What therapy options exist while keeping a medical?

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There's hundreds of threads here about issues getting or keeping a medical when getting some form of therapy, it seems always in the sense of being diagnosed with depression or having taking anti-depressants.

Let's assume I need to continue holding a medical to keep getting paid. I'm able to function just fine, but reality is I've got issues going back a long ways and I'm getting to the point where I need to start working on them for myself and my family's sake. No desire to get put on meds and while I wouldn't call myself depressed, I could see someone potentially diagnosing me as such without my desire or consent. It seems that sort of label is what causes problems. My employer does have a bunch of good employee assistance program options, some of which are labeled "anonymous" but I don't imagine that entirely works as written on the surface.

Assuming I'm going into this from the perspective of someone who 1) is trying to make some improvements in life and 2) wants to not jeopardize my medical, are there realistic options, or is it just a case of have to make a decision to take a risk? The reality is there's nothing I haven't been living with for decades, but maybe 2020 has helped me realize that I'd be better served by trying to deal with some of these things.
 
[Warning: I'm writing as a layperson, with no professional qualifications]

Cognitive-behavioural therapy (CBT) is non-pharmaceutical, and studies over the past few decades have shown it equally or more effective than pharmaceutical approaches for dealing with many issues like depression, anxiety, PTSD, etc. It's fully mainstream. It doesn't work for some conditions, like bi-polar disorder or schizophrenia (which require pharmaceutical intervention), but it doesn't sound like those apply to you.

IMO, if you meet with a psychologist for CBT (I mention a psychologist rather than a psychiatrist because psychologists can't prescribe medication, so there's no room for suspicion), that's no different than meeting with a fitness trainer, career councillor or life coach, and is no one's business but yours. You're not suicidal or delusional, you're not taking any medication, and that's that.

Here's one sample link (but there will be CBT-trained psychologists in pretty-much any city or town):

https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
 
David Megginson said:
IMO, if you meet with a psychologist for CBT (I mention a psychologist rather than a psychiatrist because psychologists can't prescribe medication, so there's no room for suspicion), that's no different than meeting with a fitness trainer, career councillor or life coach, and is no one's business but yours.
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Your opinion is legally incorrect. Psychologists are state licensed health care professionals. They're not in the same league as a fitness trainer, career counselor, or life coach. The 8500-8 clearly states an applicant has to "list all visits within the last 3 years to a physician, physician assistant, nurse practitioner, psychologist....". Officially you have to report psychologist visit(s) and any subsequent diagnosis.

Unregistered said:
Assuming I'm going into this from the perspective of someone who 1) is trying to make some improvements in life and 2) wants to not jeopardize my medical, are there realistic options, or is it just a case of have to make a decision to take a risk? The reality is there's nothing I haven't been living with for decades, but maybe 2020 has helped me realize that I'd be better served by trying to deal with some of these things.
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Seeing the psychologist in and of itself probably isn't the issue. The problem is the diagnosis codes the psychologist associated with the visit(s). The diagnosis codes have clinical purpose, but they are primarily used to facilitate data analysis and electronic medical billing to insurance companies. The unfortunate side effect is that they encourage the clinician to record a diagnosis when they might not otherwise do so. No codes and they can't bill or get paid. Electronic billing and the associated medical records create a digital paper trail that is easily located as it's shared between parties. It's a chicken and the egg problem, you don't want a "bad" diagnosis code ending up on your record, but there's no way to know if you have a "bad" diagnosis without seeing the psychologist. There's also the issue that many large employers are self insured and may have access to diagnosis codes associated with reimbursement on behalf of their employees.

Gee I wonder why so many pilots don't avail themselves to healthcare under the current system.

Now, all that said... Mental health records are subject to more than the usual level of protection from disclosure (some portions of the record can even be withheld from the patient). Mental health professionals also have ethical codes of conduct that preclude them disclosing unless certain criteria are met (then disclosure can even be mandatory, e.g. mandatory reporting for child abuse). Paper records are much harder to locate and get a hold of. People that pay cash don't have their info shared with insurance companies/employers and diagnosis codes aren't necessary for billing purposes. This is especially true if the psychologist doesn't do electronic charting connected to a health care system where the patient has relationships with other providers in that system. I suspect a psychologist would be willing to discuss possible diagnoses with a patient after a few initial consultation visits. Do what you will with that information.
 
ThatOtherGuy said:
Your opinion is legally incorrect. Psychologists are state licensed health care professionals. They're not in the same league as a fitness trainer, career counselor, or life coach. The 8500-8 clearly states an applicant has to "list all visits within the last 3 years to a physician, physician assistant, nurse practitioner, psychologist....".
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Brutal! We have no such requirement for our medicals in Canada (at least not class 3). I guess the OP could go to an unlicensed therapist, but it seems stupid to accept inferior services just for the sake of working around an ignorantly-designed law.
 
As a retired medical physician, some of the best advice I’ve ever had were from family members, friends that knew me well, clergy. Some of the worse advise I’ve heard were from licensed professionals. Sometimes it’s not a diagnosis she need, but changing paths and old habits.
 
Eldorado said:
Sometimes it’s not a diagnosis she need, but changing paths and old habits.
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Many times people know the answer to the question but are looking for a way to deny it. One of the first things anyone must do is to be brutally honest with themselves. The cost of fixing the problem (whether it's money, position, popularity, etc.) will be small in comparison to what could be lost if some conditions are not admitted to and a true remedy sought for and found.

One thing that helps many people is having a form of art in their lives. Either through drawing, music, writing songs, poetry, sculpting, or many other such things a release can be found for things that build up inside and drag us down.

Some do not have a way to release the ebbs and flows of life so they search for someone to help them manage the things that they can't seem to control. As humans we have a body, soul, and spirit that needs to be at peace. The advice above is spot on in that sometimes it is the change from old paths and habits and a move in an entirely new direction with a purpose that helps more than pharmaceuticals or therapist. Not to say that these don't have their place but usually the answer is easy when we are completely honest with ourselves.

Just one old man's opinion ...
 
FAA wants you well.
If you have a lot of s_uff going on how good a pilot can you be?

Use good judgement and self ground until it's over. Get any help you need. Pastors friends, if it has to be licensed professionals, get well. We'll sort it out when it's over.

GET WELL.
 
bbchien said:
FAA wants you well.
If you have a lot of s_uff going on how good a pilot can you be?

Use good judgement and self ground until it's over. Get any help you need. Pastors friends, if it has to be licensed professionals, get well. We'll sort it out when it's over.

GET WELL.
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Bruce, I appreciate your thoughts. However it doesn't address my question. Your statement assumes mental issues beyond what I posted. And as I said, nothing I haven't been living with for years and can't continue to live with for years to come. But also things that I know I should address. I've proven the ability to safely and proficiently operate aircraft and you've known me for some time (not disclosing true identity at this point) and last I understood anyway, you think I'm a good pilot. So to flip your statement around, how bad can my issues be if you think I'm a good (or at least decent) pilot who doesn't accept minimum standards?

So back to my original point of what options exist that won't screw up my medical, I'm taking from your post that essentially if it's any kind of licensed professional, that will create an issue that I have to deal with as far as maintaining a medical is concerned. If that's correct then I have the answer I need to examine what path to go with further.
 
ThatOtherGuy said:
Your opinion is legally incorrect. Psychologists are state licensed health care professionals. They're not in the same league as a fitness trainer, career counselor, or life coach. The 8500-8 clearly states an applicant has to "list all visits within the last 3 years to a physician, physician assistant, nurse practitioner, psychologist....". Officially you have to report psychologist visit(s) and any subsequent diagnosis.
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No, that's wrong. Why didn't you quote the instructions for this question on the form?

The answer to the OP's question is right on the form:

19. VISITS TO HEALTH PROFESSIONAL WITHIN LAST 3 YEARS -- List all visits in the last 3 years to a physician, physician assistant, nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for treatment, examination, or medical/mental evaluation. List visits for counseling only if related to a personal substance abuse or psychiatric condition. Give date, name, address, and type of health professional consulted and briefly state reason for consultation. Multiple visits to one health professional for the same condition may be aggregated on one line. Routine dental, eye, and FAA periodic medical examinations and consultations with your employer-sponsored employee assistance program (EAP) may be excluded unless the consultations were for your substance abuse or unless the consultations resulted in referral for psychiatric evaluation or treatment. See NOTE below.
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Having "issues" and wanting to talk to someone about them is not a "psychiatric" condition. And it specifically lists EAP consultations, which the OP asked about, as being not reportable.
 
UnregisteredOP said:
Bruce, I appreciate your thoughts. However it doesn't address my question. Your statement assumes mental issues beyond what I posted. And as I said, nothing I haven't been living with for years and can't continue to live with for years to come. But also things that I know I should address. I've proven the ability to safely and proficiently operate aircraft and you've known me for some time (not disclosing true identity at this point) and last I understood anyway, you think I'm a good pilot. So to flip your statement around, how bad can my issues be if you think I'm a good (or at least decent) pilot who doesn't accept minimum standards?

So back to my original point of what options exist that won't screw up my medical, I'm taking from your post that essentially if it's any kind of licensed professional, that will create an issue that I have to deal with as far as maintaining a medical is concerned. If that's correct then I have the answer I need to examine what path to go with further.
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If you really want to address these issues find a licensed professional and pay in only cash. Then omit on next medical application.
 
Eldorado said:
As a retired medical physician, some of the best advice I’ve ever had were from family members, friends that knew me well, clergy. Some of the worse advise I’ve heard were from licensed professionals. Sometimes it’s not a diagnosis she need, but changing paths and old habits.
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Did you ever receive actual counseling from a professional? If you haven't, then it's hard to say "best advice I've ever had" if it's the only advice

My ex wife, and as a defacto of that most of my friends, work in the mental health field. Friends aren't mental health professionals with experience in the field, and depending on the person and what's going on with them their friends, family, etc., may not be the best source of advice, in fact sometimes they're a big part of the issues the person is struggling with

If the OP needs help he should get the help. Your mind is the the most important thing.. don't ever let yourself start losing it

jstone said:
If you really want to address these issues find a licensed professional and pay in only cash. Then omit on next medical application.
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..and perjure yourself on federal documents? I'm sorry, but that's awful advice. Don't do this.


**btw, to the OP.. it says right on the FAA https://www.faa.gov/about/office_or...aam/ame/guide/app_process/app_history/item19/ that you need only disclose it IF the following are true

"
The applicant should list visits for counseling only if related to a personal substance abuse or psychiatric condition.
"

..do you have a psychiatric condition or struggle with substance abuse? You might just need someone to vent to and who can listen and offer some different ways of thought, etc., that go beyond what a friend or family etc may offer
 
Lindberg said:
No, that's wrong. Why didn't you quote the instructions for this question on the form?
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It's not wrong, and you're correct that it's on the form. That's why I quoted directly from the form.

1. The line I quoted was, "List all visits in the last 3 years to a physician, physician assistant, nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for treatment, examination, or medical/mental evaluation." Anyone reading that line with full comprehension will most definitely conclude that psychologist visits ARE reportable. Psychologist visits that result in a diagnosis are absolutely reportable under 18(m). One could make an argument that the OP should be answering yes to 18(m) for depression as stated in his/her post.

2. The post to which I replied recommended a visit with a psychologist to pursue CBT. I personally think that could be beneficial, but that's up to the OP to decide. That post equated a psychologist visit to other non-reportable visits which is inaccurate.

3. I didn't even address EAP as it was clear the original OP isn't enamored with the idea of utilizing his employer's EAP program (and I don't blame him). You are correct, EAP consultations are not reportable unless they're related to substance abuse or result in a referral to a licensed professional.

4. I never said having "issues" is a psychiatric condition, but since you want to go there... "Issues" could be a symptom of a psychiatric condition, and mental health professionals are trained to look for said conditions. I stated that mental health professionals usually bill insurance, and in order to bill insurance they have to indicate a diagnosis and a procedure. If the wrong diagnosis code ends up on your chart you've now got a psychiatric condition and it's going to be up to you to disabuse that diagnosis. In some cases the psychiatrist/psychologist won't even inform the patient of the diagnosis for their own well being. That is the risk of using insurance when visiting a psychiatrist/psychologist.

I don't have a problem admitting when I'm wrong or someone disagreeing with my opinion. I only ask that if you're going to make assertions about the accuracy of my posts I would appreciate if you'd actually take the time to read the thread.
 
I seriously wonder how many pilots there are out there who basically have themselves together but could benefit from talking to a professional now and then who don't because of the risks to their medical.

I am well aware there some mental issues that someone really really shouldn't be flying with. OTOH you have people like OP who, taking everything at face value, has things under control but could use a little help. I know we always say "health first flying second" around here, considering that most of us do this recreationally it's a good mantra. However this is one area where I feel like it may fall short.

Attitudes around mental health are changing, it used to be looked at as something for crazy people. Now we're shifting to see it more like going to any other medical professional. I still have my doubts about it but having seen someone close to me who was pretty stable in public benefit greatly in private from talking to someone my own opinion is... evolving.

For people in the sort of situation where they've been living with some sort of mild depression for a very long time and learned to deal with it, it's not so straightforward of a question. Especially if it's a question of livelihood. They've lived this long with the issue, they can probably keep going. Why risk your career, why risk this recreational activity that is bringing joy to your life? Maybe the life changes from losing the medical will make your mental health worse. I strongly suspect there are a lot of pilots out there not seeking help for this exact reason.

Not sure what the best solution is but the FAA and flying community in general really should address this IMO.
 
ThatOtherGuy said:
It's not wrong.
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Yes it is. You said all psychologist visits must be reported. That's not true. It's explicitly contradicted by the 8500-8.

https://aviatorshq.com/can-pilots-see-a-therapist-psychologist/
https://www.aviationmedicine.com/article/counseling-depression-and-psychological-support/

From AMAS:
FAA Reporting Requirements
A 1991 change in the reporting requirements on FAA Form 8500-8 mandated all visits to health care providers, including counselors and psychologists, were required to be reported on each physical. The Federal Air Surgeon (FAS) wrote a letter to all Aviation Medical Examiner’s (AMEs) in September 1992 acknowledging that the effect of this interpretation of the 8500-8’s instructions discouraged pilots from seeking mental health assistance. The FAS indicated that the FAA encourages pilots to seek assistance for all conditions, but does not want to restrict flying for those conditions that did not affect flying safety. His clarification, later incorporated into the explanation section of question 19 on the 8500-8, stated that visits to mental health professionals were reportable ONLY if it was due to alcohol/substance abuse OR resulted in a personal psychiatric diagnosis.

Clearly, pilots and controllers seeking counseling for marital or family problems who were functioning well, but seeking to improve their situation, have no obligation to report that counseling. Counseling by clergy, or even your personal physician, is not reportable if there is no personal psychiatric diagnosis, no alcohol or substance abuse and no treatment with medications. Visits to Employee Assistance Programs (EAP) for conditions described above are also not reportable. (emphasis mine)
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Pilots are scared enough about getting help and losing their medicals. Why scare anyone unnecessarily?
 
UnregisteredOP said:
Bruce, I appreciate your thoughts. However it doesn't address my question. Your statement assumes mental issues beyond what I posted. And as I said, nothing I haven't been living with for years and can't continue to live with for years to come. But also things that I know I should address. I've proven the ability to safely and proficiently operate aircraft and you've known me for some time (not disclosing true identity at this point) and last I understood anyway, you think I'm a good pilot. So to flip your statement around, how bad can my issues be if you think I'm a good (or at least decent) pilot who doesn't accept minimum standards?

So back to my original point of what options exist that won't screw up my medical, I'm taking from your post that essentially if it's any kind of licensed professional, that will create an issue that I have to deal with as far as maintaining a medical is concerned. If that's correct then I have the answer I need to examine what path to go with further.
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I answered that way because it is not possible to know, based on what you wrote. Surely you cannot expect a good answer based on no specifics (which I think you should not post).

There is a difference between a psychiatry condition that requires treatment, and a psychiatry condition which does not require treatment and is not symptomatic.

Unfortunately using licensed professionals,commonly moves a pilot from Situation #1 to Situation #2 (though not always).

The ONLY situation specifically exempted from reporting is marriage counseling!
 
bbchien said:
Unfortunately using licensed professionals,commonly moves a pilot from Situation #1 to Situation #2 (though not always).
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That's essentially what I'm trying to avoid.

The ONLY situation specifically exempted from reporting is marriage counseling!
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Well that's out. My wife is fantastic.
 
The entire way the FAA views mental health is antiquated and backwards. How many pilots suffer in silence with treatable (though admittedly not curable) conditions because they don’t want to lose their cherished passion or even more importantly for those who’s job would be jeopardized by a medical revocation.

Wouldn’t we all rather have a pilot who is under treatment for his/her depression, adhd or whatever else they struggle with, rather than keeping it quiet.

I still find it ridiculous that I can legally be trusted with explosives/NFA firearms at 21 with a 3 year old suicide attempt, but somehow a class 3 medical for recreation is completely out of the question for the next 7 years.
 
Whatever you do, DO NOT use your primary care physician. I’m stuck in a rut where I have a “diagnosis” of panic attacks and agoraphobia, and a fear of flying, based on a 5 minute conversation where I mentioned I get motion sickness when flying, and was asking if something can be prescribed to help.

I’ve been seeing a licensed mental health councilor after dealing with some family issues back in 2018, and after a detailed history, and months of discussions when I recently mention what I discovered in my medical records in preparation for a class 3 she was floored by the fact that such was documented.

Now, I have to jump though numerous expensive hoops to prove otherwise.

My advice is to ALWAYS, discuss what your diagnosis will be. Had I known about it earlier on, I would have pursued an opinion from a specialist at the time.

For people like me, regulatory medicine is simply too black and white for an area that has many grey areas.
 
UnregisteredOP said:
That's essentially what I'm trying to avoid.
Well that's out. My wife is fantastic.
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Be careful. She doens't have control about that. Find out what your provider CODED. that is controlling as that is what can be found. If if you omit something that by code should have been reported, the _rap will rain down upon you for a very long time.

The CODES are accesable to the Federal administration upon request.
 
We have "English proficient" on our certificates. Somehow...

The form says: "List visits for counseling only if related to a personal substance abuse or psychiatric condition."

So don't list the visit unless it's for a personal substance abuse or psychiatric condition.

Just be honest. if the counseling is for personal substance abuse or psychiatric condition, list it. If not, don't.
 
jbarrass said:
We have "English proficient" on our certificates. Somehow...

The form says: "List visits for counseling only if related to a personal substance abuse or psychiatric condition."

So don't list the visit unless it's for a personal substance abuse or psychiatric condition.

Just be honest. if the counseling is for personal substance abuse or psychiatric condition, list it. If not, don't.
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I think the point is being made that the OP may not think he has a psychiatric condition, but a psychologist may diagnose him with such condition(correctly or erroneously) all the same. If that’s done and coded, there is no easy way back and it has to be reported
 
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