The professor kind of scoffed at me at first when I brought up pilots as, like, a marginalized group, and he laughed in my face and I was like, excuse me. And I kind of showed their receipts of the federal policies that have their restrictions. And, you know, his jaw was on the floor.

Welcome to therapy is my therapy, a podcast where licensed counselor Olivia and unlicensed client Tanya, you delve deep into real and raw conversations in order to demystify what really happens in that 50 minutes hour. Heads up. This podcast contains strong language and sensitive topics related to mental health.

Hey, everyone. Tanya here in this episode, we talk about the hidden stigma that pilots face in regards to seeking mental health support. The idea for this episode was inspired by a conversation with my pilot friend, who had told me that they were struggling with emotional issues but couldn't ask for help without fear of being grounded by the Federal Aviation Administration, aka the FAA. So we reached out to Cora, aka the aviation therapist, who's a part of the fight to help aviation professionals feel that they're able to seek help without being punished for it. Cora provided us with valuable insight in regards to this fascinating intersection of public safety, personal autonomy, and the stigma of mental illness, both societally and within the aviation subculture.

And if you'd like to learn more.

About Cora, she can be found at aviation therapist on Instagram, and we've left links to her and other resources in the show notes. Enjoy the episode.

So thank you for joining us, and if you want to tell us a little bit about yourself.

Sure. So I am Cora, starting the therapy journey about seven years ago. I started out mostly working with men out here in my community of Portland metro area. Portland. There wasn't many spanish speaking providers, so accessibility really guided my entrance into therapy. And then my roommate is a pilot, and so he told me about the restrictions for FAA. So kind of like accessibility. Again, how do I get that service to people? So I've been doing that for about two and a half years now. For good or bad news, depending on how you've looked at it. Business has been booming. So I've hired three other counselors to work for me, started an Instagram account. I did not expect for it to take off the way it did, so that's obviously an indication of the need in the industry, and it's a niche market, so that's what I do mostly. I'd say it's 80% working with pilots and then ATC or anps that also have medicals that they need to hold. And then also I get flight attendants where they're not under any government restriction for therapy, but it's nice to just have someone that understands the industry. But I'd say, yeah, predominantly, it's mostly pilots.

We had initially reached out to Cora because we wanted to speak to someone who was part of that fight to help pilots and aviation industry workers feel like they're able to reach out or access mental health support. And for myself personally, I came up with the idea because I had, I'm just going to figure out, to maintain confidentiality. I have a friend who is a pilot, and they were dealing with some personal issues, and they weren't in a really good place. And generally, my first suggestion to anyone is, have you spoken to a therapist? Are you able to do that? And, well, they replied with, I can't, because if I do, it's a mark on my record, and it could cost me my job. And that completely blew me away because I didn't consider it before. But I can see how the aviation industry would keep track of mental health reports and other health concerns that pilots may have. But that's fucked up, because by reaching out for help, this person would be punished and could cost them their job. And from what I understand, most pilots, this is their livelihood, this is their passion. They love to fly. And to even have that being risk taken away, I can see why it would be very difficult for this person to reach out. So for me, this topic was really interesting to me because it's this really fascinating convergence of public safety, personal autonomy, and the societal stigma of mental health. Olivia, if you have anything you want to add.

Yeah, I mean, it's something that I had awareness of just from my own work as a therapist, that there are groups of people in different occupations that really can't seek therapy without there being risk, especially if you're going through insurance, there being risk of it affecting their job. And so I knew that with things like military police, that kind of areas, but I didn't even think about that being an issue with pilots. And it makes so much sense knowing it now, especially when that's a job that you have to do well at such a high percentage that if you do anything wrong, it has such catastrophic effects that I can't think of a group that would be able to use mental health services more. And so learning that that's another occupation where they really aren't able to was very sad to hear. So I'm really glad that you're able to provide that. And I guess, just like I know you said, you have a roommate who was a pilot. So hearing that experience, how did you go about getting into the work you're doing?

Yeah. So Tanya brought up a really good point earlier about kind of like this convergence of public safety and the social implications of it. And prior to working with pilots, I was working with a lot of those jobs you had previously mentioned, like doctors, police officers, military. But what I found was really interesting from pilot perspective is that there is actually the arm of a federal policy. And I feel like that's what makes this really unique. So I'm working on my second master's right now, master's of social work, and it kind of worked out. The first year I started this journey, I took a policy class, and the professor kind of scoffed at me at first when I brought up pilots as a marginalized group, and he laughed in my face, and I was like, excuse me. And I kind of showed their receipts of the federal policies that have their restrictions. And his jaw was on the floor. My graduate school is really known for working with marginalized communities and making health care and social work accessible to people, but it's been really shocking going to one of those schools that really prides themselves on that. But we're not talking about federal policies that really impact people's ability to get mental health care outside of the social stigma. And so that's kind of for better or worse. I took that policy class, and it really made me go through the FAA stuff with a fine tooth comb. The professor, he was a really hard grader. So that kind of motivated me more to be very diligent about it. So at the time, I was like, okay, this is annoying, but since then, it's been two years, and I still use a lot of that knowledge that I learned going through policy stuff. So that reinforced it just because it's just wild. There's a federal policy regulating mental health, and you don't normally see that, as we said earlier, with military, law enforcement and medical staff. So that's what kind of blew my mind was like, wow. Whole governmental national agency has decided this, and it just didn't make sense from a mental health standpoint. So, for example, this might be a little bit of a tangent here, but one of the things that really stood out to me about the policy was that they said mood disorders were a disqualifying disorder to fly. And growing up in the, you know, we throw sad around seasonal affective disorder like it's candy because it's dark a lot of the time here. And so, technically speaking, sad is a mood disorder. So to bar someone from flying. If they report having seasonal affective disorder, that just blew my mind. As someone who knows everyone and their cousin, that usually gets it every year. And for folks listening, a mood disorder is basically where you're stuck in the same mood for more than three or four months. And that's when we kind of start to get worried when you can't shake it. But if you live somewhere where the climate is dark four, five, six months out of the year and you have a therapist that's just trying to do their best and diagnose you, that can bar you or at least put you on pause from flying. So that's adding the policy to real life. Just didn't connect.

I just wanted to take a second for the listeners, if Cora could fill us in on what the FAA or the organizational body that does the policy, just so those folks can have an idea as to who are these people that are making the policies.

So the FAA is the federal regulating body. It stands for the Federal Aviation Administration. So basically, anything you're doing with airplanes, whether it's drones, flying, medical, they are the overseeing body of that. So you refer back to it a lot when you're in the industry, it's kind of like the big rule book.

Could you tell us more about what the policy is? I know you mentioned a few of the things of, like, mood disorders. Just overall, what is the policy around mental health?

So for folks listening that don't know, pilots have to go in annually for their annual medical. And I think once they reach 45, they have to do it every six months. Don't quote me on that, but I think that's the age where they have to do it twice a year. And they meet with their ame, which stands for an aeronautical medical examiner. And the job of the Ame is to go through, make sure there haven't been any changes. And some of the changes that they look for are mental health visits. So you are required to report any medical professional visit is actually, the language used in the policy is a medical professional visit. And depending on what kind of mental health you are seeing, especially here in the US where we go through insurance, and that requires a. Sometimes, you know, I'm sure you can relate, Olivia. We're put in a really hard place of, like, we need to give this person care. And maybe the puzzle piece of the diagnosis doesn't quite fit, but we got know get it to go through insurance. So you get a specific diagnosis, such as depression, ADHD is actually one of those interesting ones where regardless of if you've kids of the 90s, we threw that word around like it was candy. So even kiddos that were diagnosed in third grade or 6th grade, that diagnosis, if you report it, will follow you. And that's one of the ones that will bar you completely. Some of the other ones that maybe might put you on pause might be depression, single incident anxiety or depression. And so I'm not going to say that reporting it is an automatic no more flying because that's not true. But generally the consensus from the policy and folks I've worked with is you get put on pause. The FAA does kind of investigation to just make sure you're safe, but that becomes an issue if you're not flying. And that's your livelihood. It's famously known for taking months. So if you've trained to fly since you've gotten out of high school and now that's on pause, it's really hard to go find another job because so many of the people start really young and then you have to pay for the evaluations. Like I was saying earlier, all out of pocket. And it's a very limited amount of providers approved by the FAA, which costs thousands of dollars, which circles back to, if you're not making an income, then that's going to be really hard to do that. So a lot of pilots just forego mental health care because it's this big scary thing and you might not be able to fly forever or you might have to pause. I do know some people that have gotten really lucky and it's been really streamlined and the FAA has come out to make more positive changes. But I think it's this crux of acknowledging that there are positive changes being made, but also honoring the struggle of people that have had their livelihoods ruined. And so I run an Instagram account, and sometimes people are like, you're a little negative about the FAA. And it's like, yeah, I try to do a good balance of, hey, these are new policies being passed, but also to just tell everyone whose lives got turned over, like, it's okay. Now, there's this new policy can also definitely rub people the wrong way because I think it's important to honor the struggles of people before you because that's usually why changes get made. So I think I answered your question.

That was fantastic.

Yeah, definitely.

Okay, so there seems to be a mix in regards to the FAA's policies that a lot of them are based out of the also a lot of them were very big responses to there's a chinese airline and the 2015 german wings incident. And this industry has such tiny margins of error. I'd love to hear your thoughts on how that response. Is it proportional?

Yeah. So I do work with some airlines. Shout out to alaskan horizon if anyone's listening. The selling point and kind of why we've started collaborating is this idea of redundancy. And so it's really interesting in an industry that is so redundant, checklists after checklist and all these safety measures that eventually I'd like to sell mental health care as like a redundancy, like a safety feature, because that's kind of how they're seeing it. I think there's a huge part of the FAA not wanting to acknowledge it because, say, for example, God forbid a pilot reports to the FAA that they were depressed or whatever, and then another german wings happens. For folks listening that don't know, german wings happened a few years ago. The pope pilot was suicidal and then they locked, can't remember if it was the first officer, captain out and then crashed into the side of the. I believe so. You know, say if that were to happen, the FAA went to court, say the know, the loved ones that died wanted to sue, which they should because their family just got obliterated. If the FAA acknowledges that they knew, they're on the hook for millions of dollars. And so in terms of the assets they're trying to protect, they can't be held liable if they never acknowledge that they knew about it. And so it kind of opens this wormhole of like, if we acknowledge it, then if something does go wrong, how much on the hook are we going to be financially liability wise? So I think, I don't agree, but that's my guess as to why.

Yeah, it just sounds about right for how things go in the mental health industry. And like you were talking about earlier with insurance for people who are not in the field and don't know what that looks like for you to provide care for your clients who have insurance and who are using insurance, which is often the only way they can afford it because out of pocket is a lot, then you have to prove to the insurance company that there is medical necessity to see them, which means you have to give them an approved diagnosis to continue care. So a lot of times that happens where there's things like grief or other transitions that are normal for people to struggle with. Like, let's say your mom just died. Yeah. If you're a pilot and your mom just died, you're probably really sad and it would really help to talk to someone, and that doesn't necessarily mean that you're at risk of harming yourself. It's just that you're going through a major change. But insurance won't cover that unless we can diagnose you with something, even though there is nothing that is really out of the ordinary about what symptoms you're having. So it's like a whole. Like you said, it's that loop of, okay, well, I can't help you if I don't diagnose you, but if I diagnose you, I'm screwing you later, because then you can't do your job. And that the only alternative is like, well, you can't use your insurance.

So that kind of leads to, how do I see all these pilots as therapists? So basically, we call it life coaching. That was really important. That's technically not a professional medical visit, I'm sure. Olivia, as you know, as therapists, we're bound by our state licensure as to what other states we can practice. And so just life coaching. There's no diagnosis needed. And usually it kind of does work out to be like that. A lot of folks come for career advancement or just like, processing or gaining skills. So it kind of does fit that and then making the prices accessible. So basically, I was like, how much does insurance charge? I literally just cut it in half. So from what I make at the brick and mortar clinic, I just was like, well, we're not putting in the effort to do all this filing and paperwork, so just cut it in half. It makes it accessible to people. So that is how we get around it, is just calling it life coaching and then making the access point of pricing very easy. And then we also have, like, a sliding scale, which is 50% of what 50% was. So, yeah, accessibility is really important. And if I have to call it life coaching for people to have access to it, let's do it. Right.

And so that also allows you then to see people virtually across state lines, which you can't do as a therapist unless you're licensed in each state.

Correct. So the way I do it is coming from Oregon. I will read people the mandatory reporting laws. That's something I'm not here to mess with. I'll let them know, the ones here in Oregon, and then from whatever state they're joining me, I will search for it and then read it to them. So, at bare minimum, I am a mandatory reporter. That's never going to change, regardless of if it's life coaching versus therapy. And then when you do practice over state lines, making sure that we're honoring those mandatory reporting laws and it's really important. Anytime I start with a new client, that's the first thing I go over is like, these are the very specific things I need to report outside of that confidentiality. If it were like a pyramid, confidentiality would be on the bottom as the base. So just giving people transparency and what I like to call a consensual choice to continue knowing what I'm obliged to report to local law enforcement. So while I can get away from a lot of the clinical stuff, mandatory reporting is something I do take seriously. I'll share the four that Oregon has. They cover most states. I still will look it up. If you're my client, I'm going to say the first thing mandatory reporting wise is if you're actively suicidal, and that doesn't mean you've contemplated it or you've thought about it. For me and this is where, depending on your therapist, this could be interpreted many different ways. So this is why I try to be specific as possible. So suicidality, if I feel like you're going to take your own life within like five or ten minutes of telling me, God forbid, on the phone, then that's when I would report it. If you've report previous attempts or just thinking about it, that's not going to raise the same amount of flags as if I really thought it was an immediate and imminent threat. The second one is if you tell me the first and last names of someone you would like to murder, if you have homicidal thoughts, and again, something I think that's going to be immediate and imminent, then I would need to report that. The third one is if you tell me the first and last names of an older, vulnerable adult or child that has been abused or neglected, then I would need to report that. And then if you name first and last names of any two people within a correctional institution that have had sex, then I would need to report that. In Oregon we have what's called PrIA, the prison Rape Elimination act. So yeah, people like out of state always laugh at that. I'm like, I didn't make it up, but that is something I am contractually obligated to report.

It ties me back to the FAA in regards to, I was doing a bit of research and so ADHD, if I understand correctly, that's something that's no go if you are diagnosed with it. And then there's other things such as I was learning about how there's four ssris that seem to be sort of approved. And I read those ones. Those are rough. Those are rough. Ssris. I've done that dance and I've been on at least one, and one of them is okay and the other one is unpleasant and it depends on the person because each person responds differently. And that's one of my points is what if those four suck for that pilot, but this other one that's off that list, that one works wonderfully and they're functional. What happens then? Does the FAA go, sorry, they're not on the approved list, so you don't get to fly.

That's actually one thing. I'm glad you brought that up. Going back to highlighting good things while also honoring the struggles of stuff before, that's one of the things they are working to expand. I think they might have more than four now, maybe five or six. Yeah. So I guess hopefully wait or talk to your doctor or therapist about hopefully addressing it another way. But to your point, yeah, you're kind of stuck, unless you want to go under hiding, and that's like a whole nother wormhole that I don't recommend. So to your point, yeah. If you're starting out and you're depressed or feel like you need medication, it might look like taking that approved list into your doctor and being like, all right, do you want to start in alphabetical order? Do you want to start in kind of going from there? I hope to see it expand more. I hope they continue this momentum after just adding the other one. But I don't know. Hopefully we'll see more people and more research come forward to say it's not a death sentence. And what a lot of people don't necessarily know is that you can be on an antidepressant or an SSRI for less than a year, maybe a few months. That's what we call like a bridge. Say if you're going through something really tough, your doctor might prescribe, let's do three months while you're grieving this family member. So a lot of people think once you're on it, you're on it forever. And that scares people away, too. So to also in the mental health community say, hey, it's not forever, let's just do it for two or three months, see how it is. That can also have people feel hopeful. But unfortunately, flight crew are kind of stuck to those five.

So as you were starting this and able to find the little loopholes so that you could still do the work and make it accessible, what was the response from pilots who were interested in working with you? Did you have a lot of pushback? Like, were there barriers? You faced to them trusting you, obviously, you're doing all of the work of informing them what the limitations are, making them aware that as much as possible, it will be confidential. But how was their reaction to that?

Yeah, good question. I run an Instagram page. It's basically like two thirds meme, one third mental health tips. And so I feel like I gain a lot of legitimacy from, God, this is a stupid sentence. I gain legitimacy from making memes because the memes are so specific. So I feel like people see that and they're like, oh, you know, this tiny thing. And so seeing that also just living with a pilot, people are like, why do you give a shit? Basically? And I'm like, my best friend is a pilot, and I treat people as if I would treat him and not want him to lose his medical. Also, just using the lingo and using the talk kind of legitimizes it. I think in general, I hear people say like, oh, I've been looking for someone like you. And I think, like I was saying earlier, there is value. And even if you're cabin crew and you don't have the same toughness of medical, to not have to pay someone to explain the ins and out of your job, so even if that's ten extra minutes in a session, that they don't have to go through the basics of their employment, people see value in that. So I'd say again, memes, and just kind of what I post get shared. And people are like, oh, if you know about this little thing, then you must know about this. And then just having conversations with people, I think I get a decent amount of referrals, too. So outside of Instagram or my website, I'll get messages of like, hey, so and so recommended you. So that always feels really good when I get a referral because that's obviously someone that was happy and feels like I knew what I was doing and sent their colleague to see me or one of my other professionals. If it's like a conflict of interest, obviously I'll send them to someone else that works with me. So, yeah, I guess the Internet and word of mouth.

Yeah, it sounds like the cardigan effect, the healthy balance of memes and humanness and also education and professionalism that shows them you know what you're talking about, but you also get it.

Yeah. And I think working, obviously, aviation is kind of more of a male dominated industry. So I've had training prior to this, working with men and men's issues. So that I think has really helped as well, is just saying, like, hey, this is what my background know. Mental health is kind of, at least out here. I can't speak for the US, but I feel like we have an abundance of women therapists and not a lot of men. So while I can't just spontaneously become a man, I can at least put effort into some of their issues. And so I do have men say, like, you're the first one that has even talked about men's issues in a not ironic way. So, yeah, just putting that out there, everyone has their issues.

I just had two questions. So the first one is, how did you learn the language required to make some pretty fire dank memes? And also, actually, no, let's start with that.

Okay. Yeah, so I follow a lot of meme pages. I'm going to do a non sequitur here for a second. So I went on a date recently, and it was with someone in aviation, and they were like, yeah, let's hang out. And we hung out. And they're like, honestly, the only reason I hung out with you so soon was that I saw all these meme pages were following you. So I knew you had to be a real person because a bunch of the meme pages follow my personal page. Also talking about legitimacy, these meme pages that know what they're talking about in the industry are reposting my stuff, and we have relationships and they follow me. So being like, oh, okay. These people who are definitely pilots, are advocating or supporting or being associated with me in that way. So the lingo, I'm interested in it. So when my roommate or one of my other best friends who's a pilot talks, I'm sincerely interested and I ask questions. I have always loved air travel. I think it's the closest thing we have to time travel in that you can start off in a really snowy place, but then sit in a metal tube and get dumped off in, like, a desert. And I think that's really cool. So just sincere interest in the industry, I think is really important. And then just surrounding myself with really good people that have really good standings within the aviation community also helps. So I hope that answered your question.

Yeah. And in my little dive in your instagram, are you also getting a pilot's license or are you doing that sort of thing?

Yeah. So anyone who's a pilot knows it's extremely expensive. So I've taken a few lessons up to this point. I am finishing my master's degree. So flying is one of those things that if you don't do it consistently, then you don't really gain the skills. So I've taken a few lessons just under the premise of one, getting hours to work towards my ppl, but two, what are my clients going through and just working on the steps and leading up to the flight in flight and then takedown that I can help. My client doesn't have to explain it because I've done it, but definitely after I get my master's in June, then the extra time I'll be able to work and then make money. I'm going to put towards flight training where I can do it more consistently. But yeah, that's my goal.

No, that's wonderful. And from what I gather, masters just leaves you with the abundance of time and money. Just nothing but time and money. But I think that's great that you have stepped into the cockpit and the shoes of pilots and worked to understand where they're coming from. Were there any things that came to mind as you're learning this process of how to fly? And you went, oh, this is what they have to deal with. And those realizations helped add to your ability to treat your clients again.

Like living with a pilot and then being best friends with a pilot really shows kind of the behind the scenes. So one of the first doors that opened that I was like, oh, maybe I don't know as much about the industry as I thought was, okay, this is going to sound really bad, but I didn't realize how smart pilots had to be. There's like the adage of once they get to airlines and that's what we see as consumers. They're like, oh, you just sit up there and spin dials and push buttons. But seeing all the training leading up to it and knowing how many hours they need to get. I'm sure Olivia, for your licensing it took 2000 for mine, I don't know what it took for yours, but also relating on I know how much time, energy and effort it takes to get any kind of hours. So realize ours was 4500. Fuck. Well, I'm only an associate, so I'm just an associate. But yeah, that's what I have to look forward to after graduation. So basically learning how much time, energy, effort and money goes into it. I actually used to be a little bit afraid of flying because I wanted to know what the pilots were thinking and they obviously get behind that big door and that's great for them. But from the consumer side and someone that wants to know what they're thinking, it's actually really helped with my flying because now I can personalize it and be like, oh, this is probably what they're doing. And this is kind of like the steps, but just knowing one, you can't really be a dummy to fly. I'm smart, and I don't know if I could even make it to mainline. It takes a lot of effort. And, yeah, just seeing all the effort and energy that goes up to going to the airlines and then to maintain.

Being at the airlines, I'm sure that that's really helpful for clients that you know what that looks like, because I get that question a lot with clients of like, well, if you're not a parent, how can you help me with parenting or, like, clients who are emts or police or military? It's like, well, if you haven't been through it, how are you going to help? And on some ways, I shouldn't need to have been through it to be able to empathize. But on the other hand, it makes total sense that when you've been through something that specialized, that it's truly an experience that other people are not going to understand fully without being in it. That having your provider know and truly have been through what it looks like on the other side of the plane.

Yeah, I was really lucky. I got to have a few hours in an a 320, like, full motion sim. And to this day, that's probably been one of the highlights of my life. It was so much fun. But also going from the really small plane, I kind of skipped a lot of the stuff in the middle, but then going to, this is what people work towards, and this is what it looks like. And having someone take the time to explain from gate up to down, back to gate, I feel really lucky. I will never say I'm like a self made man because I'm only here because people took the time to explain things and sometimes dumb it down for me. Sometimes I'm like, could you explain it like I'm five? And then we can build up from that. So just. I cannot express how grateful I am to people that have taken their time with no obligation to help me, but just to make me a better aviation therapist, I could have not done it on my own. And all the experiences that I have really treasured are just because people have stepped up and helped me. So, yeah, no means am I self.

Made, apart from being able to fly this thing. What are general examples of ways people in the industry have helped you become a better aviation?

So, you know, their time. I mentioned, you know, working with horizon in Alaska, so having people see me on Instagram and reach out and say, you know what? You're promoting, I think, really fits in well with our culture. So I've had heads of training departments reach out to me and say, like, hey, can you come talk to this incoming class? Or same with Alaska. Folks have found me on Instagram and have invited me to do events, know talk. So that's kind of one of them. Just people that find me. This sounds so cheesy, but find me and are like, I really believe in what you're doing. So I'm so lucky. People have mailed me things, just offered advice. So, yeah, even people that are upset with me because I posted something and they chew me out for it, I'm like, okay, I'm still going to listen and respond. I can't remember what you're, oh, right. How do people, so just people finding me and reaching out and saying like, hey, have you tried this or have you done this yet? Would you be interested in it? Much like folks like yourself, but just from the industry.

What kind of activities? Have you read this book? It's those sort of general recommendations.

It usually stems from, like, if I'll post something, someone would be like, oh, did you know this about it? Especially internationally, I do have some international followers. So if I post something, then someone from Italy might dm me and say like, oh, this is how we do it in my country. And the Internet is really cool because it gives you a global perspective and props to the aviation community for being so willing to just message a stranger, basically to say, you know, have you considered this? Or this is how we do things in Australia or wherever they're coming from. But I feel really fortunate that a lot of, I'm only in my second year of doing aviation, but I don't know many people that I got to go play in a full motion sim or just be surrounded with people that are like, hey, let me take you flying, or I have a plane. I don't know, people are just really nice.

That's fantastic. And aside from me, it wasn't a full motion sim. It was at a science center. But even those flight sims, I lasted about 10 seconds and then almost puked from the motion sickness. So besides the ADHD and everything else that's going to preclude me from my pilot career. But the FAA seems to be in this interesting place because I was listening to, I believe it's Dr. Northrop do a talk about how they're in this predicament because in order to make changes, they need data. But pilots aren't willing to come forth to speak up about a lot of things. And I know there's a study with a Dr. Hoffman that is starting to gather more and more data and hopefully more policy changes happen. But it seems to be in this really weird place of, and this is an uneducated, hot take, lukewarm, tepid take, where the policing body, it makes a lot of slow, but also very fast moving, responsive changes, because there's instances like the german wings incident and then not to do with mental illness, but one of the famous ones is how the korean pilots had issues with hierarchy and communicating, and they crashed into each other. They seem to respond very quickly in those instances, but then we've got instances where there is apparently some very archaic mental health policies that are in place. So I'm just trying to think, like, your thoughts on just this weird nature of this very fast yet slow moving policing body.

Yeah, I guess two things come to mind. Rules in aviation are written in blood, so they don't have a lot of incentive to kind of keep things going until there's that public pressure of, like, children died in a crash that shouldn't have happened. So, unfortunately, with governmental agencies, it usually does take some kind of mass tragedy to bring light to that. And then the second part is, it's a governmental entity. It's moving at the pace that everything else, bureaucracy wise, does. So, yeah, I guess bureaucracy, the general mistrust from people. Yeah, no, it makes sense.

Yeah. And in the Hoffman talk on healthcare seeking behavior in pilots, I believe, is the talk. And they talked about how the navy, apparently, the pilots, they had mental health issues. They fixed that relatively quickly. But from what I understand, military surgeons have both regulatory and therapeutic relationships to patients. So if they have a no, as in the patient is mentally unwell, they can get them to a yes, where a civilian ame is solely regulatory. In a perfect world, what would you like to.

Ooh, perfect world, probably. I'm not saying there shouldn't be checks and balances, but I think the exclusivity of a lot of the evaluators, for example, that if people do report, I don't think it's bad that there is, like, a second step to check, but because the scope is so narrow for who is allowed to do these exams, people end up waiting for months to get in that. So some kind of hybrid of let's get those checks and balances, but also have the resources to do it. And until we do, don't tell people. It's like an easy process. Just be honest about, hey, this is what to expect. I think the FAA is trying to make it seem a little bit more streamlined than it is. And I like the upward momentum and I want them to keep going, but again, honoring the clients that I have that are stuck not flying for several months. So just for it to not take as long and be more accessible for folks that do need to get their medical deferred, because even if they do get a chance, it's thousands of dollars. So again, just pushing the inaccessibility further and further, I'd just like to see things more accessible.

As we've talked about, it's one of those circular issues of because you can't really do it through insurance or in ways that people are willing to talk about it, it's hard to show that you get positive results, which makes it harder to change the policy. So what has your experience been, just anecdotally of how pilots have benefited from your services and other mental health services?

Yeah, so I think I'm kind of breaking the stigma of only crazies. People need therapy. Like we mentioned earlier, some people are just grieving natural occurrences of life, whether it's the death of a loved one, the ending of a relationship, or a divorce. So I think saying, like, hey, these are the multiple reasons people go see a life coach or a therapist such as myself, is some people want skills. Maybe it's social skills. Maybe I can't fall asleep at night and I just help me with my routine or my sleep hygiene. Sometimes it just looks like people booking a session every three to six months and just dumping and knowing that there's a place that's safe to put all this information, maybe they don't need help processing, they just need a place to put it and walk away from it. So just kind of highlighting suicidality is such a small reason why people see life coaches. So just to kind of highlight the positive benefits and again, frame it in a way that's safety redundant. So it might look like let's do life coaching to improve crew resource management, which depending could be like social anxiety, or if we frame it in a nicer way, crew resource management. So just like one in a stupid way, like rebranding what we do, you see kind of a lot of that in law enforcement. They'll just throw the word like tactical in front of things to get that buy in.

Tactical crying?

Yeah, tactical crying. Tactical panic attack. So, yeah, just bringing light to the 99 other reasons why people go see a therapist other than they want to unalive themselves.

You had mentioned that the aviation industry is very male dominated, and even if a pilot were a woman navigating that. That can come with its own challenges. And they need somewhere to go. They need somewhere to talk to. And it doesn't have to be a big to do. It doesn't have to be a big crisis. And that's one of our mission statements here, is to look into therapy to demystify it and talk about what it could actually be. Again, to respect confidentiality. I won't get into too much detail, but the issues that pilots come to you with, are they often industry specific, as in the stress of work, or they also do with personal lives, because those two will affect one another?

A lot of it is the same. I think it just looks a little bit different. So, for example, most couples fight or have problems, and that's okay, but it looks a little different when one of the partners is gone for 15 to 17 days a month. So I feel like a lot of the problems are pretty mainstream, but you don't have the same parameters to work with to fix it. Especially for pilots that fly overseas, saying have a date night or FaceTime every day is really hard if someone's 15 hours ahead. So to take everyday problems that people have but then apply the solutions through an aviation lens is kind of fun. That's kind of what I like about it, is it takes away from the mainstream and puts it in a very specific set of parameters. Same with I'm never going to suggest Xanax for someone because I know they can't take it. And that's a way people deal with anxiety, but that's totally off the table for someone in aviation. So I wouldn't say there's a lot of specific stuff. There's obviously, like, career advancement, but who doesn't get stressed at a new job or a promotion. But, yeah, I'd say 90% like everybody else problems. But just the way you respond to it is a little bit more niche. And for what's available to folks in aviation, that's fascinating.

That didn't even occur to me that the demands of what that pilot does, you have to come up with different solutions, creative solutions. And, Olivia, do you have any situation where you can't come up with the standard have a date night or whatever suggestion that most therapists could just give to their clients?

Yeah, and it happens a lot depending on people's jobs and other factors in their life, where if you give a suggestion that normally people find helpful and there's an immediate, well, that wouldn't work for me because of this. And it's like, oh, you have to take a step back and recognize that. That's partly why therapists aren't giving just advice, because everyone's situation is so unique. That saying, like, well, make sure you're getting 8 hours of sleep a night. Those are things that, as you've heard from us, they're not always applicable. And so I think it's definitely something I've seen with people with various professions for various issues that giving suggestions isn't always the most useful thing. A lot of times they just want what you're doing, which is normalizing that of like, well, yeah, of course it's hard for you to have date nights. You're across the ocean and you're 15 hours apart. That makes sense that you're struggling with that. And so I think keeping away from pathologizing everything can be really helpful of saying, yes, what you're experiencing is normal. And we'll brainstorm some ideas together and especially for you because, you know, you are able to give more direction of skills that might work versus just general activities that would work for a couple who lives together and isn't flying.

Yeah, I always joke that any suggestion that I do has to be done in a hotel room or within a flight deck. So that's another random set of parameters is like, well, you can't bring a weighted blanket with you on your trip and that's something people can use for stress relief. So maybe try bring a pillowcase from home that can fit in your luggage. So, yeah, definitely also traveling. I travel a lot. So just kind of that mindset of any suggestion that I do has to fit in a suitcase or in a flight bag. So that's, I guess one of the unique parameters of working with folks in aviation is whatever suggestion has to be able to fit in an overhead bin sized suitcase or be done in a hotel room.

So one of my questions would be that, again, one of our mission statements is to not simply get people into a therapist's office, but just have people reach out for help. And even according to the FAA, they want people to reach out. Allegedly, they want people to reach out earlier because they're seeing what terrible effects can have when someone doesn't seek help early enough. So what are some of the common misconceptions and the phrases that you hear from pilots, especially because it being such a male dominated industry as the Hoffman talks about it, it seems that they are almost more predisposed to depression or anxiety and issues because of the pilot status?

Yeah.

No. For anyone listening, Billy Hoffman is a PhD or MD and writes a lot of cool stuff. So anyone listening? It's Billy Hoffman. What's up, Billy? If you ever listen to this. So anyways, I'd say one of the biggest, I don't know if it's misconceptions, because a lot of that stuff is based on historical pasts. But just I think the biggest thing people come to me for is how can you tell me that you are going to keep my stuff confidential? Obviously there's some machismo, but same with women. Sometimes there's marianismo of these roles. I think also when working with men, and I don't know if it's a misconception, but a good place that I like to start is generally men feel like more somatic symptoms before they feel dialogue symptoms. So someone might think they're not depressed because they're not sad, but maybe they're irritable, like their stomach's always hurting, their sleep is off. And so, hey, let's look at this more through symptom versus what you think it is. And I feel like it's helpful with men to relate it to physiological responses more so than talking through or labeling things. So while that's not necessarily a misconception, that's probably something that we got appealed back because so many men are used to. Like I said earlier, the psychology industry is a little bit more women dominated right now. So a lot of research is done by women for women, and that's awesome. I love representation, but that leads to a disconnect from providers who don't actively seek out gender specific mental health care, whether it's working with trans folks or men or whatever. So again, not necessarily misconceptions, but more just like, well, no wonder therapy hasn't worked for you in the past. If you have done it, let's try doing it in a way that is approaching it more specific to your gender or anything else that kind of makes you and you.

Yeah, and I think that happens a lot, and I see that, too. Just in general with clients that growing up, at least in this generation and previous ones, men are often taught that the only pain they're allowed to exhibit is physical. So they don't always notice that the symptoms they're having are a result of emotional or mental health issues because that was never allowed. And so I have that all the time where male clients will come in and have all of these somatic symptoms and they have no idea what's going on until they reach a point where they think they're having a heart attack and they end up in the hospital and they find out it's a panic attack and they're minds are blown. And so I think even just creating more awareness around that, that anxiety and depression and all of these things are not always going to look the same, especially if you're in that societal belief of like, well, men have to be.

Strong and depression only looks like crying or only looks like eating ice cream in bed.

Right. Especially, like you said, being in that specialty of a male dominated field, you have to be aware of that, otherwise people are going to have their symptoms go overlooked because you're not going to notice.

And I think language is really important. There really is power to words, whether it's working with men. I joked earlier about tactical, but if that's the way they've grown up and that's the way they've been intaking information, then that's how I'm going to serve it. My school is very pro. The clients are the expert of their life and stepping back from putting the therapist on a pedestal, and I think there is truth in that. So if my client thinks of their mental health in terms of stomach aches and neck aches, then that's the language I'm going to be using for them. So whatever language that the client is using, repeating that back while still also saying like, hey, this is what it is, but I'm going to use words that you brought to me to help you understand it better. And that looks different for men and women and then trans folks, too. The language we use, there is a lot of power in our words. So just to be really aware of what you're saying and knowing as a therapist, what you say might be the inner monologue of your client down the road. And so just being very mindful of how we treat people using language they understand, pronouns that are preferred for them can be really easy ways to honor your clients previous experiences.

Yeah, for sure. And like you said, what you are taught is that the clients are the experts. And I always tell that to clients in the beginning of sessions, and I always use a phrase that is actually very accurate for you. For me, it's more metaphorical, as I say that we're fellow travelers and that I'm just walking along the path with you. And that comes from Irvin Yalem, who is the existential therapist. But I'm just walking along this path with you, and I can't do things for you. I can't necessarily remove roadblocks, but I can help you and show you how to get over them and move them aside and that I'm not walking your path, I'm just next to you. So I can't tell you always what's best for you or anything like that.

Yeah, I always joke, I'm like the Home Depot. You come to me and you tell me what your project is, and I'm going to show you a bunch of different ways to do it. You might not like all of them, especially working with pilots, where I'm not here to super diagnose, I'm here to more work with whatever the symptoms are, and then hopefully that'll be okay. So I like to say I'm like the Home Depot. I'm not a mechanic. If you tell me what your problem is or we figure it out together, then I will throw all the materials and tools at you and then you can kind of pick. And I always tell folks, like, the first one might not work, and you can totally come back and say, this didn't work for me, and I'm just going to show you some other things. So reinforcing that not everything works for everyone, but that there are more options if it doesn't, right, I'm not going.

To do it for you, but I will give you the tools needed for you to do it yourself. And not every house needs the same tools. I always tell people that, too, of like, there's going to be things that don't work. I'm not going to get offended if you come back and tell me that.

Yeah, I've said many times before, in the beginning, I was like, please tell me everything. Tell me in great detail what to do. But it is actually true, as a client, where I do hear Catherine, my therapist's voice in my head. And it's fascinating because I was listening to a penny Levin talk about how stress is the relationship to the stressor and the resources that we can bring to bear to the situation. And I feel that it is very important to have the right language and to present these things in the fashion that your clients can understand. But without the tools to deal with the things in the rest of your life, it can weigh on you and that bucket can get very full.

Yeah, I mean, I think that's exactly how it is with using metaphors or examples or things that are in their world. So they're not coming into our office like we're stepping into their world. And you are very much doing that by literally stepping into the world of flying and all of it and understanding with them. So I guess just if you have any resources or things to point people towards that would be helpful for anyone in that field or anyone who wants to learn more.

So I'll start with the language. Working with pilots, sometimes they'll get suggestions that are like sit still or meditate, where their job literally is normally to take in everything, listening for sounds, doing eye scans. So using the skills that I know they already have to then apply it to whatever theoretical or therapeutic model I'm trying to get to. So your strength is noticing your surroundings, and that's what makes a good pilot. So how can we use that for our goals? With the skills that you use to be a pilot that you like doing can be really helpful. And then as far as resources, I'll drop two and then let folks know where they can find me. So first thing is therapy. So it's like the air up and it is a peer to peer support network run by an amazing person. She's fantastic. She's really one of those people that walks her talk. So therapy is a really good one. Also, shout out to the pilot nutritionist. She specifically works with folks that need to maintain annual medical. But as someone that has used her services, I can say, like, my mental health got a lot better because there is truth to like, you have a brain in your gut. So for folks that might want to approach mental health through a different way, I'll give a shout out to Jill. And then finally, for folks that want to work with me or any one of my colleagues can find me on instagram at aviation therapist or online@flightdeckcommunity.com so those are two places you can find me if you want to shoot me an email. Flightdettcommunity@gmail.com happy to answer any questions or refer you to anybody that I know.

Thank you so much. This was so great talking to you.

Same. You guys have really good questions. I like it.

Thank you.

Yeah, thank you.

And that concludes this episode of Therapy is my therapy. If you enjoyed today's episode, please consider subscribing to our podcast so you never miss an update. Once again, thanks for tuning in. The content discussed on this podcast is for educational and entertainment purposes only and does not act as a replacement for therapy. Although we may share tools that have worked for us and talk about symptoms that we've experienced, it is not meant to be used for diagnostic purposes and does not constitute medical advice.