Chapter 10: Pastoral Counseling and Mental Health

The Mental Health Ministry of the Local Church
by Howard J. Clinebell, Jr.

Chapter 10: Pastoral Counseling and Mental Health

In itself psycho-analysis is neither religious nor non-religious, but an impartial tool which both priest and layman can use in the service of the sufferer. I am very much struck by the fact that it never occurred to me how extraordinarily helpful the psychoanalytic method might be in pastoral work.( Sigmund Freud and Osker Pfister, Psychoanalysis and Faith, trans. Eric Mosbacher ;New York: Basic Books, 1963), p. 17.)

-- Sigmund Freud

The most significant direct contribution of clergymen to mental health is their counseling and shepherding of troubled persons.( Action for Mental Health, p. 134.) In his report on the activities of the churches in the mental health field, Richard- V. McCann declares: "The minister as counselor is perhaps the one role in which the relations between religion and mental health are most sharply illuminated," (The Churches and Mental Health, p. 46.)

No one really knows how much time the typical clergyman spends in counseling. The ministers in McCann's study averaged only 2.2 hours per week in formal counseling relationships. In contrast, a survey of the activities of thirty-four clergymen in suburban Pittsburgh showed that they spend thirty percent of their time in counseling at least thirteen hours each week.( J. W. Eaton, et al., "Pastoral Counseling in a Metropolitan Suburb," Journal of Pastoral Care (Summer, 1963), pp. 93ff.) In any case, the total investment of pastoral energies in counseling is impressive. If the 246,600 clergymen serving churches in this country average only 2.2 hours per week, a remarkable total of over half a million (542,520) hours of pastoral counseling occurs weekly. The fact that these hours are frequently spent with persons whose mental health is in jeopardy gives counseling a qualitative significance for mental health which far outweighs the quantitative investment of pastoral time.

Troubled people are more apt to seek help from a clergyman than from a member of any other professional group. This puts the minister in a strategic and demanding position. An oft-quoted study of a cross-section of the American adult population revealed that one out of every seven Americans has sought professional help with a personal problem. Of these, forty-two percent went to clergymen, twenty-nine percent went to family doctors, eighteen percent to psychiatrists and psychologists, and ten percent to a special agency or clinic.( Americans View Their Mental Health, p. 307). Ministers are on the front lines in the efforts to help the burdened and the troubled.

In most small communities the only professional people available for counseling are ministers, physicians, and lawyers. Although the minister's counseling training may be less than adequate, he ordinarily has considerably more such training than persons in law and medicine. In the study just cited, sixty-five percent of those who had consulted clergymen reported being "helped" or "helped a lot"; another thirteen percent indicated that they were helped to a lesser degree.(Ibid., p. 319) Clergymen led the helping professions in the proportion of counselees who expressed satisfaction with the results of counseling. In spite of the limited training in counseling of many ministers, the majority apparently function with impressive effectiveness. As more and more clergymen receive clinical and academic training in counseling, the quality of ministerial work with the heavy-laden will continue to rise. The mental health potentialities which can be realized by increasing the availability of skilled pastoral counseling are immense!

In addition to formal counseling, the general work of pastoral care involves rich opportunities for informal counseling. Pastoral care is the multifaceted ministry of caring for the spiritual welfare and growth of persons of all ages. This function is invaluable as a sustaining, nurturing influence in the lives of millions of people. The minister's caring symbolizes the caring of the religious community and of God and is expressed in many ways -- for example, a friendly word as people leave the worship service, a congratulatory note when a member is honored by his company, a visit to welcome a new family to the community, and the vital pastoral ministries in the pivot points and crises of life -- marriage, birth, death, confirmation, sickness, accidents, and so forth. For countless persons, this supportive ministry is indispensable to the maintenance of robust mental health. Over the years many times as many people are helped through a minister's general pastoring as are helped through formal counseling.

The Heritage of Pastoral Care and Counseling

The clergyman as counselor has a heritage which is many centuries older than those of the mental health disciplines. As Robert Leslie indicates, "For centuries the church was the only agency concerned with the maladjusted." (Unpublished PhD. dissertation, Boston University, 1948, p. 10) Counseling is one aspect of a concern for healing which has been integral to the Hebrew-Christian tradition through the centuries. In recent years there has been an astonishing flowering of this ancient pastoral concern; it has been watered by streams of new insight concerning man which flow from the behavioral sciences and from the new methods of the psychotherapeutic disciplines. These new resources enable clergymen to fulfill their traditional helping functions with new vigor and effectiveness.

The counseling pastor walks in the footsteps of the great pastors of the past. He seeks to follow the example of one who was called the "Great Physician" whose healing influence brought release of the captives of inner conflict, recovery of sight to the spiritually blind, and let the broken victims of mental illness go free. To some, it must have seemed that he devoted a disproportionate amount of time to the sick. But he knew that it is the sick who need a physician, that those in crises are both more in need of and more open to help. The counseling pastor works beside the modern Jericho roads with people robbed of happiness and beaten by their fears, their guilts, and by the savage cruelty with which disease, pain, and death often strike. It is in response to the raw stuff of human suffering that a person-centered minister functions as counselor.

The Nature and Uniqueness of Pastoral Counseling

Counseling is the utilization of a one-to-one or small group relationship to help persons handle their problems in living more adequately. In contrast to psychotherapy, it is usually short-term (ten sessions or less) and does not aim at radical changes in personality. It deals mainly with contemporary relationships and problems rather than exploring childhood relationships. Its aim is to help a person mobilize his inner resources for handling a crisis; for making a difficult decision; for adjusting constructively to an unalterable problem; or for improving his interpersonal relationships, including his relationship with God.

The heart of counseling is the establishing of a warm, accepting, honest relationship between pastor and parishioner. As Carroll Wise has pointed out, the counseling relationship is simply an intensification of the same quality of relatedness which should exist throughout the life of a church. Experiments conducted under Carl R. Roger's direction demonstrated that growth tends to occur in a counselee when three qualities are present in the counselor: congruence (authenticity, inner openness, self-honesty), unconditional positive regard (warm caring and respect for persons), and empathic understanding (entering into another's inner world of feelings and meanings) .(Carl R. Rogers, On Becoming a Person [Boston: Houghton Mifflin Company, 1961], pp. 263Ff.) Carl G. Jung also emphasized the importance of the counselor's personality: "Learn your theories as well as you can, but put them aside when you touch the miracle of the living soul. Not theories but your own creative individuality alone must decide."( Carl G. Jung, Psychological Religious Reflections [New York: Pantheon Books, 1953], p. 73.)

A psychiatrist (who is an active churchman) writes: "My hope is that we may develop a more intensive in-reaching mission, a ministry to those lost within themselves in our own congregations." ("The Terror of Good Works," p. 250.) This is the goal of pastoral care and counseling. It is an instrument for implementing the basic purpose of the church -- increase of love of God and neighbor -- by helping to release the ability to love in those in whom this ability has been blocked or crippled.

The mental health potentialities of counseling by a minister can best be realized when he is cognizant and appreciative of the uniqueness of his counseling role. What are the clergyman's particular contributions within the general field of counseling and psychotherapy?

(1) To some extent the minister is unique among the counseling professions in his training. Unlike most other counselors, he is trained in philosophy, theology, comparative religions, and psychology of religious experience. This training should equip him to be of special help to those whose problems root in an unsuccessful search for a philosophy of life which would give meaning to their existence. The minister's training should help him develop expertness in facilitating growth in the relationships of persons with God. Paul Tillich describes pastoral counseling as a "helping encounter in the ultimate dimension." (Address at the National Conference on Clinical Pastoral Education, Atlantic City, November, 1956.)

(2) The clergyman is unique among counselors in his explicit goal of spiritual growth. Any counseling which enhances a person's ability to relate to another makes for greater vitality in his relationship with God. Most religiously oriented counselors, however, regard the development of a more mature relationship with God as essential for personality wholeness. The fact that a minister has a continuing concern for the quality of his counselee's relationship with God, whether or not this is ever discussed in theological terms, inevitably influences the nature of the relationship and the direction of counseling. For many people, God is dead. He can come alive for them only as they are able to remove the blocks to awareness of his living presence. These blocks usually stem from distortions in early relationships which can be reduced through experiencing grace -- unearned acceptance and love -- in a counseling relationship (or elsewhere) .

A minister should be aware of the theological realities with which he deals constantly in counseling -- guilt, grace, sin, alienation (from God, oneself and others), the terror of meaninglessness and death, the dark, "demonic" destructiveness of inner conflicts, the struggle for rebirth to wider dimensions of relationships, and the powerful, God-given drive toward wholeness. It may be helpful for the counselor to point out to persons from religious backgrounds that they are dealing with profound theological (as well as psychological) realities in the counseling experience. With others, the use of "religious" language may actually block religious growth. A theological student, reflecting on his clinical training experience, described it as "theology on an experiential level." This is precisely what effective pastoral counseling is. The ultimate goal of such counseling is spiritual rebirth through loving reconciliation with oneself, others, and God.

(3) The minister is unique among counselors in his professional role. Because he is a religious authority figure, people spontaneously project on him a rich variety of associations from their early life, including powerful feelings about such matters as God, heaven, hell, sex, parents, Sunday school, death, sin, and guilt. This provides a sensitive clergyman with a superb opportunity to help people mature in these emotionally charged attitudes. Through their relationship with him, he can help them grow in their relationships with all authority figures, including the supreme authority, God. This will occur most readily if his professional self-identity is clearly that of a minister.

Unique dimensions in pastoral counseling are derived from the minister's role as leader of a local congregation and his function of shepherding persons from birth to death. His continuing contacts with families (often stretching over many years) give him advantages in counseling which those in no other counseling profession possess. Many people seek his help because a bridge of relationship already exists with him. Often they have trusted ministers since early childhood.

Another advantage derived from his role is the expectation that he will go to his people in their homes and places of work without a special invitation. He can often detect problems in their early stages and bring help before they have reached the final, destructive stages. As a pastor, he is normally with his people during periods of stress when major problems often develop. Unlike most counselors, he can be consulted informally, without calling the helping process "counseling" or necessarily going through the often difficult matter of appointment-making. The setting of a religious fellowship within which the minister functions as counselor offers a rich variety of group resources which can undergird, broaden, and complete many of his counseling efforts. As a counselor, the clergyman has many things in his favor.

(4) There is uniqueness in the religious instruments which the minister naturally employs when appropriate in his counseling. When used carefully, prayer, scripture, sacraments, and devotional literature can be of distinct value, particularly in supportive and crisis counseling. When used indiscriminately, these instruments can block rather than facilitate the emotional and spiritual growth of persons. Whether or not the minister uses religious tools in a particular relationship, the counselee knows that he represents the religious community and the vertical dimension of existence upon which both can draw in counseling.

Pastoral counseling should always be done in the spirit of prayer -- that is, openness to and dependence on the growth forces of the universe which constitute the source of all healing. Growth in counseling is the result of the release of these God-given resources which have been blocked within the person. The effective counselor is only a catalyst in the person-to-person interaction through which these growth-healing resources become available to the individual.

In order to avoid using religious instruments in irreligious ways (which block growth), they should be employed in counseling only after one is aware of their meaning to that person. It is wise to explore their impact on the person by inquiring after a prayer, for example, "What was going through your mind as I prayed?" The use of instruments and symbols of religion tend to strengthen the dependency aspect of a counseling relationship by stirring up childhood feelings. In some cases, this may arouse guilt feelings which block the catharsis of anger, jealousy, and sexual or destructive fantasies. The content of some prayers tends to arouse expectations of magical solutions not involving struggle on the counselee's part. In general, religious instruments should be used sparingly in insight counseling, more frequently in supportive counseling, and generously in the wider ministry of pastoral care. A prayer of thanksgiving at the close of a counseling relationship can be a beautiful way of articulating the gratitude which both pastor and parishioner feel for the mystery and miracle of healing.

Types of Parish Counseling

The client-centered approach has dominated pastoral counseling literature too long. This approach constitutes one valuable aspect of a minister's training, helping him master the art of disciplined listening and lessening the occupational tendency toward facile verbalizing. However, a minister must modify the client-centered approach in a variety of ways if he is to serve those who seek his help. A minister with only a client-centered string on his counseling fiddle often feels guilty or blocked in counseling situations requiring the constructive exercise of authority, functioning as a teacher-counselor, or serving a parishioner emotionally in a feeding role.

The father of client-centered counseling states clearly that many troubled people cannot benefit from an insight-oriented, client-centered approach because of excessive instability, aging, or unfavorable environment.( Carl R. Rogers, Counseling and Psychotherapy Boston: Houghton Mifflin Company, 1942, pp. 61-80.) In my experience, a majority of those who seek a pastor's help cannot respond to a pure Rogerian approach. This approach is sometimes effective with reasonably intelligent, highly verbal, young or middle-aged neurotics who are strongly motivated to obtain help. Attempting to use it with troubled persons ,who lack these characteristics usually results in what a social worker, Gordon Hamilton, describes as an adventure in passivity(Howard J. Parad (ed.), Ego Psychology and Dynamic Casework (New York: Family Service Association of America. 1958), p. 26.) -- a rambling relationship which becomes an exercise in mutual frustration. Many people's capacity for insight and self-directedness is so limited, crippled, or ossified that they cannot respond to an insight-oriented approach. But, they can be helped to greater adequacy in living by varied counseling approaches involving the selective use of guidance, authority, instruction, along with a focus on improving interpersonal relationships (rather than effecting major intrapsychic changes) and seeing one's situation from a more constructive perspective.

The full person-helping potentialities of a minister's counseling can be released only if he develops skills in several basic types of counseling To some degree, these types utilize different facets of his personality. Here are the basis types of counseling which the minister is normally called on to do: (a) Marriage and family counseling, (b) supportive (including crisis) counseling, (c) counseling for referral, (d) short-term educative and decision-making counseling, (e) superego counseling, (f) informal counseling, (g) group counseling, (h) religious-existential problem counseling. Several of these types usually are employed in the same counseling situation.

Before looking more closely at these types, the ingredients which all effective counseling approaches have in common should be mentioned:

(a) Establishing a growing therapeutic relationship through warm nonjudgmental concern. (b) Disciplined listening to and reflecting the parishioner's feelings. (This encourages the pouring out or catharsis of bottled-up feelings which is like draining the poison off a wound.) (c) Seeking a growing understanding of the person's "internal frame of reference." (d) Gaining a diagnostic impression concerning the nature of his problems, his weaknesses, and inner resources. (e) On the basis of this tentative diagnosis, suggesting an approach to help. These general procedures have been discussed in standard books on pastoral counseling.( See, for example, Seward Hiltner, Pastoral Counseling (Nashville: Abingdon Press, 1949), Rogers, Counseling and Psychotherapy, pp. 83-173, and Carroll A. Wise, Pastoral Counseling: Its theory and Practice (New York: Harper & Row, 1951), pp. 39-114). The mastery of skill in establishing and utilizing a therapeutic relationship in these ways is the foundation upon which the minister can build a differential approach to the major types of pastoral counseling.

Marriage and Family Counseling

A minister needs to be reasonably proficient in all eight varieties of counseling, but he should acquire a high degree of expertness in three types -- marriage counseling, crisis counseling (especially bereavement), and counseling on religious-existential problems. In these types he should be among the most skilled persons in his community. Because of his socially defined role, he occupies a strategic position of opportunity to help persons in these areas.

In the nationwide mental health survey mentioned earlier in this chapter, nearly sixty percent of clergy counseling opportunities were family problems (forty-two percent marriage, twelve percent parent-child and five percent other family relationship problems). (Americans View Their Mental Health, p. 305.) The clergyman's natural entree to families gives him a major advantage in this type of counseling. There can be no doubt that skill in marriage and family counseling is essential for an effective ministry!

There are two basically different approaches to marriage counseling. One method consists of individual counseling with one or preferably both parties. The goal is to help both achieve sufficient personal growth so that they can relate more maturely in marriage. The assumptions of this approach are that problems between people always reflect problems within them (which is true) and that the problems within must be dealt with to improve their relationship (which is not always the case). For the pastor, this method has serious drawbacks. It requires extensive training and ordinarily is highly time-consuming. Distorted feedback between the partners sometimes damages the counseling relationships. "The minister said . . ." is misused in moments of anger between the partners. The counselor has the arduous task of keeping strict track of who said what, so that he does not unwittingly violate confidences. Considerable insight and growth may be achieved by the better-motivated party without substantial improvement in the sick marriage.

The newer approach is called "role-relationship" counseling or "couple counseling."( A useful book on this method is Charles W. Stewart's The Minister as Marriage Counselor. Rev. ed. (Nashville: Abingdon Press, [1961] 1970). This approach tends to be more efficient time-wise and also more effective in healing a sick marriage by improving the quality of marital interaction. It usually does not have long-range effectiveness with grossly disturbed persons whose weak egos and need to act out their inner problems vitiate the effects of counseling. But I regard it as the method to try first in most marriage counseling. If it does not prove helpful, individual counseling in more depth or referral to a psychotherapist or a family service association is in order.

Role-relationship counseling aims neither at basic personality changes nor at depth insight. Its goal is more modest -- to help the couple make their relationship more mutually need-satisfying. The marriage relationship itself is sick. It is the patient. The focus of counseling is on the interaction which occurs in and shapes their relationship. The "between" of a marriage is seen as far more than the sum of the problems within the two persons. The "couple identity" (see Chap. 9) is a psychological entity which has been created by their interaction. Frequently, significant improvement in the quality of interaction can occur without basic changes in the underlying personality patterns. Marital interaction occurs on many levels and can be improved on many levels. For adults, counseling procedures which aim at improvement on the relationship level are usually the most helpful.

The Greens are having serious trouble with their marriage. They seek their minister's help. Using a role-relationship approach, his goals with them will be: (a) To help them reestablish meaningful communication (that is, on the level of feelings, hopes, and personality hungers) so that they will have the instrument for working at their problems. (b) To interrupt their negative, self-perpetuating interaction pattern of mutual attack and retaliation. Because both have been hurt so severely they probably cannot extricate themselves from this vicious cycle unassisted. The cycle's momentum can carry a couple into the divorce court. (c) To help them become aware of the nature of their interaction and the conflicts in the role expectations which each has had for himself and the other. Most interaction in sick marriage is blind, automatic, and maladaptive. (d) To assist them in discovering ways to modify their attitudes, role-expectations, and marital behavior so as to decrease friction and increase mutual need-satisfaction. This includes helping them decide on some mutual goals (which both desire) and then beginning to work toward them. (e) To help them learn how to relate with their more mature rather than their more childish sides. (f) To help them accept the things about their partner which cannot be changed. This means giving up their futile campaigns to reform each other. When this pressure is removed, many couples actually begin to change in significant ways.

In counseling with the Greens, the minister is a combination referee, who sees that each gets an opportunity to voice his views on each issue, and coach, who helps them learn how to play the marriage game more constructively. After an initial joint interview in which the minister senses the nature of their interaction, he decides to see each person separately for a few sessions. This drains off some of the extreme pressure of hurt and anger, which otherwise would block couple counseling. It establishes rapport with each person and gives each the opportunity to divulge information or feelings which would not come out in a joint session. After three or four separate sessions, counseling proceeds mainly by triangular interviews, the couple meeting together with the minister. He helps them communicate and encourages them to explore specific incidents of conflict in depth. "How did you feel when that happened?" is directed first to one and then to the other. Occasionally the minister summarizes how each perceives or feels about a given incident or aspect of their relationship. The focus is, "What can we learn from this fight (or satisfying experience) ?" Through practice during the counseling sessions the Greens gradually acquire the ability to be aware between sessions of what is occurring in their relationship. Awareness of their patterns of interaction is the first step toward changing these patterns. Couples with a reasonable degree of ego strength can often acquire the ability to help themselves within as few as six to ten sessions.

For the minister with strong training in counseling, a method called family group counseling offers a useful tool for helping families with a disturbed member or with parent-child problems. As Jerome D. Frank says so well: " 'No man is an island' and the degree and permanence of change in any individual will depend in part on corresponding changes in those close to him and on support of his wider milieu." (Jerome D. Frank, Persuasion and Healing (New York: Schocken Books, 1963), p. 234.) The family group counseling approach is useful in cases of troubled adolescents where intrafamilial communication has broken down. After an initial conference with the parents to explain the need for family sessions and gain their cooperation, subsequent sessions include the entire family. The assumptions and goals are similar to couple counseling. Since the family is an interpersonal organism, the most efficient way to help a disturbed member is to increase the health of family interaction. The goals are to help them reestablish meaningful communication, develop awareness of the roles and interaction patterns of various family members, experiment with modifications in roles and behavior, and, most important, to allow the family to experience its essential unity and interdependence. The counselor's presence as referee and coach allows the family to experiment with new patterns of relationships.

To do family group counseling well, a minister needs considerable skill and sensitivity to interpersonal relations. Clinical training and participation as a member of a therapy group are valuable as background training experiences. A minister who wishes to use this approach should study John E. Bell's monograph, "Family Group Therapy" (Public Health Monograph #64, U.S. Government Printing 0ffice, Washington 25, D.C. sec also Virginia Satir, Conjoint Family Therapy (Palo Alto, Calif.: Science and Behavior Books, 1964). and then arrange to have his work supervised by a well-trained psychotherapist, preferably one who has done family group therapy. The minister who masters this approach has an invaluable instrument for rendering relatively short-term help at the source of personality problems.

Supportive and Crisis Counseling

There are at least four varieties of supportive counseling: crisis, stopgap, sustaining, and supportive growth-action counseling. All four make significant contributions to mental health through providing supportive relationships.

1. Crisis counseling. Gerald Caplan ("Principles of Preventive Psychiatry (New York: Basic Books, 1964). shows how a person's mental health is enhanced or depleted by the way he handles crises. No matter how psychologically healthy a person is there are times when his inner resources are severely strained by crises such as accidents, illness, bereavement, natural disasters, unemployment, handicaps, and family traumas such as alcoholism. At such stress-points, many individuals are helped by a supportive counseling relationship.

In a sizable church, a minister's counseling is often primarily crisis counseling. During a given week, he may be called to the home where a child has died, asked to appear in court to help a teen-ager in trouble with the law, consulted by a woman suffering from menopausal emotional problems, called on by a man who has just learned he has cancer, and another whose self-esteem is shaken by mandatory retirement. The crisis ministry to such persons may prevent the development of major personality illnesses. Such a ministry ordinarily combines three things -- walking with the person through his dark valley by maintaining a supportive relationship, giving emotional first-aid by means of informal counseling and guidance, and watching for possible signs that the individual's built-in recovery resources may not be adequate. If a person is not pulling out of the emotional tailspin caused by the crisis, intensive pastoral counseling (if the minister has the time and training) or a psychiatric referral are in order.

Fortunately most people have latent resources which allow them to handle even staggering blows. By standing with a person in crisis the minister helps him to mobilize these inner resources and also to draw on the resources of the religious tradition and community. During stormy crisis periods, a person's sense of worth and meaning are temporarily depleted, his world shattered. The support of his pastor can help keep the floundering ship of his life from sinking. Ordinarily, when the storm's fury diminishes, the ship will right itself.

Bereavement, the universal crisis, strikes an average of two American families per minute. Active bereavement involves at least a million Americans at any one time. Nearly every feeling known to man can be involved in this crisis. Sigmund Freud commented on the death of his father: "He had passed his time when he died, but inside me the occasion of his death has reawakened all my early feelings. Now I feel quite uprooted." (Ernest Jones, Life and Work of Sigmund Freud (New York: Basic Books, 1953), I, 324)

The loss of a loved one is a psychological amputation. A part of one's world of meaning and identity has been cut off. One's response depends on the nature of the relationship. The psychological mechanisms employed are the same which one uses in coping with other frustrations. In normal recovery the psyche has an orderly process which it follows in working through the loss over a period of months or years. Experiences during this process include feelings of unreality and shock, physical distress, preoccupation with the image and memory of the lost one, pouring out of grief, idealization of the deceased, guilt feelings, anger, loss of interest in usual activities, the unlearning of thousands of automatic responses involving the deceased, relearning of other responses, resumption of normal patterns of living, and the establishment of substitute relationships.

The minister's role in normal grief is essentially to support, to encourage catharsis of feeling, and to make religious resources readily available. Proximity to death arouses deep death-fear in the survivors (including the minister). This existential anxiety can be handled constructively only by the experience of religious trust. Through his priestly role the minister brings familiar rituals and theological beliefs to serve as vehicles of trust. He should avoid blocking the natural flow of grief by implying that it is somehow unchristian to experience or express deep sorrow. Mourning -- experiencing the awful pain of loss -- is an essential part of the healing-recovery process.

Abnormal or pathological grief reactions are like infected wounds which cannot heal. As Edgar N. Taskson puts it, if working through the grief does not occur at the time of loss, "it will be done later at a much greater cost to the total personality." (Edgar N. Jackson, Understanding Grief (Nashville: Abingdon Press, 1957), p. 143.) Here are some warning signs which may indicate abnormal grief: an absence of mourning, increasing withdrawal from normal life, undiminished grieving, psychosomatic illnesses, severe depression which does not lift, personality changes, severe undiminishing guilt. It is the persistence of such symptoms over a considerable period of time that shows most clearly that normal psychological healing is not occurring. Repressed feelings of guilt, anger, and dependence deprivation are usually involved.

Pastoral counseling and/or psychiatric treatment should be instituted as soon as possible, hopefully before the problem moves into a chronic, difficult-to-treat stage. The goals are to help the person in releasing the "emotional tie to the deceased, despite the attending discomfort of sorrow and subsequently to replace the type of interaction lost." (Henry H. Brewster, "Grief: A Disrupted Human Relationship" Human Organization IX (195O), 19-22.) The method is to focus on memories of the loved one, assisting the person to become aware of and resolve his powerful, conflicted feelings about the loss. The process is painful, but there is no other road to healing. Medical help should be sought when psychosis, severe depression, or psychosomatic problems are obvious or suspected.

2. Stop-gap supportive counseling. A seriously disturbed young man contacted a minister in the town to which he had moved recently. The minister recognized immediately that he needed psychiatric treatment. Limited financial resources made the community mental health clinic the only feasible referral. After an initial screening interview, he was placed on the clinic's waiting list. During two months of waiting, the minister saw him regularly, making no attempt to engage in insight counseling. He merely allowed the man opportunity to pour out his fears and troubles in a supportive, accepting relationship. This relationship probably allowed him to remain functional until psychiatric help was available. In many similar cases, a pastor can render invaluable stopgap aid to a person in desperate need.

3. Sustaining counseling. For some persons who have low ego-strength or are irreversibly crippled emotionally an ongoing relationship with an authority figure allows them to continue to function. The minister's symbolic role makes him a natural supportive counselor. Dependent persons are inevitably attracted to him because he represents a parental strength upon which they need to lean. They can identify with him as he functions in various leadership roles (see Chap. 3) and their dependency needs can be distributed among other leaders in the church organizations. These factors make it possible for a minister to help sustain a network of dependent persons with an economical expenditure of counseling time. An occasional counseling contact in which they tell him "how things are" and he gives them whatever guidance is needed will have greater meaning to them than many sessions with another counselor. Their awareness that he knows them and is concerned about them, has an ongoing ego-sustaining effect. Many people are able to keep going in desperately difficult situations because of this kind of relationship in their lives.

In ascertaining whether dependency relationships are constructive two questions are relevant: Does the minister need to collect such relationships? Does he do things for people (make decisions, for example) that they could do for themselves? If both can be answered in the negative, such relationships are probably not blocking growth and, on the contrary, are serving a vital need.

4. Supportive growth-action counseling. Supportive counseling with certain people does much more than simply sustain them. It provides the interpersonal environment in which they can grow in their ability to handle life constructively, The heart of such counseling is a steady, dependable relationship with the minister. The person acquires strength, not by achieving depth insight, but by the exercise of making decisions, taking responsibilities (often small, at the beginning), and handling the stresses of his life-situation while in a supportive relationship. Self-esteem grows as the person is helped to hold a job, experience modest success in his relationships, and reduce the disorganization of his life. In short, the supportive relationship permits the person to function constructively. From this he gains strength which gradually allows him to function with less support.( For a more comprehensive discussion of supportive growth counseling see H. J. Clinebell, Jr., "Ego Psychology and Pastoral Counseling, " Pastoral Psychology (February, 1963), pp. 26-36.)

Alcoholics Anonymous provides a vivid example of a supportive-growth group. By successfully interrupting the "runaway symptom" of drinking to overcome the effects of previous drinking, A.A. enables the alcoholic's personality resources to become available to him for handling his problems in living. It provides a supportive social environment in which the alcoholic's desocialized, semiparalyzed ego can acquire enough strength, by identifying with an accepting group, to renew its functioning. This functioning in interpersonal relationships eventually restores ego strength. Through A.A.'s supportive-growth approach nearly 300,000 "hopeless" alcoholics have recovered, most of them with no attempt or need to explore the deep personality conflicts which probably caused the addiction.

In supportive-growth-action counseling, the pastor focuses on present reality, current relationships, and the practical problems of handling one's life situation more adequately. He is as interested in what a person does about his problems as how he feels. No attempt is made to ferret out deep underlying causes. Rather than search in the irrational and immature side of a person's life the minister relates to his rational and mature side. The goal is to help the person's adult side (which, as Eric Berne shows,( Transactional Analysis in Psychotherapy [New York: Grove Press, 1961] even the most inadequate person possesses) gain strength by functioning, so that it will rescue control of the person's relationships from his child side. Such counseling aims at discovering and activating whatever areas of potential strength and competence a person possesses. The realization that significant enhancement of a person's general adequacy in living can occur without anything approaching depth insight opens a wide door of new effectiveness for the counseling minister.

"Insight" has been the ultimate goal, the magic word in pastoral counseling for too long. For persons who have the time, money, and emotional resources to acquire self-understanding in depth, it can be a life-transforming experience. But it is unrealistic to expect this in short-term pastoral counseling. Many people lack an appreciable capacity to acquire depth insight. Many of these, and others who have the capacity, do not require insight in order to enhance their relationships and increase their effectiveness in living.

A teen-ager who has withdrawn from his peer group because of emotional problems becomes progressively less able to relate to other adolescents because he misses important learning experiences in relating. His emotional problems are increasingly aggravated by his actual lack of social skills. A vicious failure-withdrawal cycle develops. If this is recognized early enough and the underlying emotional problems are not too severe, the most helpful "treatment" is getting him back into an accepting peer group. Often an emotionally secure teen-ager who "belongs" can be found to serve as a bridge to such a group. If this is successful, no psychotherapy may be needed.

A school dropout often gets caught in a runaway, self-perpetuating failure cycle- the more he fails, the more he expects to fail and the less his chances for success. Helping him interrupt and reverse this vicious cycle by some experience of success is often more useful to him than psychotherapy. Countless other examples of this could be cited. If taken seriously by the minister counselor the supportive growth-action approach provides him with a counseling tool which he is naturally equipped to use and which will allow him to help scores of people who do not respond to a client-centered approach. Some form of supportive counseling is indicated when working with persons having weak or rigid personal structures. This includes most alcoholics, drug addicts, overt and borderline psychotics, those with severe psychosomatic problems, religious fanatics, rabid "positive thinkers," and those with a protracted history of chronic failure in adult roles (marriage and job). A supportive, rather than an uncovering (insight) approach is also the most helpful one with most "senior citizens." Personality structure generally becomes less resilient with the passing years.

Referral Counseling

Since many people trust his judgment and turn to him spontaneously when trouble strikes, a minister is in a strategic position to assist them in finding competent, specialized help. A wise referral is one of the most significant services he can render a suffering parishioner. A family who, in the midst of a traumatic problem, is guided by its minister to effective help, is usually eternally grateful to him. A minister can multiply his service to the troubled manyfold by using all the helping resources of his community to the hilt. It is unfortunate that some ministers feel that referral is an admission of weakness or failure. Action for Mental Health reports: "The helping process seems to stop with the clergyman and physician in the majority of cases, and far more so with the clergyman than with the physician." (Action for Mental Health, p. 104.)

As soon as a clergyman arrives in a new parish, he should begin to assemble a "referral file" of community resources. If his community has a welfare planning council, it may provide a directory (or a phone information service) listing health and welfare services. Professionals who have been in the area for a while are often sources of reliable information. Accurate evaluations of the relative competence of counselors and psychotherapists may be difficult to acquire except by firsthand contacts and by observing the results of referrals. It is helpful for the minister to have personal acquaintance with such persons and with key agency workers before he needs to make a referral. Having lunch with such persons, attending an open A.A. meeting, or visiting the local mental health clinic can strengthen one's referral-making ability.

Here are some basic guidelines for referral counseling: (a) Create this expectation -- When the minister's availability for counseling is presented in the church paper, his function of assisting persons in finding specialized help should always be mentioned. (b) Mention the possibility early in any relationship in which one suspects a referral might be in order. The longer one waits, the more referral will arouse feelings of rejection. If a counselee doesn't improve after four to eight sessions, he probably should be referred. (c) Use rapport with the minister as a bridge over which the person can walk into another relationship. This is facilitated if he knows that the minister knows and trusts the person to whom he is referred. (d) Attempt to remove any emotional blocks which may prevent him from going to the person or agency suggested. This may take several sessions or even several months of counseling. When a referral is recommended, the minister should routinely ask what the person has heard about that person or agency and how he feels about going there for help. It is essential to search out the fears, misinformation, and emotional resistances which otherwise will cause many referrals to be unsuccessful. It is also wise to ask the person to report back, indicating a continuing interest in his obtaining the best available help. (e) If possible, the person should make his own appointment. This keeps the initiative where it belongs and also begins a relationship with the new helping resource. (f) The minister should let the person know that his pastoral concern and care will continue undiminished after the referral. This will lessen the sense of rejection. However, it is essential that a person referred for counseling or psychotherapy not also continue to counsel with the pastor. One counselor at a time!

Short-term Educative and Decision-Making Counseling

In many counseling situations, the minister needs to combine the skills of the educator, the guide, and the counselor. Effectiveness in such short-term "pastoral guidance" depends on the minister's wise use of his special knowledge and authority. Awareness of when to use advice, instruction, and guidance to facilitate rather than block growth is one aspect of the sensitivity of a well-trained counselor. Lacking this sensitivity, a counselor's advice, like that of Job's "comforters," is apt to be a burden rather than a blessing.

The pastor's authority is "strong medicine" and should be used in counseling (as elsewhere) with caution and moderation, under circumstances such as these: (a) When a person's decision-making ability is temporarily crippled. Encouraging a grief-crushed person to choose a coffin within his price range is an example. (b) To block a precipitous, impulsive action with serious, irreversible consequences. A minister is obliged to use persuasion, coercion, and even physical restraint if necessary to save a person bent on suicide. In cases where any dangerous, impulsive actions are planned, the minister's role is to interrupt the person's momentum, to encourage him to explore the probable consequences, and to consider alternatives. (c) With those who are mature enough (in their relations with authority) to accept or reject suggestions after weighing their merits, it is relatively safe to advise. Except in an emergency, a wise counselor will never give advice or attempt to instruct a person until he understands something of that person's inner world.

A seasoned pastor has a wealth of knowledge from his training and experience which counselees lack and some of which they need as grist for the decision-making process. The minister's legitimate fear of "playing God" in the lives of other people should not prevent him from sharing his knowledge when appropriate. He should, of course, be alert to the emotional problems which frequently lurk behind requests for information. When advice and/or instruction are used in counseling they constitute only part of the process. They should always be combined with work on the feeling level. It is usually more constructive to help a person explore alternatives than it is to suggest one course of action. The counselor should respect people's freedom to make their own mistakes and their own decisions even when they seem to him to be in error. (He should shield them, if possible, from mistakes which have disastrous or irreversible consequences.) There are many things that a person cannot be taught. He can only learn them for himself.

One thing a minister needs is faith in the effectiveness of skilled short-term counseling. Experience at family service centers has shown that many people can be helped significantly in one or two sessions at a time of crucial decision or crisis.( From a discussion on April 5, 1963 with Carl Shafer, formerly director of the Pasadena Family Service Association.) An impulsive decision to initiate divorce proceedings made during the heat of a domestic battle, often proves, when the smoke has cleared, to be unfortunate. Because of the chain-reaction of lawyers' maneuvering and mutual recriminations which follows such a decision, the action may be difficult to reverse. This is why a minister is usually justified in using pressure, if necessary, to persuade a couple in a marriage crisis to agree to a moratorium on legal action until they have had several months to explore alternative ways of resolving their conflicts.

Robert Frost's poem, "The Road Not Taken," has a certain relevance to short-term pastoral guidance. In vocational counseling, for example, a fork-in-the-road ministry may be all that is needed. A minister who encourages a bright adolescent to take the college fork rather than its alternative may in one interview have a decisive positive influence on that person's next sixty years. In many cases, of course, vocational dilemmas involve emotional conflicts which call for longer-term counseling.

If a counselor expects to be genuinely helpful in a few sessions, the odds that he will be are improved. The Court of Conciliation in Los Angeles maintains a counseling service for disturbed marriages. Sixty percent of their couples have already filed for divorce. All couples are seen from one to three times. For one third of them, this is enough to effect reconciliation. These are families in which pressures such as loss of job, ill health, in-laws moving in, and so forth, have knocked the marriage off balance. Their problems snowball. Often this runaway process can be interrupted and they can be helped to get their marriage back in balance in a short time. The other two thirds of the couples are disturbed persons who require more extended help. The remarkable thing about the conciliation service is that in spite of the advanced disintegration of many of the marriages, an average of sixty out of a hundred couples decide to try to save their marriages through a "trial reconciliation." Follow-up studies after a year show that three fourths of these are still together.( This report on results and methodology is from a talk on April 5, 1963 by Meyer Elkin, Director of the Court of Reconciliation counseling service.) One reason for the success of this service is its atmosphere of hope. The counselors expect to help people and they do!

The approach of this service has aspects which can be used in short-term pastoral counseling. Here is what these counselors do: (a) Furnish disciplined listening. (b) Provide ego support. The counselor helps a couple to keep their heads above water and see what is happening. (c) Help the couple mobilize their inner resources. They often discover these as they talk with a counselor. (d) Help them to distinguish an impulse from a final decision. "I want a divorce" may mean "I don't want a divorce" or "Help me" or "What do I want?" (e) Interpret only conscious material. The counselor may be aware of unconscious material but he does not deal with it. (f) Use questions and confrontation. A question, skillfully used, is to a counselor what a scalpel is to a surgeon. (g) Focus on the marriage relationship, instead of on the inner problems of the individuals. (h) Use authority constructively. At the conciliation service, seven out of ten couples actually sign a written agreement which aims at helping them reorganize their role-relationships. The ritual of working it out is often helpful.

Superego Counseling

In the period when modern psychotherapy was born, many of those seeking help were crippled by neurotic, puritanical consciences which stifled their creativity and loaded them with neurotic guilt feelings. The goal of counseling with such persons was and is to decrease the severity of their hair-shirt consciences and to help them become more self-accepting. The pastor still sees many people who need precisely this help. But he also sees persons whose inner controls or consciences are underdeveloped and weak. They have not internalized the culture's major values and therefore have not learned to control their impulses. Such "character problems" sometimes stem from homes where weak parents mistook permissiveness for love and were unable to maintain stable limits or dependable discipline. Many others come from barren, loveless homes or from homes with a physically or emotionally absent father.

A girl of seventeen came to her pastor to discuss her sexual activities. Her father was an emotionally nonresident commuter. Although she consciously felt little or no guilt about her activities, she was fearful of "getting caught." If the minister had responded to her reports of promiscuity in a passive or permissive way, she would have interpreted this as more of the weak, detached permissiveness of her father. She needed more acceptance than she was getting at home, but not more permissiveness! On the contrary, what she needed was for the minister to be both an accepting and a firm father-figure from whom she could gain strength in controlling her own behavior and in relation to whom she could establish her own constructive limits. After rapport was well developed, the minister made it clear that from his point of view, certain behavior is harmful to persons and therefore morally wrong. Using accepting confrontation he helped her face rather than avoid the probable consequences of her behavior. Most important, he helped her become aware of and work through her confused, lonely, rebellious feelings which provided fuel for the behavior. In reflecting on this experience, the minister realized that the girl was, by her behavior, pleading for some adult to set limits. In fact, this is probably why she had come to a minister.

Every minister represents the value structure of the community. This is an aspect of his socially defined role which is essential to the mental and moral health of our society. He should never be afraid, in any relationship, to stand for the things he regards as right. If his acceptance of feeling is mistaken by counselees for acceptance of their person-hurting behavior, they will be confused and letdown by him. His role as a value-symbolizer keeps some troubled persons from seeking his help. But for the many who come suffering from either weak or punitive consciences his symbolic role provides a tremendous counseling advantage. In using confrontation and firmness with those who have underdeveloped consciences, it is essential that the minister "speak the truth in love." If he has achieved reasonable awareness and self-acceptance of his own weaknesses and sin, he will be better able to stand for what he regards as right without being self-righteous, moralistic, or rejecting of other sinners.

Edmund Bergler has written that "a feeling of guilt follows every person like his shadow, whether or not he knows it."( The Battle of the Conscience [Westport, Conn.: Associated Booksellers, 1948], p. vii.)

As indicated in Chap. 2, human guilt is of two intertwined varieties -- normal, resulting from hurting persons; and neurotic, resulting from breaking puritanical mores. Normal guilt is healed by confession, making amends, and experiencing forgiveness. As a religious leader, the minister counselor can use the healing symbols of Christianity by which such guilt can be transformed. Neurotic guilt can be alleviated temporarily by compulsive self-punishing atonement devices. It can be removed by the maturing of the person's conscience through depth counseling.

Informal Counseling

The idea of the psychotherapist who sits in his office seeing clients for fifty-minute hours is inapplicable to much of a clergyman's counseling. Many of his best counseling opportunities occur informally, as a part of his general pastoring. One aspect of the uniqueness of the pastoral office is the opportunity to apply counseling sensitivities and insights in the ordinary encounters of parish life. It is well to recall that the counseling of Jesus apparently occurred in such informal settings as by a well with a Samaritan woman. The minister should develop the skill of turning pastoral calls and chance conversations into counseling opportunities, formal or informal. Unless he does this, he will miss many who need help but are afraid to seek it directly.

Some people who cannot overcome their resistance to admitting their need for counseling can pause for a few minutes after a meeting to tell the minister something about a situation. They may or may not move into a formal counseling relationship. Even if they do not, they can receive some supportive help and guidance from occasional informal contacts. Counseling-shy persons sometimes edge into counseling by coming to discuss other matters and then in an offhand way bring up the real problem.

In informal counseling many of the approaches of short-term formal counseling are useful -- sensitive listening, reflecting feelings, seeking to understand empathetically, giving ego support, summarizing the person's perception of the problem, asking questions, examining alternatives, giving information, and, occasionally, advice. If a serious problem is evident, the minister should make every effort to continue the counseling. One Sunday morning a middle-aged parishioner paused after the other worshipers had left to mention that she was planning to seek a divorce. After listening for several minutes, the minister said, "Let's step over to my study where we can talk about this more fully." (If this had not been convenient, he could have said, "I'm going to be over your way this afternoon about two o'clock. If it's convenient, I'll stop by so that we can discuss it more fully.")

Creative pastoral calling gives rise to many opportunities for informal counseling, particularly in cases of shut-ins, the sick, the unemployed, the aged, and the rootless who move frequently in a futile effort to escape themselves. To make the most constructive use of his calling time a minister might maintain a "Special Help List" of the names of those whom he knows or suspects have special needs. In addition to those just mentioned, the bereaved, the alcoholic (hidden or open), the handicapped, and the vocationally or maritally maladjusted have a place on such a list. The minister does well to invest a greater than average amount of pastoral time in these members of his flock. His aim will be to allow a strong bridge of rapport to grow with them so that they can walk over it (psychologically) to seek his help. If they do not do so, and the relationship is strong or the need great he should not hesitate to take the initiative in offering help.

How does one keep pastoral calls from being merely pleasant social visits, dominated by the usual social "chitchat"? The minister can offer opportunities for the communication to move to a deeper level. John Sutherland Bonnell used this question to open doors of pastoral opportunity: "How are things going with you spiritually?" Subtle distress signals such as a catch in the voice, a slip of the tongue, tension in a marriage relationship, or a change in the pattern of church participation can often be picked up if the minister has his psychological antenna out to catch these cries for help. If a parishioner sounds burdened or despondent, simply saying, "You sound as though you're feeling discouraged," often opens the door to counseling.

Group Counseling

Much pastoral counseling now done on an individual basis could be done more efficiently and effectively in small groups. In his volume on group counseling in the church, Joseph W. Knowles writes:

Group counseling is integral to the ministry of the church. The doctrines of church and ministry reveal the depth nature of a counseling group, and a counseling group can become a means of grace whereby the church is enabled to be the church. Furthermore, the ministry of the church is the ministry of the entire people of God. Group counseling can become one means by which the pastor fulfills his essential function "to equip God's people for work in his service" (Ephesians 4:11-12, NEB), and through which laymen perform their priesthood as members of the Body of Christ.( Group Counseling [Englewood Cliffs, N. J.: Prentice-Hall, 1964], pp. 7-8.)

Group counseling offers the richest single field for future development within the general pastoral counseling field. (This underscores the importance of providing training in group dynamics and group counseling for theological students and ministers.) As indicated in Chap. 7, the proliferation of small groups in churches all over this country and in many other parts of the world shows that this exciting development is already well along.

Religious-Existential Problem Counseling

A relatively small percentage of those who seek pastoral help come because of overt "religious problems" -- problems of belief, doubt, prayer, and so forth. When such problems are presented in counseling, they sometimes are surface-level manifestations of deeper emotional problems. A man in his early forties consulted his minister because his prayer life had lost its meaning. In the course of counseling it became clear that he was suffering from an oppressive load of guilt linked to the death by suicide of a relative for whom he had felt some responsibility. When this problem was worked through in counseling, vitality returned to his prayer life. The minister should be aware that psychological problems, including psychoses, sometimes come disguised as "religious problems."

It is equally important to be aware of the spiritual emptiness and lack of a meaningful philosophy of life which are at the root of many neurotic problems. Paul Tillich points out that those who are empty of meaning are "easy victims of neurotic anxiety"( The Courage to Be (New Haven: Yale University Press, 1952), p. 151) and conversely, that a high degree of neurotic anxiety renders one hypersensitive to the threat of nonbeing.(Ibid., p. 67) Thus, there is a reciprocity between neurotic and existential anxiety -- each reinforcing the other.

There is a religious dimension to every human problem in that existential anxiety is inherent in all human existence. When a person lacks a vital religious life he has no way of handling his existential anxiety constructively. As noted in Chap. 2, it is only as a person faces his existential anxiety and makes it a part of his self-affirmation that it becomes a creativity-stimulating rather than a deadening influence in his life. It is possible to confront existential anxiety only to the extent that one has achieved a viable personal religion, including a meaningful philosophy of life, a challenging object of devotion (and self-investment), a sense of mystery and transcendence, and a deep-level experience of basic trust in God, oneself, others, and life. When these have been achieved to a significant degree existential anxiety becomes, in Kierkegaard's words, a "school" -- a source of wisdom and growth.

The basic religious problem consists of finding these four experiences so that one can handle existential anxiety creatively. Until the middle years many people are able to ignore their unsatisfied spiritual hungers. But when a person crosses the halfway point in his life, his value "vacuum" or inner poverty becomes painfully obvious as he moves on the downward slope toward death. Frequently such persons become depressed with a sense of utter futility. Helping the person find a religious orientation and dedication is often the central task in counseling with such persons. Helping him look at his life from a religious perspective can change his basic feelings about his problems. As a specialist in spiritual growth, the minister should be able to render unique help to such individuals.

Specialized Ministries Of Counseling

Every church of more than five hundred members should have one minister on its staff with advanced training in pastoral counseling. (His training should be such as to qualify him for membership in the American Association of Pastoral Counselors.) (Clinical membership requirements include: college and seminary degrees, a masters degree in pastoral counseling, ordination and good standing in a denomination, three years of parish experience, six months of clinical training and 250 hours of supervision of one's counseling, and personal therapy.)

Here is a job analysis for a Minister of "Counseling":

1. Provide a pastoral counseling service for members and constituents.

2. Develop a group counseling program for those with special needs and those who wish to raise their level of creativity in relationships.

3. Work with the leaders of church groups with the goal of increasing their groups' abilities to meet the needs of persons.

4. Develop a long-range program of premarital education and counseling.

5. Provide vocational counseling of youth and young adults.

6. Serve as a resource person for renewal and planning retreats.

7. Work with the Christian Education Committee in developing a parent and family-life education program, teacher and leadership training workshops.

8. Participate occasionally in the preaching ministry, the leadership of public worship, ministering to the hospitalized, and speaking to church groups.( This is an amended version of the goals of the ministry of counseling in which the author engaged at the First Methodist Church of Pasadena. Not all of these goals were achieved.)

The emergence of pastoral counseling as a specialty within the ministry has been paralleled by the development of church counseling centers in many parts of the country. There are now 164 of these sponsored by denominations, councils of churches, individual churches, seminaries, and privately.( Berkley C. Hathorne, A Critical Analysis of Protestant Church Counseling Centers (Washington, D. C,: Board of Christian Social Concerns, The Methodist Church, 1964) The majority of these are staffed by clergy counselors; some have interprofessional staffs. These counseling centers have opened a new, significant dimension in the churches' mental health ministry. In his study of the Churches and Mental Health, Richard V. McCann states that pastoral counseling centers "could be at least a partial answer to the need for substitutes for mental health facilities in small communities." (Churches and Mental Health, pp. 94-95.)

I share the enthusiasm of his conclusion: "The church counseling centers, in attempting to meet the mental and spiritual needs of people, seem to be the best way, organizationally, to make this aspect of the ministry available to people who need it." (Ibid., p. 95)

In the most comprehensive study of these centers now available, Berkley C. Hathorne arrived at these conclusions:

1. The church counseling centers have restored an historic tradition to the Church by meeting neglected needs. 2.... provide help for many who would not otherwise get assistance. 3.... perform a significant community service by functioning in part as a referral agency. 4.... may aid in the prevention of more severe disturbances. 5.... may provide unique opportunities for personal and spiritual growth. 6.... have fostered inter-professional association and cooperation. 7.... demonstrate another dimension of interdenominational cooperation. 8.... provide a clinical setting for advanced training in pastoral counseling. 9.... provide a clinical laboratory for research. 10.... confront American Protestantism with the challenge to extend and expand the ministry of counseling. (Hathorne. pp. 79-83.)

The specialist in pastoral counseling, whether he works on a local church staff or in a counseling center, shares many of the counseling advantages of the parish minister and, in addition, has time and training to do depth counseling or pastoral psychotherapy. This is a salutary development, since it means that persons with theological training will now be cooperating with secular disciplines in seeking depth understanding of the human psyche.

Spiritual Healing and Pastoral Counseling

In a survey of ministers from Protestant churches one third had attempted spiritual healing in some form.( See Charles S. Braden "Study of Spiritual Healing in the Churches." Pastoral Psychology, Vol. V, No. 44 (May, 1954), pp. 9-15.) The current upsurge of this interest represents a revival of an ancient but long-neglected ministry. The term "spiritual healing" seems to suggest that some healing is not spiritual. Since all healing involves the release within a person of God-given growth forces, all healing is spiritual healing. Actually, what the term usually describes is approaches to healing making primary use of traditional religious forms and instrumentalities such as prayer, communion, the laying on of hands (Mark 16:18), and anointing with oil (James 5:13-16) .

Both the spiritual healing and the pastoral counseling approaches are useful in a local church's program. Both have the same goal -- the restoration of persons to greater wholeness. Experience has shown that some persons respond to one approach who do not respond to the other, and vice versa, while others benefit from a combination of counseling and healing services. Each approach tends to serve as a corrective of the other.

The physical danger in the spiritual-healing emphasis is that it will encourage persons to delay or neglect using the resources of medicine. A sound approach, of course, urges the use of all channels of God's healing, including the full range of medical resources. Psychologically, spiritual healing may increase unhealthy dependence on the leader and encourage the expectation of cures from the outside not involving struggle with inner problems. Theologically, this approach may cause people to feel they are manipulating divine forces to their own end, in a magical way. If a person is led to believe that enough faith will cure any condition, then failure to be healed saddles him with a load of guilt for his lack of faith. Enlightened approaches to healing strive to counteract these dangers. The emphasis is on opening the channels of one's life to the everavailable healing power of God and on healing of the personality. Physical healing may or may not be one aspect of this deeper healing of the spirit.

One danger that besets pastoral counseling is that it will lose its awareness of the spiritual element in all healing and will become infatuated, in an idolatrous way, with the human cleverness of psychology. The spiritual healing emphasis, particularly in its priestly aspects, can help a pastoral counselor retain a robust awareness of the vertical dimension in all relationships, including counseling relationships. It can remind the person enamored with counseling that the principles of the spiritual universe are much too complex to fit any machine model comfortably. There is infinitely more that we do not know than we do know about the human spirit and its relation to the Spirit of the universe.

The emphases in counseling on respect for the orderly cause-effect sequences in the world of the psyche and on the necessity of a person's growing in his responsibility for his own inner life can help to counteract any tendency in spiritual healing to function in ways which encourage magic or the temptation to shift the total responsibility to God. Training in counseling can help a minister use his authority constructively in healing rituals. Thus counseling and spiritual healing methods are complementary instruments for enhancing the wholeness of persons.



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