Therapy and coaching for aviation professionals.

Yes. The medical question gets the headlines, but most of what pilots actually want to talk about is life: training debt and instructing years that barely pay, the 1,500-hour countdown that owns the calendar, the strain hour-building puts on a family, a stretch at home that got hard.

If you’re a military aviator, one thing to be upfront about: my flying is general aviation and my clinical work is civilian. I’m glad to work with you on your life. For military aeromedical questions, your flight surgeon and your service’s aeromedical channels are the right route.

Not automatically. Your AME doesn’t have a back door into outside therapy or coaching records. The FAA’s own guidance for pilots, updated in 2026, says it usually does not see outside therapy records at all. When it requests documentation, it is usually a brief summary from the therapist, not session notes.

What changes that picture is what you disclose on MedXPress, what you authorize through a records release, including any VA or Social Security disability benefits the form asks about, and the National Driver Register check you authorize when you sign the application. Insurance claims do not go to the FAA on their own. If you disclose therapy, the FAA asks you to send records or sign a release for your treating providers, and it usually wants only a brief summary from your therapist. Self-pay coaching with me generates no clinical record. Self-pay therapy with me generates a clinical record I hold, protected by HIPAA, and not released without your written consent outside the narrow legal exceptions that apply to every therapist, like a court order.

Form 8500-8, completed through MedXPress, has a medical history section in Item 18. Sub-item 18.m asks about mental disorders of any sort, with additional sub-items covering substance dependence, substance abuse, and DUI history. Item 19 asks about visits to a health professional in the last three years. The form’s own instructions say counseling visits are reportable only if related to a personal substance abuse or psychiatric condition, but the FAA’s newest guidance for pilots, published in 2026, reads the question more broadly, with narrow exceptions like most couples counseling and most EAP visits. The two documents word the question differently, so read both. Honest disclosure is required, and falsifying an FAA medical application can cost you any certificate you hold and carries a civil penalty under 14 CFR 3.403, on top of the federal false-statements law, 18 U.S.C. 1001.

Coaching isn’t psychotherapy, and under the form’s own instructions coaching visits are generally not Item 19 reportable. One honest wrinkle: because I’m also a licensed clinician, the most cautious reading of the FAA’s current guidance could treat any visit to a licensed provider as reportable. If a coaching engagement addresses a substance use or psychiatric concern, it can become reportable, and I’ll tell you if we’re moving into that territory. Therapy with a diagnosis is the kind of care those questions are written about. Exactly what to list for your situation is the kind of question AOPA Pilot Protection Services and your AME exist to answer, and worth settling with them before you file.

Coaching is goal-focused work on decisions, performance, and transitions. It isn’t psychotherapy and doesn’t generate a clinical record, so on its own it generally doesn’t enter the medical certification picture. Whether to list any visit to a licensed provider on your application is a question for your AME or AOPA Pilot Protection Services.

Therapy is different. If you’re in therapy, particularly with a diagnosis, that’s something the FAA is asking about and you need to think carefully about how to handle. What it means for your medical is case-by-case. It depends on the diagnosis, the treatment, the medication if any, how stable things are, and what class of medical you hold. The changes since 2024, which have continued through 2025 and 2026, have broadened what AMEs can handle at the exam without deferring to the Aerospace Medical Certification Division, particularly for several anxiety and depression diagnoses, and have shortened some medication waiting periods. For several common diagnoses, an AME can now issue at the exam even while you’re in active talk therapy, and the FAA’s 2026 guidance for pilots says plainly that therapy is encouraged and that starting therapy doesn’t require reporting anything until your next medical application. The right answer for you is one your AME and AOPA Pilot Protection Services should help you reach.

If therapy is what you actually need, the question is how to do it well rather than how to avoid the conversation.

HIMS, the Human Intervention Motivation Study, started in the 1970s as a structured pathway for pilots in recovery from alcohol or substance use. The program itself is still built around substance recovery, but the same HIMS-trained AMEs now also handle pilots on approved antidepressants and some other mental health certification work. HIMS involves a HIMS-trained AME, a documented aftercare process, monitoring, and a Special Issuance authorization.

Talking to a therapist or a coach does not put you in HIMS. It applies to specific situations. If your situation looks like one HIMS would cover, I’ll tell you so and we’ll think together about what that pathway involves and who the right professionals are to bring in.

Special Issuance, authorized under 14 CFR 67.401, is the mechanism the FAA uses to grant a medical certificate to a pilot who would otherwise not meet a specific medical standard, when the pilot can demonstrate they can perform their duties safely. It carries conditions, documentation requirements, and periodic re-evaluation. It is used both for conditions that require case-by-case review and as the pathway back to certification for some pilots with specifically disqualifying conditions after demonstrated stability. At the end of 2024, about 40,000 active airmen, roughly 6 percent of all FAA medical certificates, were flying under Special Issuance, including about 21,000 first-class pilots (FAA 2024 statistical handbook). It’s not the end of a career.

Whether your situation would lead to Special Issuance, and on what terms, is genuinely case-by-case. AOPA Pilot Protection Services and your AME are the right people to map out the specifics. I can talk through the options and the trade-offs with you.

That worry is one of the most common reasons pilots delay reaching out, and it’s a reasonable thing to think through carefully rather than dismiss.

Two things I’ll say honestly. First, symptoms that go unaddressed tend to surface later anyway, usually at a worse time and in a less controllable form than if you’d worked on them earlier. Second, since 2024 the FAA has added pathways rather than removed them: a rulemaking committee report with 24 recommendations in April 2024, therapy and counseling guidance added to the AME Guide in May 2026, and a new AME-assisted Special Issuance for anxiety and depression in July 2026.

Current FAA medical standards list four specifically disqualifying mental conditions: psychosis, bipolar disorder, severe personality disorder (one that has repeatedly manifested by overt acts), and substance dependence. The same rule also bars substance abuse within the preceding two years, which is a separate item from dependence, and gives the Federal Air Surgeon discretion on other conditions.

“Specifically disqualifying” is a regulatory term and does not always mean permanently disqualified, but the pathway back varies sharply by condition. For substance dependence, HIMS is a structured route back to flying run jointly by airlines, pilot unions, and the FAA, and the program reports that more than 4,500 professional pilots have completed treatment and returned to their careers (HIMS). For bipolar disorder, psychosis, and severe personality disorder, the AME must deny or defer, and you can ask the FAA for a Special Issuance, which the FAA decides case by case (AME Guide). It usually involves substantial documentation and evaluation. It is not a pathway to plan a return-to-flying timeline around without AOPA Pilot Protection Services and a HIMS-trained AME involved. Most other concerns, including depression, anxiety, and PTSD, are considered case-by-case rather than automatically disqualifying. The FAA’s own published figures put final denials at about 0.1 to 0.2 percent of applicants who disclose a health issue and complete the process. Initial disqualification for mental health diagnoses is more common: the FAA’s advisory committee put that rate at about 20 percent.

The right next step is usually to get clear on what you’re actually dealing with, what frame fits, and what disclosure would actually look like for your situation, with AOPA Pilot Protection Services and your AME involved before you commit to anything irreversible.

Yes, as your own client, for your own life. That can be therapy in Michigan or Ohio, or coaching anywhere. What I don’t do is family-of-pilot consultation, where the goal is managing the pilot’s situation from the outside. If what’s going on in your life runs through aviation, the schedule, the medical fear, the HIMS structure, I already know what those mean.