aerospace Medicine. A clinician who has done that training has read the documents. One who has not, probably has not.
A few other terms you will run into:
- FAA Tier 2 psychologist. A designation for psychologists who perform certain FAA evaluations. I hold it and use it for air traffic controller evaluations. It signals FAA-facing evaluation work, which is useful to know about, and it is not the same thing as being your therapist.
- Aviation Medical Examiner, or AME. Your AME is a physician who conducts flight physicals and makes certification recommendations. A psychologist is not an AME and cannot make a certification decision. Anyone who implies otherwise does not understand their own role.
- Former pilot. Not a credential, and useful anyway. It means you do not have to explain what a sim ride is, or why reserve wrecks your sleep, before you get to the thing you came to talk about.
Ask directly: what aviation-specific training have you done, and when? A clinician who works with aviators will answer that in one breath.
A therapist who has never read the AME Guide can create a reportable diagnosis by accident
This is the practical reason the choice of therapist matters more than the decision to go.
Most therapists have never opened the FAA's Guide for Aviation Medical Examiners, and there is no reason they would have. But that means a careful, well-trained clinician can write a diagnosis into your chart on day one because it is the code that gets the session paid for, without any idea that the word now has a second life on a federal form. Item 47 on the medical application asks about mental health diagnoses. Item 19 asks about visits to health professionals in the last three years, which is a separate question with its own answer. The clinician who does not know those items exist cannot help you think about them.
An aviation-aware therapist raises this before the work starts. In my first session with any aviator, we settle what kind of work this is going to be: counseling that does not involve a diagnosis, or treatment for something that meets criteria. Both are legitimate. The difference has consequences you should hear about in session one, not at your next physical.
To be clear about what this is not: it is not a strategy for keeping things off your record. What is in your record is yours to report honestly, and lying on a medical application is a federal offense. The point is that you are entitled to know what is being written down about you, and why, while it is being written.
Ask who is paying before you ask what it costs
Insurance is worth asking about, and the question underneath it is worth asking first. Billing a claim means sending a diagnosis code to a third party, because that is what a claim is. For most people that is a fine trade. For a pilot, it is a decision with an extra variable in it, and the clinician should be able to walk you through that variable without flinching or lecturing.
Some aviators pay out of pocket for exactly this reason. Others use their benefits with their eyes open and are glad they did. There is no single correct answer, and a therapist who treats aviators will have had the conversation before. My own rates and the carriers I take by state are on the rates and insurance page.
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Ask how your therapist handles FAA reports
If a certification question is likely to come up, ask early whether the person treating you can also write the report the FAA asks for. I do both, and for many aviators that is the better arrangement: the person writing the report already knows your history, has seen how you are actually doing over months rather than in one appointment, and you are not starting over with a stranger at the moment the stakes are highest.
What makes it work is being clear about which job is happening when. Therapy is where you say the things that are hard to say out loud. An FAA report answers the specific question Aerospace Medicine asked, and it has to be accurate even when the accurate answer is not the one you hoped for. A clinician doing both should tell you plainly when the work shifts from one to the other, what the report will cover, and what stays in the room. If they cannot explain that boundary in a sentence or two, that tells you what you need to know.
Licensure decides who can see you, and your month may cross a dozen states
This one trips up aviators more than anyone else, because the rule follows your body rather than your address.
Psychology licenses are state by state, and what governs a session is the state you are physically sitting in when it happens, not the state on your driver's license. For a pilot on a four-day with a hotel in a different time zone every night, that is a live problem. A therapist licensed in one state can be the right clinician and still be unable to meet with you on Tuesday because of where Tuesday happens.
PSYPACT is the agreement that fixed this for psychologists who join it. It lets a participating psychologist practice across state lines, which is why I can see pilots and controllers in more than 45 states and schedule around trips, reserve, and shift rotations instead of around geography. If you fly for a living, ask every clinician you talk to whether they are authorized where you will be sitting, not just where you live.
Six questions that tell you whether a clinician knows aviation
A consultation call is an interview, and you are the one conducting it. These six get you most of the way:
- What aviation-specific training have you done, and when?
- Do you work with pilots and controllers now, or have you in the past?
- Are we doing counseling, or treatment for a diagnosed condition, and how will you decide?
- What will be in my record, and will you tell me before you write it?
- Are you licensed or authorized to see me in the states I will be physically in?
- Do you also write FAA evaluations, and how do you keep that separate from our therapy?
You are not being difficult by asking. You are doing the same preflight you would do on anything else that carries you.
Three answers that should end the call
"Don't worry, none of this ever has to go anywhere." Overpromising is a sign the person does not know the rules. The honest version is more specific and includes what does have to be disclosed.
"I'll just put down an adjustment disorder so your insurance covers it." A diagnosis chosen for billing convenience is still a diagnosis, and a clinician who treats aviators knows better than to pick one casually.
"Just let me handle the FAA paperwork. You don't need to see it." A report about you goes into a federal file with your name on it. You are entitled to know what it covers and what it is based on, and a clinician who will not walk you through it is asking for trust they have not earned.
The bottom line
The hard part of getting help as a pilot is not the decision. It is the half hour of searching that follows, and the search rewards specificity: a licensed clinician, with aviation-specific training you can name, who will tell you in the first session whether this is counseling or treatment, who is authorized to see you where you will be, and who can tell you plainly how your therapy and any FAA report will be kept straight. Everything else is fit, which you can judge yourself once the fundamentals check out.
That is what my therapy for pilots and controllers page exists for, and if you want to run the six questions above past someone before committing to anything, the free consultation is a reasonable place to do it.
Frequently Asked Questions
How do I find a therapist for pilots?
Start by deciding whether you need ongoing therapy, an FAA evaluation, or coaching, because those are three different jobs. Then look for a licensed clinician with aviation-specific training you can name, such as FAA/HIMS training, who is licensed or PSYPACT-authorized in the states you will physically be in. Ask on the first call whether your work will be counseling or treatment for a diagnosed condition, and what will go in your record.
What is an aviation therapist, and do I need one?
An aviation therapist is a clinician who treats pilots and controllers and understands how the FAA handles mental health diagnoses, medication, and reporting. You do not need one for every problem, but you do need one if a diagnosis or a medication might come into the picture, because a therapist who has not read the FAA's guidance cannot help you think about what gets written down.
What does HIMS trained mean for a therapist?
HIMS stands for Human Intervention Motivation Study, the FAA's framework for evaluating and monitoring aviators with substance use and certain mental health histories. HIMS training covers how the FAA thinks about fitness to fly, what gets reported, and how a case moves through Aerospace Medicine. It is the clearest signal that a clinician has read the FAA's own documents rather than a summary of them.
Can my therapist also do my FAA psychological evaluation?
Yes, if they do FAA evaluation work and are clear about the two roles. A therapist who already knows your history can write a better-informed report, and you avoid starting over with a stranger when it matters most. Ask how they keep the roles separate: when the work shifts from treatment to evaluation, what the report will cover, and what stays confidential.
Can a therapist in another state see me if I fly for a living?
It depends on licensure, and what counts is the state you are physically in during the session, not the state where you live. Psychologists who participate in PSYPACT can practice across participating state lines, which is what makes consistent therapy possible for a pilot whose month crosses a dozen states. Ask every clinician you talk to whether they are authorized where you will be sitting.
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