Psychotherapy is no longer required for AAPC certification, but candidates are asked what they have done to ensure that their personal conflicts do not interfere with their ability to provide psychotherapy and counseling. The interview concludes with suggestions to encourage the candidate’s personal growth and professional development.
Working with pastoral counselors
Pastoral counselors are especially well-qualified to address certain types of mental health problems (Box 3).9 A psychiatrist who can identify these problems and make the appropriate referral will provide an important service to the patient.
When to refer. Patients experiencing loss or dealing with bereavement are often struggling with theological questions and can benefit from therapy from a pastoral counselor. Chronic or terminal illness likewise can bring up existential questions, and pastoral counselors can explore with the patient the meaning of suffering, providing spiritual healing when medicine offers no cure.
Some patients frame their mental illness as punishment for a past wrongdoing or sin, and standard psychotherapy is limited in its ability to confront this religious belief. Misinterpretation of biblical or other religious texts can support dysfunctional views of illness, and pastoral counselors can help guide patients to more informed and healthy views of the role of religion and spirituality in health. To help with this, they might bring into therapy such spiritual concepts as faith, forgiveness, reverence, stewardship, evil, suffering, and repentance.
The position of many pastoral counselors as pastors of religious congregations can help some patients make the transition from institutionalization to community life. These counselors can help patients connect with community resources and social groups associated with the patients’ religious affiliations. Some patients newly-diagnosed with a psychiatric illness may be reluctant at first to see a psychiatrist but will see a clergy member. In these cases, pastoral counselors can provide a pathway into the mental health system.
When not to refer. Referrals to pastoral counselors should be avoided when patients are perceived to be using clergy involvement to avoid psychiatric treatment. Some patients might use religion to get special privileges in treatment or to try to look healthier or more functional than they are.
Pastoral counseling is also contraindicated:
- when role confusion might result, such as when the pastoral counselor is also the patient’s pastor or seminary instructor
- in patients who denounce religious involvement or beliefs.
Split treatment As is done with psychologists or social workers, psychiatrists can split treatment with pastoral counselors and prescribe psychotropic medications. Regular communication among all clinicians ensures consistent treatment goals and reduces the risk of splitting dynamics and behaviors.
Certified pastoral counselors are trained in mental health assessment and are educated regarding safety concerns, including warning signs of suicidal or homicidal tendencies and symptoms of psychosis, such as delusions. Pastoral counselors who work in mental health agencies may be best able to respond to these psychiatric emergencies appropriately and expeditiously.
Related resources
- Friedman EH. Generation to generation: Family process in church and synagogue. New York: The Guilford Press, 1985.
- Fowler JW. Stages of faith: the psychology of human development and the quest for meaning. San Franscisco: Harper and Row, 1981.
- Pruyser PW. The minister as diagnostician: personal problems in pastoral perspective. Philadelphia: The Westminster Press, 1976.
- International Center for the Integration of Health and Spirituality. www.icihs.org