Evidence-Based Reviews

Pastoral counseling: What is it, and when can it help?

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Certified pastoral counselors can be particularly helpful for patients experiencing loss, terminal illness, or conflicts regarding religious beliefs.



Pastoral counselors represent a valuable resource for psychiatric referrals as they are uniquely qualified to address certain mental health issues—including bereavement and coping with terminal illness. Pastoral counselors trained in behavioral sciences can help assess and treat patients who prefer psychotherapy that reflects their spiritual beliefs.

Ministers have been counseling members of their congregations since ancient times. As many psychiatrists may not be aware of the skills and services offered by pastoral counselors, this article:

  • describes their background and credentialing
  • identifies clinical scenarios in which splitting care with a pastoral counselor may benefit the patient.

Short- or long-term counseling

Pastoral counselors practice in a variety of settings, including pastoral counseling centers, inpatient and outpatient mental health facilities, and in private practice. Individuals generally seek therapy from a pastoral counselor because of their connection with a particular faith, whether Christian, Jewish, Native American, or others. Pastoral counselors— with training in both a religious tradition and the basics of psychology and psychotherapy—can challenge rigid, defensive, or misinformed spiritual beliefs that might contribute to a patient’s psychological distress and dysfunction.1

Box 1

  • In the Torah, the word for counsel, etsah, is used 84 times. Its verb, yaatz, is the root of the Hebrew word for counselor.3
  • In the Bible, pastoral counseling prototypes include ministers assigned by Moses to guide the Hebrew people in family, community, and religious life; the prophets Samuel, Jeremiah, and Ezekiel; Jesus of Nazareth; and the apostle, Paul.
  • In the 6th century, manuals for Christian priests on assigning penance during confessions (the “Penitentials”) were also intended to reconstruct the personality.3
  • Sixteenth-century documents detail steps to “growth in holiness” and prayer and meditation for persons aspiring to greater “perfection.”4
  • Martin Luther, leader of the Protestant Reformation in the 16th century, emphasized reasoning and individual freedom rather than doctrine in the Christian church.

Some forms of pastoral counseling are short-term and problem-focused, whereas others address long-standing conflicts and require a long-term relationship with the therapist. For this reason, some therapists prefer the term “pastoral psychotherapy,” feeling it better reflects the work and goals of the counseling they do.

Pastoral counseling and psychotherapy are predominantly insight-oriented but include other therapeutic models as well. Clinebell recommends that pastoral counselors be familiar with four types of therapy:

  • behavioral
  • human potential (e.g., transactional analysis and Gestalt psychology)
  • relational
  • and spiritual growth (e.g., based on theories and practices of Carl Jung).2

Integration of religion and science

Examples of pastoral counseling can be traced throughout Judeo-Christian history (Box 1).3,4 As early as 1861, Congregational minister Horace Bushnell of Hartford, Conn., advised parents of the importance of the first 3 years of life in the development of a child’s character.5

Pastoral couseling was shaped by the scientific exploration of the human mind in the late 19th century. William James’ 1890 work, The Principles of Psychology, described the nature of human consciousness and contributed significantly to what became the profession of psychology.6 At the same time, Sigmund Freud was developing his theories of the unconscious. Whereas James explored the dynamics of the individual mind, Freud explored interactions with significant persons at critical periods of development, bringing out the importance of relationships in psychological organization.

The study of the psychology of religion was well underway by the turn of the 20th century, with the publication of E. D. Starbuck’s The Psychology of Religion (1899) and James’ The Varieties of Religious Experience (1902). Ministerial training programs introduced courses in the psychology of religion to help clergy educate and counsel parishioners. Rollo May’s The Art of Counseling (1939), which was presented as a series of lectures to Methodist student workers, is regarded as the first systematic study of counseling techniques. It incorporated the theories of Freud, Jung, Otto Rank, and Alfred Adler.3

Physicians also helped to nurture pastoral psychotherapy by providing clinical experience to seminarians:

  • William Keller, MD, of Cincinnati supervised five students from Bexley Hall, an Episcopal seminary in central Ohio, in 1923.
  • Richard C. Cabot, MD, then on the faculty of Harvard Medical School, collaborated with minister Anton T. Boisen to develop a clinical pastoral training program at Worcester State Hospital in Massachusetts in 1925.3
  • Psychiatrist Smiley Blanton, MD, collaborated with the Rev. Norman Vincent Peale in the 1930s to form the American Foundation of Religion and Psychiatry. The New York-based organization—now called the Blanton-Peale Institute—provides clinical training for pastors and pastoral counselors.

Clinical pastoral education has allowed clergy to practice counseling under the supervision of experienced professionals and has laid the foundation for the pastoral counseling profession.

A ‘theology of relationship’

The theological and community focus of modern pastoral counseling have led some to describe it as a “theology of relationship.”7 Extending from Freud’s understanding of the impact of relationships during infancy on subsequent personality development and Erik Eriksons’s work on the formation of identity through relationships later in life, pastoral counseling considers the individual’s relationship to the community of humankind to be a significant determinant in mental health and illness.


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