Questions to Ask a Therapist Before You Book: Pilots

Many pilots think about therapy for a long time before they reach out. Part of what holds people back is not knowing what to ask. Will this person understand a trip schedule? Where are they licensed? What happens if I'm on a layover when my session comes around?

A short consultation call before you book is a good place to get those answers. Below is a practical list of questions for that call, and what to listen for in the answers. You don't need to ask all of them. Pick the ones that matter most to you.

This post is about vetting a therapist before you commit. If your main worry is the FAA or your medical certificate, start with our guide, Will Therapy Affect My Medical? A Pilot-Friendly Guide to Getting Help, and take questions about your own certificate to your Aviation Medical Examiner (AME).

Before the call: get clear on what you want

You don't need a diagnosis or a polished explanation. A sentence or two is enough:

• "I've been running on empty for months, and it's affecting my sleep."

• "Things at home are tense, and my schedule makes it harder."

• "I get keyed up before checkrides and want tools to manage it."

• "I just don't feel like myself."

Knowing roughly what you want help with makes it easier to tell whether a therapist is a good match. It also helps to have your typical month in front of you (trip lengths, reserve, commuting) so you can talk about scheduling in concrete terms.

Questions about fit and experience

"Have you worked with pilots or other aviation professionals?"

Airline, corporate, and charter pilots, flight instructors, and other aviation professionals deal with things many people don't: irregular duty periods, time away from home, high standards, and a culture that values staying composed. A therapist doesn't have to be a pilot to help, but it's fair to ask how familiar they are with the work. Listen for an honest answer rather than a sales pitch.

If you're weighing whether aviation familiarity matters for you at all, see Do Pilots Need a Specialized Therapist, or Is Any Therapist Enough?

"What do you usually help people with?"

Pilots come to therapy for stress, burnout, anxiety, relationship strain, sleep and schedule problems, grief, career transitions, and questions about identity outside of flying. Ask whether the therapist regularly works with the thing that brought you to the call.

"What does a session with you actually look like?"

Some people want structured, practical tools. Others want space to talk things through. Many want a mix. Ask how a typical session runs and whether you'll leave with something to practice between sessions. Stephen's pilot pages describe using cognitive behavioral therapy (CBT), a structured approach focused on the link between thoughts, feelings, and behavior.

Questions about licensing and where you can meet

"What is your license, and in which states can you see me?"

Therapists are licensed by state, and you can look up a license yourself on the state's official site. Ask for the license type and number, then check it.

For example, Stephen Rought is a Licensed Clinical Social Worker (LCSW) in California, license #118018, which you can look up on the California Department of Consumer Affairs license search. He is also registered with the Florida Department of Health as an out-of-state telehealth provider (registration TPSW5524), so sessions for clients located in Florida are online only.

"What happens if I'm on a layover in another state?"

This is the question many pilots don't think to ask. Telehealth rules generally depend on where you are physically located during the session, not where you live. So a session that's fine from your living room may not be allowed from a hotel room in another state. Ask the therapist what their policy is for sessions when you're traveling, and how rescheduling works if you can't be in an approved location.

"Do you offer in-person sessions, telehealth, or both?"

Many pilots like in-person sessions when they're home and secure video when they're not. Stephen offers in-person sessions in Chino Hills, California, along with telehealth for clients located in California and Florida. In-person office at 14712 Pipeline Ave B, Chino Hills

Questions about privacy and confidentiality

"How do you handle confidentiality, and what are its limits?"

Licensed therapists follow legal and ethical confidentiality rules, and those rules have exceptions, such as situations involving serious risk of harm or legally required reports. A good therapist will explain the limits in plain language rather than promise more than they can. [CLIENT TO CONFIRM: Stephen approves this general description of confidentiality limits] Be cautious of anyone who promises that nothing could ever affect your career. No therapist can guarantee that.

"What records do you keep, and how are they stored?"

It's reasonable to ask what goes into your record, who can see it, and how it's protected. Stephen notes that he takes steps to minimize unnecessary digital storage of sensitive client information whenever possible. [CLIENT TO CONFIRM: current record-keeping practice as described on /pilot-therapy]

"What platform do you use for video sessions?"

Ask which video platform the therapist uses and whether it's designed for healthcare. Stephen's site says online sessions are held on doxy.me, a HIPAA-compliant telehealth service.

"What can you tell me about FAA questions?"

Be clear about roles. FAA medical rules are set by the FAA, and decisions about your medical certificate are made through the FAA medical system, starting with your AME. Stephen Rought is a therapist. He is not an AME or a HIMS evaluator, and he doesn't make medical-certification decisions. A good therapist will tell you what they can help with, such as stress, anxiety, sleep and relationships, and will point you to your AME for certificate-specific questions. You can find an AME through the FAA's AME locator.

If you're already in the HIMS program or expect to be, ask any therapist exactly what role they can and can't play, and confirm requirements with your HIMS AME.

Questions about scheduling, cost and other support

"How flexible is scheduling around trips and reserve?"

Ask how booking works around changing schedules, how far ahead you need to book, and the cancellation policy. Stephen's site describes flexible options that work around demanding flight schedules.

"What does a session cost, and do you take insurance?"

Ask about fees, which insurance plans are accepted, and whether you'll get a superbill (an itemized receipt) for possible out-of-network reimbursement. Stephen's site says he accepts Aetna and private pay and offers superbills. Current details are on the Getting Started page.

"How does therapy fit with other support?"

Therapy is one option. Many in aviation also use peer support programs through their union or employer, or an employee assistance program (EAP). A good therapist will be comfortable with you using more than one source of support.

What to listen for

Signs of a good fit often include:

• You feel heard rather than rushed.

• Things are explained in plain language.

• The therapist is honest about what they do and don't do, including the limits of confidentiality and anything FAA-related.

• They don't make promises about your medical certificate or your career.

• They give straight answers about licensing and where you can be during sessions.

• You can picture yourself talking to them about something hard.

If something doesn't feel right, it's fine to keep looking. Finding a good match is part of taking care of yourself, not a failure.

Frequently asked questions

Do I need to know exactly what's wrong before I call?

No. "I haven't felt like myself" is a perfectly good place to start.

Is a consultation call the same as starting therapy?

Usually not. It's a short conversation to see whether you're a good fit, and you decide afterward whether to book. Stephen offers a free 15-minute consultation.

Can a therapist tell me whether therapy will affect my FAA medical?

A therapist can talk through your concerns, but questions about your specific medical certificate should go to an AME. Our guide Will Therapy Affect My Medical? covers the background.

How do I check a therapist's license?

Use the state's official lookup. In California, that's the Department of Consumer Affairs license search. In Florida, use the Department of Health license verification portal.

Ready to talk?

If you're a pilot or aviation professional and you've been thinking about therapy, a consultation call is a simple first step. Learn more about therapy for pilots with Stephen Rought, LCSW, bring the questions above, and see whether it feels like a fit.

Call (408) 357-0265 this is the right number for new clients or schedule a consultation from the pilot therapy page. Bring your questions and we'll start there.

Stephen Rought, LCSW (California #118018). Florida out-of-state telehealth registration TPSW5524 (telehealth only). Chino Hills, CA.