Therapy and Your FAA Medical: What Pilots Need to Know
- Jun 10
- 4 min read
Updated: Jun 25
Many pilots avoid therapy because they fear it will cost them their medical certificate. The FAA's updated guidance, released May 2026, takes a clear position. It encourages pilots and air traffic controllers to seek help at the first sign of difficulty, and it treats therapy as compatible with medical certification.
This article explains how therapy intersects with FAA certification: what gets reported, what stays off the report, when a pilot self-grounds, and what the FAA reviews when therapy appears in a medical history.
For a full overview of the evaluation process, see the FAA Evaluations page.
Can pilots and air traffic controllers go to therapy?
Yes. The FAA encourages it. Aviators benefit from therapy at different points in their careers, and the agency frames early help seeking as a sign of insight rather than a liability. Therapy is often used to address anxiety, mood symptoms, life transitions, relationship challenges, and stress management.
Does seeing a therapist create an FAA-reportable diagnosis?
A therapy visit becomes a diagnosis only when the provider assigns one. Speaking with a therapist often produces an assessment, which may or may not reach a diagnostic threshold. The provider makes that determination using their clinical judgment.
When do pilots report therapy to the FAA?
Pilots report therapy at their next application for a medical certificate, putting it on the MedXPress application rather than the moment treatment begins. Air traffic controllers follow FAA Order 3930.3C and consult the appropriate flight surgeon before performing safety-related duties.
What therapy has to be reported?
All visits to licensed healthcare providers, including psychotherapists and counselors, belong on the MedXPress application. Several categories stay off the report:
Couples counseling stays off the report until the aviator receives a referral for individual therapy.
EAP consultations stay off the report until the consultation leads to a referral for psychiatric evaluation or treatment.
Educational counseling stays off the report.
Religious counseling stays off the report, with one exception: it becomes reportable when the clergy member also holds a counseling license.
When should a pilot self-ground?
A pilot self-grounds when symptoms reach a severity that impairs concentration, memory, emotional stability, judgment, decision-making, or alertness. The FAA gives examples that warrant immediate self-grounding:
Loss of control with alcohol or mind-altering substances, including medication misuse.
Major depression with low mood, loss of interest, and sleep disturbance.
Delusions, hallucinations, or paranoia.
Severe anxiety or panic attacks.
Rapid mood changes or difficulty regulating emotion.
Suicidal thoughts.
Any mental state that distracts from cockpit functioning, awareness, or communication.
Self-grounding reflects good insight, and the FAA views it as a sign of sound judgment.
Can pilots keep flying while in therapy?
Yes. Therapy is compatible with an unrestricted medical certificate and with special issuance. Many pilots and controllers continue therapy, or resume it, while holding a special issuance. Medication adds requirements, and the approved-medication pathway carries its own steps.
What does the FAA review when therapy appears in a medical history?
The FAA focuses on five things: diagnosis, insight, stability, current functioning, and risk factors. It looks for evidence that the aviator can recognize symptoms, seek appropriate help, self-assess fitness for duty each day, and self-ground when warranted. Transparency carries weight in the review. Accurate disclosure tends to move a case faster than an incomplete account that later contradicts the records.
Why your therapist's documentation matters
The FAA publishes separate guidance for the therapists who treat pilots, updated May 2026. It asks providers to document using DSM-5-TR terminology, to record the specific criteria met along with severity, insight, and capacity for self-monitoring, and to keep psychotherapy process notes separate from clinical progress notes. It asks them to avoid both upcoding and minimization, using V-codes or Z-codes when a presentation falls below diagnostic threshold.
Most therapists treating pilots have never seen this document. A well-meaning provider who overstates a diagnosis, omits severity and insight, or applies terminology outside the DSM-5-TR framework can turn a clearable case into a deferred one. Documentation written to FAA standards reflects the diagnosis, severity, insight, and current functional status the agency reviews.
Where a neuropsychological evaluation fits
When the FAA defers a case or requests further review, it may call for a neuropsychological evaluation by a HIMS-certified neuropsychologist. The evaluation documents diagnosis, severity, insight, and current functioning in the format the FAA expects, and it addresses each concern raised in the deferral letter.
Next steps
A therapy history rarely ends a flying career on its own. With accurate disclosure and documentation prepared to FAA standards, many pilots move through certification with less friction than they feared.
If you carry a therapy history and face an upcoming medical application, or if you have received a deferral letter requesting a full evaluation, set up a free 15-minute consultation to discuss your situation.
Related resources
Written by Jason Olin, PhD, Licensed Clinical Psychologist and Neuropsychologist.
Dr. Olin provides psychological and neuropsychological evaluations for high-stakes testing and licensing decisions, including FAA-related evaluations. He sees clients onsite in Newport Beach, California, and by telehealth across 43 PSYPACT states and New York.
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