Pastors, know when you’re in over your head as counselors

thumbs up drowning

Seeking counseling at church can be highly precarious.

Many are left with a choice between equally bad options: do I (a) tell my pastor about my affair, addiction, suicidal thoughts, hatred, etc., and risk getting ostracized, or (b) self-medicate, keep my mouth shut, and hope the guilty feeling goes away some day? There is of course a 3rd option which many Christians feel guilty for taking, that is, seeking clinical counseling outside of church. This is often viewed as somehow traitorous to the faith.

Oh the webs we spin.

This is a serious problem in the church and one can imagine what sort of destruction it has brought, much of which we will never know. How many souls have left the church due to the feeling of being set adrift by their own sins with no one they trust to paddle out and reel them back in? How is it possible that church has often become a place where people feel obligated to hide their sin when, historically, church was considered a spiritual hospital?

Could you imagine a hospital where patients purposely hid their illness from their doctors so that the doctors would allow them to continue coming to the hospital? It’s unfathomable because it is strictly illogical. By definition hospitals and doctors exist to heal the sick.

The Church exists for the salvation of mankind.

But there is more to the story. Many people are reluctant to bring their problems to their pastors simply because they worry that they will not get the help they need. As in, they don’t necessarily feel the threat of ostracism or shame, but rather they doubt the therapeutic skills of their pastors. This reluctance in many cases is well founded.

Quick warning: if the reader is easily offended by man issues please skip the next paragraph.

I remember I situation I had with my pastor during my first year of college. I lived on a floor with 20 other guys in an all-male dorm. One night during hall meeting a leader on the floor presented a challenge. He held up a sign that read “M free in 99” and explained that we should all attempt to remain “masturbation free in 1999.” We all laughed, since it was mostly a joke, but wound up deciding to give it a shot. I mean, why not? A few days after hall meeting I was on the phone with my pastor from back home and just so happened to tell him about our floor’s challenge. To my surprise he was immediately offended. He could not conceive of a floor of Christian men (it was a Christian college) even speaking of such things. I asked why and he said, “It’s blatant sin!” I said, “I know, that’s why we are trying to not do it.” He responded, “The Bible says that perversion should not even be spoken of among you.” We discussed it a bit and then I asked him, “What would you advise a teenager to do about it?” And I kid you not, he answered, “The Bible says that if one burns with lust that he should marry.” I said, “You would advise a 14 year old to get married in order to avoid masturbation?” And with all seriousness he replied, “Well that’s what the Bible says.”

I knew then that if my pastor was not up to the challenge of something like this then surely he was not one I could trust with more serious life issues. I was at that moment cut adrift.

I could tell a dozen other stories from personal experience to illustrate the point but I’m sure most of my readers could as well. Suffice it to say, pastors need to know their counseling limitations and refer out when needed. Here is a starter list of situations which I think would stretch the abilities of most pastors and, even if he or she is clinically trained it is still a good idea to recruit help at times.

  1. Cases involving psychopathy and psychosis

In general psychopathy is demonstrated in those with anti-social (i.e. sociopathic) tendencies. These are the types of people who show an extremely limited sense of empathy or remorse for others, abnormally egocentric, and usually have a fairly serious history of aggression. In the DSM 5 this condition is designated as a personality disorder. Whenever you see that qualifier – “personality disorder” – it’s a hint that the disorder is usually here to stay and very, very difficult to treat. These types are very unlikely to ever throw off the disorder completely, but can, through appropriate therapy with an experienced therapist, learn to control most of the aberrant behaviors that come with it. Even more serious are the cases involving psychosis or schizophrenia. A good hint that you might be in over your head with these cases is if you cannot readily detect their symptoms when sitting across from them. If you’re unsure what sort of thinking and behavior constitutes psychosis or schizophrenia then as a rule its best to refer them to someone who works with them on a regular basis.

  1. Cases involving sexual abuse

In all sexual abuse cases, and particularly cases involving childhood sexual abuse, the expertise and ethical standards required to do productive therapy are, in my opinion, best suited for qualified psychotherapists. Again, I am in no way implying that a loving, able pastor should immediately and in all cases refer out a victim of sexual abuse to a clinical therapist. I am saying that these cases are extremely sensitive and if the right care is not taken the victim can be re-traumatized by the therapist or therapy itself. There are also legal ramifications to consider. Psychotherapists are mandated reporters and have an obligation to involve the proper authorities in abuse situations – these standards can be easily overlooked by pastors who are inexperienced with these cases. Also, referring a congregant to a therapist does not mean that the pastor becomes uninvolved. If the victim is willing, the pastor can be made a participant in the therapy in whatever capacity the victim desires.

  1. Cases involving suicidal or homicidal ideation

It doesn’t take a genius to know that these cases usually have a lot to do with high levels of anxiety and depression. Anytime you have a case with high levels of anxiety and depression there’s a good possibility that medication might be needed and, depending on the severity, inpatient care. Get this one wrong and the effects could be life or death. Pray for your congregant, counsel with your congregant, but don’t put a psycho-spiritual wedge between taking extra measures to help the person; a wedge like the thought that says, “I believe God can heal this person and if I involve ‘secular’ help then I will inhibit God’s work through my lack of faith.” Honestly, this has to go. Have your spiritual conundrum on your own time, not the suicidal-homicidal person’s time. Their time is limited.

  1. Cases involving drug or alcohol addiction

As in the case with suicidal ideation, drug and alcohol addiction is life threatening and sometimes acutely so. Again, this is no time to have your own spiritual-worthiness-deliberation thing, it’s time to get the person help. Drug and alcohol addiction is tricky because an addict will eventually reach a level in their addiction where the addiction truly takes over and holds the person’s will hostage. Addicts are also notorious for lying, even if they never had a prior habit of lying. Their whole existence centers around securing their next high and they will do and say whatever it takes to make that happen. Unless the pastor has personal experience with addiction it is very easy to be fooled by the promises and good intension of the addict. There is no shame, no deduction of ‘faith points’ in referring the person to a recovery group or rehab.

As I said this is only a starter list. There are many more cases that warrant referral or outside help for pastoral counseling. Don’t let spiritual pride keep you from getting your people the help they need. God can work through professional counseling. If God can use a donkey to speak to a prophet, he can use a counselor to speak to your people.

Thanks for reading!

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