The Differences Between Pastoral Care and Therapy

I am a big fan of folks seeking help from their pastor. I wish more people who are experiencing difficulties would do so sooner rather than later. Pastors have an amazing ability to care for people and to walk with folks through tough times. Often people enter my office and express the following: “We saw our pastor for couple’s counseling and it really didn’t help.” I explain to people that they saw their pastor for some issues, but that is not couple’s therapy. It is pastoral care. Both serve a specific function and are important. There are many similarities between them, along with major differences. As someone who has training in both fields, I thought that it might be helpful to flesh out the nuances of each role.

What is Pastoral Care?

Pastoral care is a ministry of presence. In his book Pastoral Care: An Essential Guide, John Patton (2005) notes that pastors are “a reminder, a re-presenter of God, faith for the church, and all that religion may represent to the person cared for” (p. 25). Pastors and ministers keep us centered on what is most important in the healing process, namely, our relationship with God. In the midst of grief and chaos, pastors rise above change, cure, or fixing and simply help us to “get lost in the wonder of God” (Ed Dobson). As the Old Testament figure Job teaches us, those who simply show up and sit with us bring us comfort. They also point us to the truth of who God is as revealed in scripture and in the community of Christ.

Pastoral care is a ministry of guidance. Pastors have much influence and are able to help people get to where they need to be. Patton highlights the reality that pastoral guidance “is more related to the presence of the guide and the relationship he or she offers than to a course of action suggested” (p. 36). Pastors have an odd set of boundaries in regard to pastoral relationships. It would not be uncommon for them to spend time counseling someone about pornography use, only to have them over for dinner the next week. We could call it a dual relationship as the professional and the personal overlap.

Pastoral care is a ministry of creating a safe structure in order to heal. More than anyone else, pastors can offer a safe space and a community in which people can heal. Within this structure, a pastor’s guidance becomes the gateway through which people can find multiple sources that will bring about healing. Their influence can be the most important voice in a crisis. Typically, we trust pastors and what they tell us.

What is Therapy?

Therapy is about relational and behavioral change. Your faith is very important when you come to a therapist. It is a variable that cannot be neglected, as it tends to form the very essence of who you are. In therapy, the goal is to improve the relationship and to alter behaviors through very specific techniques that are unique to this profession. For example, we might attend therapy because we are having communication difficulties with our partner. Our pastor should be able to help us see the biblical way of interacting with our partner, but they are not typically trained to work with attachment distress (a form of anxiety that occurs when we cannot emotionally access our partner) that is often the source of the communication difficulties. Nor are they typically equipped to work with pervasive mental health issues, such as long-term depression, chronic anxiety, or psychotic disorders like borderline personality.

Each profession has a unique and vital role to play in our care and healing. We can refer to this as our scope of practice … one is typically more of an expert in one domain, while the other is an expert in another domain. The bottom line is that each profession needs to rely on the other profession. In this way, both of them can form a larger and more effective system of care. This is vital, especially when working with people who may have more severe mental illnesses. Certain diagnoses, such as Borderline Personality Disorder, are very difficult to detect even for a trained therapist. Behaviors can go on for years, keeping people stuck in unwanted and unhealthy patterns of behavior. When both professions collaborate, things tend to work better. It is more helpful for everybody involved when pastors refer people very early on. Simply put, when we work together we draw from a deeper well.

A Different Relationship

As mentioned previously, it would not be uncommon to discuss your private (and sometimes uncomfortable) issues with your pastor and to then hang out with them. However, the relationship with a therapist is considerably different and the boundaries are very clear. Therapists don’t hang out with their clients outside of a therapy session. We do not do business with our clients or engage with them on social media sites. Why not? Because these clear boundaries are necessary for a specific type of change. They focus both the therapist and the client on changing the issue without outside influences getting in the way. A pastor (trust me on this one) might be hesitant to challenge particular behaviors because the person has power over their job. But this is not an issue for the relationship with your therapist. As a result, they can lead someone to a safe space where they may not be able to go with most people.

Faith and Change Go Together

Neither profession is mutually exclusive of the other. A therapist who specializes in what is called spiritual integration is unique. They know how to balance both the psychological (relational and behavioral) and the biblical (theological and pastoral care) aspects of helping people. Both disciplines have much to offer each other and there is a lot of overlap. It is when spirit, mind, and body intersect that authentic healing and transformation can occur.

Exploring Christian Counseling

As a Christian counselor, I am convinced of the crucial role that people’s faith plays in the counseling process.