Caring When it is Tough to Care

by Joretta L. Marshall

Joretta L. Marshall is assistant professor of pastoral care and counseling at The Iliff School of Theology, Denver. She joined the faculty in 1993 after having taught at Vanderbilt University. An ordained United Methodist pastor, she is a member of the Wisconsin Annual Conference and has served both in local churches and as a campus minister.

Joretta L. Marshall is assistant professor of pastoral care and counseling at The Iliff School of Theology, Denver. She joined the faculty in 1993 after having taught at Vanderbilt University. An ordained United Methodist pastor, she is a member of the Wisconsin Annual Conference and has served both in local churches and as a campus minister.


The author deals with our feelings when confronted with a situation in which we want to care but find it difficult or almost impossible. She offers suggestions for how one can deal with those feelings in ways that show care for both self and others.

There is a prayer I often use when I reflect on the ministry of pastoral care. It was offered during a prayer circle by a woman whose name may be forgotten but whose offering has left the gift of these words:

May the knowledge of the love and grace of God sink from my head down into my heart so that it flows out of my hands, my mouth, my ears, and my eyes so that this body becomes the body of Christ in the world.

This prayer reveals one of the most important aspects of pastoral care -- engaging our physical being in the service of caring for others. We do this through our hands as we reach out and touch or refrain from touching, our mouths as we speak or remain silent, our ears as we listen to the voices of those who cry out or speak softly, and our eyes as we see things from the perspective of our faith. The church becomes the body of Christ in the way we care for one another.

But sometimes caring is tough. It's not easy to be with people in the midst of intense feelings, uncomfortable situations, and serious disagreements about moral and ethical decisions. In this reflection, I want to help you think about your feelings when confronted with a situation in which you want to care but find it difficult or almost impossible. I'll also offer suggestions for how you might deal with those feelings in ways that show care for both yourself and others.

What Is Congregational Pastoral Care?

The ministry of the church encompasses a variety of things such as worship, preaching, teaching, administering programs, and prophetic witness. Pastoral care is one of the church's ministries -- its caring response to individuals, families and communities who are in the midst of crises, life-changing decisions, even times of celebration and commitment such as baptism or marriage.

But pastoral care is the ministry of the whole congregation -- not just those individuals who happen to be ordained or called into the formal leadership of the church. As members of the body of Christ we are all called to be pastoral caregivers.

Congregational pastoral care occurs when members reach out through very concrete acts such as sitting by the bedside of someone who's ill, listening as parents describe their fears and grief when a teenager leaves home, offering hope to someone in despair, or praying for those who suffer on the margins of the church and society. To offer pastoral care is not the same as being someone's counselor or therapist. Nor is it simply being kind to people and doing nice things for them. Instead, being pastoral means being the body of Christ in some concrete living form as people turn to the church and its members for assistance and guidance in living their lives.

Why "Moral Dilemmas" in Pastoral Care?

Opportunities for pastoral care arise out of the everyday circumstances of people's lives. But these days, it's not uncommon to feel overwhelmed by the complexity of issues confronting us. In many ways, this world feels more confusing than we would wish. There may have been a time in history when it was possible to experience life as simple and straightforward. It might seem that there were clear choices and options for those who wanted to live a faithful life. That time no longer exists, if it ever did. People today face complex problems, difficult decisions, and increasingly ambiguous choices about matters of life and death. These give rise to moral and ethical dilemmas.

For the church to be pastoral it must be willing to engage in the real human drama of people's lives. This means entering into their pain and confusion, and even the messiness of life. Rarely are answers clear-cut and self-evident. As pastoral caregivers in the church, we must be willing to struggle with people as they try to figure out what to do. Moral and ethical dilemmas become opportunities for the church to express its care by its willingness to sit with people in the midst of turmoil and despair.

* In what ways is pastoral care something you do as a member of a congregation on a regular basis?

* How would you understand your role as a pastoral caregiver?

* What are people looking for when they ask members of a congregation for "help"?

* Why do people expect the church to have something to say to them in the midst of important life decisions or moral dilemmas?

Case Studies

Here are two case studies that provide an opportunity to reflect on what it means to be involved in pastoral care when people are making difficult choices about their lives. One of the most important aspects of being able to respond pastorally is to know yourself well enough to know what your reaction to cases like these might be and what kind of moral dilemmas they might pose for you.

You can probably imagine other moral and ethical dilemmas people face in their everyday lives -- perhaps from your own experience or someone that you know. If you're working through this reflection as part of a study group, it's okay to share your own examples with the rest of the group if you like. Keep them in mind along with these two case studies as you reflect on the suggestions and questions which follow.

Peter is a member of your church school class. He's 53 years old, a social worker who has always been very active in the community. Peter's married and has three adult children, two of whom still live in the same city and continue to participate in church activities. One morning, Peter asks for time during the church school class to discuss something important. He announces that he was diagnosed with Lou Gehrig's disease quite some time ago. Now the disease is advancing rapidly and doctors have told him he has only months to live. The final stages of his illness will involve a great deal of pain and suffering. Peter has decided he wants to end his life before he is completely debilitated by the disease. His son, John, is the only family member who supports his wishes. The rest of the family is adamantly opposed and this is causing great conflict.

Emilia, a young teenager in the church's youth group has become quiet and withdrawn in the last several weeks. You're concerned about her and ask if everything is OK. She lowers her eyes and admits, "Things aren't going too well." You ask if she wants to talk and she begins to unfold a story which catches you off guard. She and her boyfriend Tom (also a member of the youth group) have been spending a lot of time together. Recently they had sexual intercourse and Emilia fears she might be pregnant. She has scheduled a test at the Teen Clinic for tomorrow and doesn't want to go alone. She asks if you'll go with her. She also wonders, if she is pregnant, would you assist her in getting an abortion? She hasn't told either her parents or Tom about her problem and asks that you not talk to them either.

  * Imagine Peter or Emilia coming to you with their concerns. How would you feel? What would your initial response be? Would you feel prepared to deal with the situation?

* What moral dilemmas might their situations cause for you? For instance, Peter's wish to end his life and his family's disagreement over his decision? And Emilia's decision to keep her fears about pregnancy a secret and her possible choice to have an abortion?

  How Can I Help?

  How are we to respond when called upon in the midst of someone's decision-making about such significant and difficult issues? And what are we to do when confronted with our own moral dilemmas in the context of pastoral care? Knowing a little about the traditional functions of pastoral care might help you think about how you could respond to someone like Peter or Emilia.

  The Functions of Pastoral Care


  In its best moments, the church has been there to help people through their experiences of grief and sorrow. Bringing casseroles to the door of the family who has just experienced a loss, volunteering to do the farm chores in the wake of a catastrophe, just the presence of others at funeral homes and in hospital rooms show the very real ways people assist in healing one another's pain. Thus, congregation members perform the healing function of pastoral care as they come together in the midst of chaos, offering hope and wholeness in the midst of fragmentation and despair.

  It's more difficult to think about the process of healing when healing seems impossible. Peter's diagnosis means that he can't be physically healed from the pain and suffering of disease. Healing doesn't always mean a physical cure. Instead, it sometimes suggests how the church can foster emotional and spiritual healing in the midst of physical suffering. In Emilia's case, too, healing is an ongoing process which deals not only with physical recovery, but also emotional and spiritual well-being. Regardless of the outcome of her pregnancy test, many relationships have potentially been put in jeopardy: her relationship with her parents and with her boyfriend Tom, Tom's relationship with his family, and perhaps their relationships with others in the church.

There may also need to be healing within the congregation itself. They, too, may disagree with the choices Peter and Emilia make. They may be angered or disillusioned by Emilia's situation. They will suffer the pain of loss when Peter dies. The healing of a community may take a great deal of time and shouldn't be dismissed or rushed over.

  * What might healing mean for Peter and his family?

* Are there ways for Peter's family to experience hope and wholeness even if they disagree with Peter's wish to end his life before his illness becomes debilitating?

* As a member of Peter's church school class, how could you be part of this healing process -- with Peter, his family, and the congregation?

* If you were Emilia's youth group leader, how might you help Emilia begin the healing process?

* What do you think about Emilia's own inner-healing; what would that mean?

* What might physical well-being mean in Emilia's case?


  The second function of pastoral care is the ministry of guidance. This is one aspect of pastoral care that is often neglected. Guidance doesn't mean telling people how to live their lives. Guidance means that the church has theological and ethical resources for thinking about life decisions. People turn to the church expecting us to have something meaningful to say in the midst of conflict and confusion. As members of a community of faith, we miss the point when we refuse to offer guidance in ways that are concrete but not intrusive.

Guidance may mean engaging Peter, his family, and the church school class in thinking through issues around life and death, quality of life, individual rights versus family concerns, and how we understand God's will for our lives. In similar ways, guidance for Emilia may mean encouraging her in thoughtful moral discernment around the issues she has before her: if she is pregnant, what are her options and what are the implications of those options? Will she and Tom talk about the consequences of their sexual activity?

The important thing in pastoral care with people facing moral crises is neither to pretend we can be morally neutral nor to pronounce moralisms; rather, it is to discern with people as they engage their life issues. We must not deny our moral stand nor should we insist that others stand where we do.

The most appropriate pastoral guidance offers people the options that lie in front of them, reflects on the consequences of those options, thinks about the faith issues involved, and then remains with people as they make their choices. Be present in their questions and concerns, but don't offer to make the decision for them. Guidance is perhaps one of the most difficult tasks in pastoral care for it requires care-full deliberation and trust in the spirit of a living God who moves beyond our words and actions.

  * Do you agree with Peter's decision or with his family's opposition to it?

* What would offering guidance in Peter's situation mean?

* How could you stand by your moral beliefs and still remain open to both Peter and his family in the process?

* In Emilia's case, what would be the moral stumbling blocks for you in trying to help her deal with her situation?

* What would be involved in offering guidance to Emilia?

* How could you stand by your moral beliefs and still provide Emilia pastoral support and care?

* With either Peter or Emilia, are you in a situation where you couldn't resolve the contradiction between your moral beliefs and their request for your help? Or can you imagine such a situation occurring? What might be the most caring response then?


  No matter how tenderly and honestly we try to offer guidance, people will inevitably make choices with which we deeply disagree and may even cause us great pain. Finding a way to sit at the table with them in the midst of that pain and disagreement leads us to think about the third function of pastoral care

-- reconciliation.

Reconciliation occurs as people with differences move toward common concerns. This does not mean everyone will end up agreeing with each other. The goal isn't to agree but to remain faithful to the love and grace embodied by the gospel, while at the same time remaining true to what you believe. This requires a mature faith which insists that people can disagree with one another while still standing together. It isn't easy. But for people like Peter and Emilia who turn to us in times of crisis, it can be extremely important.

Remember that Emilia asked you to keep what she discussed with you a secret. Reconciliation at this point might mean being there for Emilia as she begins to talk about her fears over sharing her situation with Tom or her family -- fears that may be well-founded. Likewise, Peter and his family may never agree on the way in which Peter chooses to live into his dying. Perhaps they could find ways to alleviate Peter's physical suffering while mutually engaging in the difficult process of being family together.

There are times when reconciliation means simply finding ways for people who strongly disagree to still pray for each other with a sense of honesty and integrity. The church can model an ability to stand in solidarity with one another while acknowledging the depth of struggle and serious differences over decisions that are made.

  * What if Emilia and Tom, or Emilia and her family, seriously disagree about what she ought to do if she is pregnant? What if instead of supporting her, they turn away from her? Are there ways you might help them move toward honest reconciliation?

* How could you show care for Emilia and those around her in the midst of their struggle and disagreement?

* In Peter's case, what might reconciliation mean for him and the members of his family?

* Are there ways you might help Peter and his family discover and live out of their common concerns?


  Finally, both case studies illustrate the need for the sustaining ministry of the church. The sustaining power of God can be felt in the presence of a church member who says I'm with you in your suffering and, in my presence, the body of Christ is with you too. It's this sustaining power of the church which we often find creating the most hope in our lives. When one hits rock bottom it's good to know that there's a rock on which you can sit and pour out your heart. How comforting it is to know that the rock has room for the presence of another human being who can offer God's hope and care in the face of despair and confusion.

The church can help people remain stable in the midst of crises by providing a place for people to simply name their thoughts, feelings and fears without having to defend them. Indeed, one of the most important aspects of pastoral care is providing a safe place for people like Peter and Emilia as they articulate the complex realities of their lives. For the church to be an instrument of God's grace, we ourselves must provide the grace-filled spaces for people to express doubts, fears, concerns, and angers. There are few easy answers, yet God does provide the sustaining power to deliberate, pray, and reflect on what it means to be faithful.

After the immediate moment of crisis has passed, we still need to remain present and constant for people as they continue to reflect on its meaning in their lives. It's important that we stay open to those who have experienced a crisis and provide opportunities for ongoing conversation if appropriate. Remember, a decision that may have been made years before can still cause uneasiness in one's soul.

  * How could the church provide stability and sustenance for Peter and Emilia as they move through crisis and struggle with its moral implications?

* What about after their decisions have been made? What kind of needs might Peter and Emilia and those around them have for ongoing pastoral care from the congregation?


The Larger Contexts of Pastoral Care

  The moral dilemmas we bump up against in doing pastoral care reflect how individual decisions are often set in the context of broader realities which push us beyond the confines of our church membership. To be the church means to think not only about individuals and their personal crises, but also the way in which these crises affect families and communities, as well as how they may represent broader struggles in the society at large. For example, Peter's decisions aren't merely personal. His life impacts many circles of family and friends and colleagues at work who may be directly or indirectly affected by his decision. In a similar way, it's impossible to consider Emilia's situation as only an individual concern. To do so would be to neglect the reality that her choice -- whatever it becomes -- impacts the lives of her family, her boyfriend Tom, Tom's family, her unborn child if she is pregnant, her schoolmates, her youth group at church and potentially many others whose lives intersect with hers.

Our moral dilemmas also reflect issues the church and broader culture continue to grapple with. For example, both Peter's and Emilia's decisions are related to larger social issues regarding health care: rising health care costs, an individual's right to die, teen pregnancy, safe sex, and abortion. The economic and emotional burdens of caring for someone with a catastrophic illness may place extreme hardship on Peter's family and have lasting consequences for family members. Emilia's choice might be affected by lack of adequate financial support and child care options for her as a teen parent. Thus crises like these often reflect systemic issues of justice and liberation. Caring in a pastoral way about these larger contexts means, in part, exploring the needs of those who are underserved and who lack access to necessary support systems because of race, economic class, gender or sexual orientation. Congregations who take pastoral care seriously as a ministry of the church must come to terms with ways in which they may participate in the liberation and/or the oppression of people and communities.

  Another way moral dilemmas point toward larger issues and contexts is the way they reflect the ever-increasing pluralism of our culture. Inevitably, we come to realize that rarely will every faithful Christian agree on a particular moral or ethical stand. Indeed, even within denominations we're discovering the richness -- and pain -- of our pluralism. For Peter and Emilia, as is often the case, there appear to be fewer right answers and more shades of probable answers. The issue of choosing to take one's own life continues to be debated within all faith communities as do the issues of abortion, pre-marital sex, and teen pregnancy. Moving beyond the churches to the broader society only multiplies the differing perspectives impacting our life choices and decisions.

Pastoral care which is genuine and helpful, then, considers not only individuals in the midst of crises, but also the families and communities they're connected to. Caregivers also consider broader issues in the church and society as they seek to provide pastoral care which embodies not only God's presence, but also God's justice.

  * As you consider the ever-widening circle of people affected by personal crises and decisions, how does your understanding of pastoral care change?

* Would your community offer sufficient resources for Emilia, Tom, Peter and their families as they face these realities? Furthermore, does the community offer sufficient resources for people like them whom you may not know but whose suffering is just as acute?

* When someone comes to you in crisis and pain because of choices they have to make, is there one voice with which the church responds or are there many? How might this affect the ways in which you perform the four functions of pastoral care -- healing, guiding, reconciling, sustaining?

The Church's Ongoing Response

  There are many ways you can participate in the church's ministry of pastoral care. The following are some suggestions that might help you prepare better for that ministry as part of the congregation's ongoing response of care to people in the midst of life-changing decisions and crises.

  Theological Reflection

  The importance of theology cannot be underestimated. Our theological beliefs about the community of faith, the images of God we find meaningful, ethical perspectives based on our understanding of justice and care, and our interpretation of suffering and healing, sin and forgiveness, ground us and guide us in responding to the crises of members of our congregations. The reasons we respond and the ways we respond arise out of our theology. It is just not possible for the church to engage in adequate pastoral care without a solid theological framework.

One of the most helpful ways a congregation can engage in pastoral care is by studying issues that might create moral dilemmas before they are brought to the church in the form of real, live, human beings. The church can be the place of theological and moral discourse so that we're not as easily caught off guard and can attend more care-fully to people in the midst of struggle. We must always remember that we may change our position over time and still remain faithful.

  * Where is God in the lives of Peter and Emilia? * In Peter's case, what would be some of the theological questions he might ask or you might want to ask with him? How could you explore them together or with the rest of the church school class?

* Emilia might be struggling with issues of shame or regret, sin and forgiveness: What theological words or concepts might speak to her in her situation?

* How might your previous understanding of theological words and concepts change in the midst of offering care to Peter and Emilia?

* How might their situation affect your understanding of God's presence in your life?

  Identify Church Resources

  People in the congregation who have had similar experiences may be called upon to help people through the process of making a difficult decision or surviving a crisis. Experience is a wonderful helpmate. You can begin by personally contacting someone you think would be particularly sympathetic and explain the situation to them. Always make sure that you respect the confidentiality of all parties involved when seeking out resource people within the church. They may be willing to meet with others, to suggest options, or to talk with you about how you can be most helpful.

There are also professional people in the congregation who can share their expertise. Identify social workers, doctors, lawyers, and others in the church who may offer professional guidance to church members in crisis. However, once again, do this with care as people have the right to expect confidentiality at all times.

It might be a good idea to identify and contact resource people in advance of an actual crisis situation and keep a list available of those who express their willingness to help. Using congregation members as resources in this way is not only extremely beneficial, but also reflects the importance of the community of faith as the family of God.

  Locate Community Resources

  Locate those agencies within the community that are able to provide resources to people facing a particular crisis. Make sure that the phone numbers and addresses of the mental health center, the domestic violence shelter, the crisis line, hospice, or other such community resources are available and accessible to all within the church. Sometimes posting them on the bulletin board or in some other prominent place gives people the necessary information. This is especially useful for those who are facing a crisis and haven't yet decided with whom they want to share their situation. They might reach out to a community resource before talking with anyone in the congregation. Having these resources easily accessible signals people that the church is willing to be involved in caring for them and for the broader community.

  Worship and Prayer

  Worship and prayer are tremendous untapped resources for raising people's awareness of the various issues people are struggling with and for offering care in a nonintrusive manner. Keep the prayers and announcements general and never inappropriately disclose a person's name. For instance, the congregation might pray for anonymous victims of domestic violence, for those trying to make difficult decisions in their life, for family members who are disagreeing with one another, and for those members of the congregation touched by the hurt or despair of others. Allow the worship spaces of the church's life to speak to the pains and burdens people carry.

  * Who and what are some of the resources in your church and community? How might they be shared with others?

* How can a process of theological and ethical reflection begin or continue to take place in your congregation on an ongoing basis?

* Who can take responsibility for raising awareness of congregational pastoral care through worship and prayer? How might this be done?

* Do you have other ideas?

* What kind of further help or information do you need?


It's not always easy to care for and be with others in the midst of the complex, confusing circumstances of contemporary life. Perhaps the process of reflection you've experienced through this study has led you to some new ideas and resources.

  Now I leave you with a brief prayer of my own:

  May the knowledge of God's love and care be within us in such a way that we naturally reflect that love and care to others.


Suggestions for Further Reading


If you're interested in reading more about the four functions of pastoral care, see William Clebsch and Charles Jaekle, Pastoral Care in Historical Perspective (Englewood Cliffs, NJ: Prentice-Hall, 1964). And to learn more about the connection between individual care and larger social issues see Larry Graham, Care of Persons, Care of Worlds (Nashville: Abingdon Press, 1997).