Pastoral Care and Pastoral Psychotherapy (Counseling)
By Jean G. Fitzpatrick
The following article was written specifically for Episcopal Christian audiences. However, the same principles apply to other faith communities whether Jewish, Buddhist, Wiccan, Muslim, other Christian, etc. The American Association of Pastoral Counselors has members of many faiths and spiritual backgrounds. It is the accrediting body for pastoral or spiritually integrated psychotherapy. "Fellows" of the AAPC have at least two graduate-level degrees, one in their own faith or spirituality and a second in psychotherapy and counseling, as well as thousands of hours of supervised practice all leading to board certification. Reprinted with permission. From the April/May 2000 issue of The Episcopal New Yorker.
Priest or Therapist: Who Can Help Me?
It was a rainy afternoon in late November when Sarah,* huddled under an umbrella, trudged up the stone steps to her Rector's study, next door to the parish office. Closing her umbrella, she sat down in the chair across from his desk, and burst into tears. "I really appreciate you making time to meet with me," she said, sobbing. "I just don't feel close to God anymore." The Rector was startled. In the few months since his arrival in the parish, he'd already come to appreciate Sarah as a popular church leader who taught Sunday school, helped out with a thriving outreach ministry, and led a weekly Bible study group whose members relished her sense of humor. "What's going on, Sarah?" he asked gently.
"I just don't feel close to God anymore." Still sobbing, Sarah pulled a crumpled tissue out of her purse. "I don't know what God wants from me. Everything's a mess."
"A mess?" The Rector was puzzled and concerned. He knew Sarah had two adorable preschoolers, and her husband, Bill, appeared to be fond of her. She did look a little tired, but in his experience that wasn't unusual among young mothers.
"Well, not really a mess." Sarah blew her nose. "I mean, things at home are okay. Bill's a great guy, and I love spending time with the kids." She smiled, eyes brimming. "I just feel so far from God…" Sarah's voice trailed off to a whisper. "Maybe I'm just not praying right."
The Rector walked over to his bookcase and pulled out a thin paperback. "This is one of my favorite books on prayer," he said kindly. "Why don't you borrow it and see if it helps. Then we can talk again if you'd like." Hearing a knock on the door, he glanced at his watch. "Sarah, I promised to join the Buildings and Grounds meeting in the parish office, and it sounds like they're getting impatient. Why don't you and I pray together before you go?"
Sarah wiped her eyes, they bowed their heads, and the Rector prayed aloud. Then he escorted her to the door and handed her umbrella. "I'll pray for you, Sarah. Give my best to Bill."
Sarah brought the book home and put it on her nightstand, but she never managed to get past the first page. Three tearful months later she located a pastoral psychotherapist in her area and called for an appointment. The pastoral psychotherapist diagnosed her with depression.
Photo credit: Ted Crockett
The Rev. Hillary R. Bercovici, Ph.D., Rector of St. Mary's, Scarborough, and board-certified pastoral psychotherapist, in his office. He believes that pastoral psychotherapy and parish-based pastoral care are complementary, but separate disciplines.
When are counseling sessions with a priest not enough?
When life hurts and your relationship to God seems to be part of the problem, it's not always easy to know where to turn. "Usually you can tell if somebody has a fairly specific situation that they want to work through and if the concern seems very situational, you can sort through the dynamics," said the Rev. Steve Yagerman, Rector of All Saints', Manhattan. "Sometimes you can help somebody — in a single session or a couple of sessions — in a really profound way to gain some insight into their situation."
At other times, though, a few counseling sessions with a parish priest are not enough. In fact, Diocesan guidelines call for a maximum of six sessions between priest and parishioner. "This is not engraved in stone. It's just meant to remind priests that a seminary education does not qualify them to do psychotherapy with people," said the Rev. Canon Anne Richards, diocesan Executive for Ministry Development.
"I don't want to underestimate the role of the parish priest in the psychological lives of the people he or she serves, because one of the foundational understandings of Christianity is that spirit and psyche are really united," she continued. "A parish priest, by what he or she says or models, even briefly, may have a profoundly helpful effect on a person's psychological well-being. But the job of actual, intentional, psychotherapeutic treatment remains the domain of the pastoral psychotherapist (or secular psychotherapist)."
I know intuitively when I'm out of my league
Fortunately, many clergy will quickly recognize that they are not prepared to cope with a particular problem. "I know intuitively when I'm out of my league," said the Rev. Carole Johannsen, Rector of St. Luke's, Katonah. "When it comes to having to change the patterns or look for deeply buried patterns, or if it's something that clearly needs ongoing care, I'm not trained for that."
The limitations on parish clergy's ability to do individual counseling derive not only from the nature of their training, but from the nature of their vocation. "The role of a parish priest is to build up a community of faith by being a preacher, teacher, and giver of spiritual counsel," said Canon Richards.
"Spiritual counsel, however, does not mean therapy. It means that helpful conversations between a priest and a parishioner about 'issues' in the parishioner's life are those that nurture the person's relationship with God and his/her spiritual life. It's like a process of theological reflection — helping the person to see how God is working in his or her life. It's not to give therapeutic advice on family matters or make 'psychotherapeutic' observations," Richards explains.
Often parishioners are surprised to hear this. "It's very easy for priests to fall into the 'therapist'-type role since our culture is so therapy-inclined and people sometimes think that's what priests are supposed to do — give advice on family matters, understand them completely, and so forth," said Richards. When that happens, "the spiritual side of people's inner lives can be ignored. Priests miss a wonderful and powerful opportunity to help people connect with God more strongly if they allow themselves to slip into the role of pseudo-therapist and forget that as priests they have a symbolic role as a bridge to the divine."
Pastoral psychotherapy and parish-based pastoral care don't mesh
"There are a lot of things that we can do as clergy to provide counsel, guidance, and even have a therapeutic effect," agreed the Rev. Dr. Hillary Bercovici, Rector of St. Mary's, Scarborough, "but there are also a lot of things we can't do and really shouldn't do."
"If a person comes in and says, 'You know, what I'd really like to do is meet with you over several weeks and talk about the meaning of things that are going on in my life,' that's absolutely valid, but because of my other responsibilities I just can't provide that level of intensity," he continues. "Pastoral psychotherapy is a narrow focus and discipline that requires a particular context and setting to be effective. It is a kind of pastoral care, but very intense. It is so focused. Parish-based pastoral care is a broader, more wide-ranging ministry that involves everything from life transitions, baptisms, marriage, birth, and social contact throughout the week. The two contexts just don't mesh."
Unlike the priest-parishioner relationship, which takes place in the context of everyday life, the pastoral psychotherapist's consulting room is a place apart. Here the client has both the freedom and boundaries to explore feelings and experiences.
Sometimes it can be upsetting when a priest suggests that it might be helpful to consult a therapist. Parishioners may worry, "Does he or she think I can't cope? Or that I'm crazy?" Actually, seeking therapy is an act of courage and faith, an indication that a person is willing to open up to healing.
"It's a sign of strength to acknowledge that we all need help and guidance at times," said the Rev. Steve Yagerman. "If I think the person is mature enough to hear it, I would share the fact that I've been in therapy and found it helpful, as have many of the people I respect the most."
"Having been in therapy after my husband died, I can say from my own experience that it's helpful," echoed the Rev. Carole Johannsen.
"I'm not making a referral to a pastoral psychotherapist because there's anything wrong with the person, but encouraging them to avail themselves of some deeply helpful resources within the Body of Christ," said the Rev. Dr. Hillary Bercovici. "It's a matter of doing the next right thing, of deepening what the two of us have been able to begin."
If the transition from parish care to psychotherapy is to be a positive one, it's important to be discerning in choosing a mental health practitioner. Members of the American Association of Pastoral Counselors are certified mental health professionals with advanced training in theology and spirituality They are committed to seeking creative and respectful ways of bringing a client's own spirituality into the healing process.
Pastoral psychotherapists do therapy in a religious context
"Pastoral psychotherapists are people who do therapy with people within a religious context," said Canon Richards. "In other words, they understand the life of the psyche and also the life of faith, so that a practicing Christian could talk with them about psychological problems knowing that they also understand their religious beliefs and see the connection between the two."
"I would encourage people to ask up front, during the initial consultation, 'When we deal with matters of faith, how well versed are you?'" recommended Bercovici. "I ask the specific religious background of my therapist, just as I ask about credentials: 'What tradition were you raised in and where are you right now?'"
It's less important that the therapist's religious convictions and affiliation precisely match your own than that she or he respect your faith and help incorporate it in the healing process.
"What I'm looking for is somebody who is not hostile to the faith, somebody who wouldn't say, 'Oh, this belief is simply a symptom of the deeper unresolved unconscious issue with your mother,'" said Bercovici. "To say that is only to do violence to the claim that a person's faith is real and genuine."
The priest is still your pastor
If your priest suggests that psychotherapy might be helpful, keep in mind that she or he is still your pastor. Many clergy welcome feedback from parishioners they've referred to a psychotherapist. And in the months and years to come they are still available to offer spiritual support.
"I listen to their story and we encase it in prayer. I stay in touch with them and they know I pray for them," said the Rev. Carole Johannsen. "I remind them, 'Christ is walking with you and lots of people love you.' Starting therapy is a good, healthy decision that will move you toward strength and healing."
*Name and details have been changed to protect confidentiality.
Fitzpatrick, a member of the American Association of Pastoral Counselors and a columnist for <Beliefnet.com>, serves on the vestry at All Saints', Briarcliff Manor.