Where Are We Going in Pastoral Care?

by Leroy T. Howe

Dr. Howe is professor of theology and pastoral care at Perkins School of Theology, Southern Methodist University, Dallas.

This article appeared in the Christian Century, November 11, 1981, pp. 1160-1163. Copyright by The Christian Century Foundation; used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted and Winnie Brock.


The future of pastoral care rests not only with clinically competent and theologically informed professionals, but also, and more crucially, with committed and effective lay-persons.

For all practical purposes, my transition to becoming a theologian of pastoral care began with an invitation to attend the International Congress on Pastoral Care and Counseling, held in Scotland in mid-August 1979. The Congress was an extraordinarily representative gathering, bringing together more than 400 practitioners and theoreticians in the pastoral care and counseling field not only from North America and western Europe, but also from eastern Europe, Africa, Latin America and Asia. The excitement of Third World participation was evident from the start of the meetings: "indigenization" was an important catchword, and we waited eagerly to hear reports about the fashioning of distinctive pastoral theology models for non-Western contexts. As the reports came in, I found myself both impressed with and grateful for the information which confirmed that highly competent, specialized forms of ministry in pastoral care and counseling were in various stages of development everywhere. But my disappointment increased daily over the gradual discovery that the models and hermeneutics were anything but "indigenous"; all were part of a repetitive sequence of Western theological imports. Most of what needs correcting in the present pastoral care and counseling discipline -- overreliance on the literature of psychotherapy and underresourcing in theology -- appears to be shaping the second generation of programs springing up all over the world.

However, I also came to be impressed with how widespread and intense, among pastoral counselors, is the yearning for new models of integrating theological reflection, psychological literature, and clinical practice into a transforming vision of the church ministering in the world. Only once or twice did I hear at Edinburgh a posttheological voice proclaiming boldly the identity of salvation and the achievement of psychotherapeutic insight and change. As a whole, the conversation was overwhelmingly in the other direction. My subsequent reading in recent pastoral counseling literature bears out this trend. There seems to be nothing less than a massive shift of orientation beginning in the pastoral care and counseling field.

One possible new form for the discipline would represent pastoral care and counseling as oriented by ecclesiology, concerned for elucidating the structure and dynamic of human being-in-the-world by means of plurality of methods of inquiry, and especially informed by the rapidly proliferating literature, experimental and theoretical, on the human life cycle. Within such an approach, several themes would play especially important roles: pastoral care as the ministry of the whole congregation in the world; the identity of the ordained minister in his or her pastoral office as both enabler and representative of the calling of all Christians to minister in the world; and a threefold focus of pastoral care, including the person or persons in need, the gospel of Jesus Christ, and the faith of the Christian church as represented in Scripture and tradition.

Hunter relates his understanding of Moltmann’s theology to the critical assessment of pastoral care principles by reference to an incident in his own ministry, which he discusses with refreshing candor.

Hunter brings to bear on the situation in question those concepts he calls "the most basic and most widely accepted" principles of pastoral care today, five in number. The first is an emphasis on listening: the minister is to be responsive primarily to what the parishioner himself or herself wishes to say, and is to be sparing in sharing the interests, enthusiasms and moralisms of the pastoral office. Second, the minister is to attend to the underlying affect as intently as to the verbal content: what the parishioner "means," frequently unaware, is as important as what the parishioner says and is aware of saying. Third, the minister is encouraged to be accepting of negative feelings, especially those of conflict and ambivalence: the experience of acceptance, particularly of one’s otherwise unacceptable feelings, is especially conducive to personal growth. Fourth, the ministry of pastoral care is to be carried on in an atmosphere of exploration, with emphasis on discovery and growth: an open-ended, conversational, collaborative style is the watchword. Finally, a relatively high degree of emphasis is placed on personal involvement and self-disclosure on the part of the minister, rather than on the neutrality emphasized by a number of traditional psychotherapeutic schools.

One may raise questions about this list of pastoral care principles; while few may wish to quarrel with the five enumerated, at least some may be inclined to add to them, even though the respective additions might not in all cases be congruent. (For me, Hunter’s list lacks a principle for "confrontation.") But his judgment is sound in that something like this congeries of pastoral care principles, widely if not universally adhered to, has contributed in a fundamental way to the shape of present pastoral counseling practice and theory. This development in turn has given rise to the increasing plaintive cries, including Hunter’s own, for more attention to theological reflection in the exercise of this ministerial office.

As Hunter reflects critically on his own pastoral actions, he becomes aware that what characterizes most pastoral interchanges is a pattern of this sort: "I heard Mrs. B., and Mrs. B. heard me." Both Hunter and Moltmann rightly affirm the importance of pastoral action which strives for just such hearing. Moltmann’s caricature of certain traditional models of pastoral care makes plain the advance demonstrated in Hunter’s practice: the pastor visits from house to house, and from hospital room to hospital room, with Bible and prayer book in hand, reading a few verses from each to his parishioners, before moving on. An observer might characterize the whole in the following terms: "We listened together to the gospel, but I did not hear him and he did not hear me."

The careful and sensitive attention Hunter reports in his transcript is strikingly in contrast to such traditional models, and constitutes a more effective witness to the transforming power of God in personal life. But the question with which both Hunter and Moltmann became preoccupied aptly represents the fundamental theological question currently being raised about the theory and practice of pastoral care. With reference to the dramatis personae of the critical incident, the question is: "Granted that the chaplain and Mrs. B. heard one another, did they, together, also hear the gospel?"

As Hunter seeks to deal with the question in reference to his own pastoral practice, he concludes that there is indeed something of a witness to the gospel in interchanges named by his five principles, but that it is an incomplete witness at best, and one which may also profoundly distort the gospel message, at least as that message is clarified by means of Moltmann’s theology. Hunter comes to express his discovery in an interesting way. As he thinks back on the empathy expressed toward a hospital patient, he sees that what the patient received from him was an encouragement to continue trusting in the order of things. The changes which the patient was experiencing, with much travail, are nonetheless precisely those sorts of changes predictable throughout the human life-cycle, about which the fundamental task is to maintain an affirmation of the natural order, with all its vicissitudes. Moltmann puts the matter with characteristic succinctness: as he sees it, what is involved here is "primal trust in the natural course of things," a reduction of the gospel to a form of creation faith only.

But while the trinitarian structure of Moltmann’s theology gives high priority to the doctrine of creation, the central motifs of his system most germane to pastoral care ministry are to be found elsewhere. Especially important is his articulation of the Christian gospel in reference to Jesus Christ’s identification with God in his humiliation and abandonment: "the crucified God," who, only in the hopelessness of his situation, can bear the divine promise of a future Kingdom. The eschatological tension of this situation, constituted essentially as the denouement of a ministry of suffering love, implies for ministry something other than mere encouragement to persons who are suffering.

The kind of empathic support which Hunter offers, though commendable in the light of present pastoral care theory and practice, nonetheless is oriented to the horizon of life, and to the overcoming of suffering. Acceptance of negative feelings about suffering, along with changes in life style and orientation and in attitude toward dying, aim at liberating the sufferer to retrieve primal trust. But Moltmann’s theology, Hunter believes, impels a different kind of pastoral strategy, attuned to the possibility of hoping in spite of the irreversibility of suffering and dying, and of calling others to hope in the midst of their own suffering rather than taking false hope in their recovery and restoration. Pastoral care is not to look beyond abandonment and hopelessness, but rather to confront the hopelessness itself as the primary, although not exclusive, setting in which the Kingdom of God and its promise are to be apprehended. Moltmann pays particular heed to the plight of the terminally ill and the irremediably retarded as representing the depths of that hopeless suffering in which the crucified God becomes the bearer of a significant promise. Contemporary pastoral care theory and practice, by contrast, seem to bear the message of hope, liberation and the coming Kingdom of God only as alternatives to hopeless suffering rather than as a horizon of meaning within hopeless suffering.

In my judgment, the fundamental issue here is that, for Christian faith, the trustworthiness of things in general, and most specifically of events within a fallen world, can be affirmed only paradoxically, from hope which arises out of situations of suffering, abandonment and exile. Only this kind of hope is a sign of God’s future. "Hope against hope" expresses a different kind of trust in the order of things than that of the infant, who is called upon to trust that nature will indeed minister to him or her. Hope against hope, which it is one task of pastoral care to discern and elicit, raises instead the possibility of a form of life which, precisely in its unrelieved and unrelievable suffering, can be the bearer of the gospel message of the Kingdom. Is it possible to envision pastoral care that is both empathic to the actuality and the horror of unrelievable suffering, and courageous in calling the sufferers themselves to ministry? Can those otherwise abandoned to hopelessness become, in their being and in this bearing, heralds of the graciously offered future of God?

It is important to reflect on the aim and form of pastoral care. As we look again at Hunter’s "basic principles," what stands out is the way in which the recipient seems to determine both the acts and the theory of pastoral care. Pastoral care and counseling theory has been, and not without justification, person-oriented (or, in the technical vocabulary of one school of psychotherapy, "client-centered"). Generally, the primary aim has been understood in terms of restoration of "health" and "wholeness" to the client. Just how the restoration process itself is understood depends to a large extent on the theory of personality and psychotherapy being integrated with a theology of ministry. Hence, restoration can be understood as relief from symptoms, strengthening of ego functioning, acquisition of self-esteem and interpersonal relations skills, recovery of unique potentialities or identity formation. That these specifications seem wholly indebted to secular psychotherapies is itself a problem demanding theological examination. The most important problem, however, is that of conceptualizing "health" and "wholeness" as functions of the individual organism, when, and by contrast, the Christian tradition has tended to speak of the salvation-health linkage within a larger understanding of the destiny of the whole people of God. For Christian faith, individuals within the laos tou theou derive their own health and wholeness in faithfulness to the ministry and the mission of the called-out people.

This means that "functioning" is to be understood in terms including but also transcending those pervading secular psychotherapeutic theories. A person’s functionality is to be understood in reference to that ministry to which all disciples of Jesus Christ are called. In this light, the aim of pastoral care needs reformulation in terms which speak of restoring persons’ capacities to function as ministers within a community of faith and mission. Whatever would constitute removal of blockages to functioning and, as necessary, even reconstruction of personality itself needs to be understood in the light of this larger end: equipping the saints for their ministry.

How, then, might the form of pastoral care be specified, given a reformulation of its primary aim or goal? Moltmann’s theology may be especially germane here. From his perspective, equipping the saints for ministry will require a form of pastoral care which is oriented toward incorporation (and reincorporation) of persons into communities of love and service. This means that no pastoral care can be complete which does not assume a form including a call to renewed discipleship to those capable of actively witnessing to the Kingdom of God in their own lives, as well as a call to affirm respectfully the incapacitated as themselves signs of God’s gracious presence and identification with those deemed hopeless in the world’s sight.

This is a double call to discipleship, really; it seeks to enlist persons in ministering to others, and it also asks from those ministering their cultivation of a capacity to be ministered to by others who can only "be," and whose "being" seemingly never can include genuine receptivity, response or mutuality. The call itself -- to whomever -- must issue as much from the serving community as from the "pastor" alone, to both the pastor and the whole community. What this, implies, finally, is that the future of pastoral care rests not only with clinically competent and theologically informed professionals, but also, and more crucially, with committed and effective lay-persons. Developing caring congregations, as well as effective, professional counselors, in the words of scholar Howard Grimes, is the "missioned task for pastoral care in today’s church."