The shepherd needs great wisdom and a thousand eyes, to examine the soul’s condition from every angle. As there are plenty of people who are puffed up into arrogance and then fall into heedlessness of their own salvation because they cannot stand bitter medicines; so there are others who, because they do not pay a proportionate penalty for their sins, are misled into negligence and become far worse, and are led on to commit greater sins. The priest, therefore, must not overlook any of these considerations, but examine them all with care and apply all his remedies appropriately, for fear his care should be in vain.— John Chrysostom, from On the Priesthood
Good diagnosis leads to accurate treatment. Like any competent physician, pastors don’t know what interventions to provide for a distressed soul until they first listen to that soul. When I was teaching this classical model of the cure of souls to seminarians, I had an excellent physician whom I saw on a regular basis. At one of my visits I commented on the parallels between physical care and spiritual care, lamenting that we pastors didn’t have at our disposal technological tools to analyze spiritual complexities that remain hidden to our human senses. Internally I was jealous; wouldn’t it be wonderful if there were x-ray or imaging machines to tell us what was impeding the soul’s spiritual health?
“It’s a common fallacy that we doctors rely on tests like that for our diagnosis,” my physician replied. “They’re wonderful to give you an accurate picture of exactly what’s going on physically right now, but they don’t reveal the actual cause of the body’s distress or disease.” He went on to explain that such scans provide only about 10 or 15 percent of the information he needed for a diagnosis. “For that I rely mostly on a patient’s oral history.”
It amazes me that the medical profession depends on something that we pastors in recent generations have tended to dismiss: quiet, probing conversation accompanied by a great deal of attentive listening. In my experience, the listening itself provides an immensely therapeutic benefit. Most people in our time are frenetically occupied with so many things that they don’t take the time to sit down and unburden their hearts. And if ever they are inclined to do so, there’s no one to listen. So simply by giving someone your undivided attention for 60 or so clock ticks, you’ve given them an immense gift.
John Chrysostom, in his treatise On the Priesthood, warns every would-be shepherd against haste or dictatorial methods in dealing with God’s sheep. “The decision to receive treatment does not lie with the man who administers the medicine but actually with the patient.” He calls for tact and patience among pastors, lest in rushing ahead with uninvited spiritual care they jeopardize the health and life of the soul. “The shepherd needs great wisdom and a thousand eyes, to examine the soul’s condition from every angle,” he writes. Proper diagnosis is of the utmost importance for faithful physicians of the soul. To rush in uninvited or with the wrong medication courts spiritual disaster.
What makes for good public preaching makes for effective individual teaching. Pastors must first listen to the soul before they can minister to the soul. Since the condition of the soul is disclosed primarily by the heart, effective physicians of the soul need to polish their listening skills, opening up not merely their ears but their hearts to the suffering of the soul as well.
Spiritual Truths for Spiritual People
Pastoral care is not purely an emotional or relational transaction. Ultimately, this is a spiritual exchange. And so at one and the same time as I give my undivided cognitive and sensory attention to what a person is telling me, I simultaneously intercede silently for the Spirit’s help and guidance. Specifically, I pray that this soul may speak the truth of what lies heavy on their heart and also that I might accurately discern how best to provide the help and healing that God intends by means of his Word and sacraments.
While faithful pastoral care demands the highest standards of excellence in training in every discipline of theology (dogmatic, historical, exegetical, pastoral) and the very best skills we can muster intellectually and emotionally, the essential core of what we do as shepherds of souls is always spiritual. By definition, that means our work has to do with the Holy Spirit.
The whole process of the care of souls revolves around the operation of the Holy Spirit. You and I as spiritual physicians are not interested in generic “spirituality.” According to Scripture, what is truly “spiritual” flows from the person and work of the Holy Spirit. Our insight into a person’s condition—an accurate diagnosis—and our treatment of that condition both hinge on the revelation of God’s Spirit in his Word. To properly grasp the whole circumstance, we need more than a perceptive mind or emotional intelligence; we need accurate discernment by means of that Word. And when we speak, we need more than human wisdom; we need instruction from God’s own Spirit by means of his Word.
Likewise what we bring to people by the power of God’s Spirit they are able to receive only because they are “spiritual,” meaning they themselves have received the Spirit by baptism into Christ. Just as a transmitter and receiver must be on the same frequency so signals can accurately connect, so the entire process of spiritual care occurs on the “wavelength” of the Holy Spirit (see 1 Cor. 2:12–13).
Though pastoral work is detective work, it’s not an inquisition. Never interrogate your parishioners or other distressed souls. You are not an inquisitor; you’re a shepherd tenderly caring for Christ’s sheep and lambs. You are interested in the manifold dimensions of their relationship with him. Yet you’re not a spiritual voyeur; you never pry into private matters or go digging for deep, dark secrets. In the course of your spiritual care, people may disclose rather personal and intimate aspects of their lives. But your interest in these things is never personal; you are there on errand and commission. You’re an ambassador and minister of Christ; Jesus intends to do his work through you.
Sometimes situations long hidden are revealed in the course of your pastoral care. Whenever they arise, you deal with those things appropriately with the tools entrusted to you, but you never go digging for dirt. That’s Satan’s work; he is the accuser. Christ on the other hand is the Redeemer; he has appeared in time to undo Satan’s work, to abolish sin and death and bring “life and immortality to light through the gospel” (2 Tim. 1:10). Now you’ve been sent to do Christ’s work, you’ve been made a minister of his gospel, to set free people long held captive to sin and give them a good conscience before God.
Treat the Disease, Not the Symptoms
Physicians really can’t proceed with treatment unless they know the ailment they’re trying to cure. It simply won’t do to treat the symptoms; you only prolong the morbidity in that case. Rather, physicians of integrity know how best to examine the patient, carefully considering all symptoms to be sure, but using those symptoms to lead them to a more accurate diagnosis of the underlying disease.
This brings to mind a congregant; let’s call him Dan. He was a middle-aged father of two sons in their late 20s. One, a very troubled young man named Robert, had given his mom and dad much cause for frustration and worry ever since adolescence. Taking up a position in the family business, Robert was putting out a good-faith effort to clean up his checkered past and seemed to be making good progress overcoming some poor life choices.
Dan and his wife, Nancy, were beginning to hope that Robert had turned his life around, although his steady girlfriend had recently broken up with him. Robert came in to see me about all of this, and I was able to point him to the promise of healing in Christ; he left my study in apparent peace.
But that night around two in the morning, the shrill ring of my phone shocked me out of deep slumber to instant alert mode. Even in my stupor, I recognized Nancy’s voice immediately. “It’s Robert,” she blurted out woodenly. “We’ve found him in our backyard. He’s shot himself.”
The rest of the night was of course a blur; I threw on some clothes and dashed to their home. Flashing squad car and emergency vehicle lights lit up the driveway and façade of the house in eerie red and blue. Dan and Nancy were in shock; I was in shock too as I prayed and ministered to them, internally going through my own “could have/should have/would have” list about my visit with this young man not 12 hours before he took his own life.
You go on autopilot in situations like that; you comfort those who mourn and you weep with those who weep. But mostly you listen in order to try to comprehend the incomprehensible so you can pray God’s consoling healing for the inconsolable, empty black hole of such a violent, horrific tragedy when everyone is left searching their hearts and finding no answers. Some days after the funeral, Dan called me late one night. “Can I see you tonight, Pastor?” he asked. “Of course,” I replied. “I’ll meet you in my study in 30 minutes.”
The agony was palpable as Dan joined me at my conference table and began. We talked and talked well into the wee hours while Dan relived the misery, pouring out his anguished heart. I heard loss and grief, of course, but I sensed there was more in there. Silently I prayed that the Spirit would give him words to speak and me ears to hear so this abscess could be lanced.
Slowly the picture emerged; Dan was fixated on the argument that he and Robert had the night he took his life. Harsh words had been exchanged between them— bitter words and hateful. Dan’s remorse was almost too much to bear. Finally, he reached the horrid, ugly core of the matter. “It was my hunting rifle he used,” Dan told me through wrenching sobs. “Why didn’t I lock it up?”
There’s no arguing with regret. There’s no use explaining the hard, cruel facts: that suicide has many victims besides the one who pulls the trigger, that irrational thoughts lead to irrational actions, that those intent on taking their own lives will find a way no matter what. Being attentive in mind and heart, I diagnosed Dan’s core hurt as guilt. Now it was time to be intentional in cure.
“Let’s take this mess to Jesus where it can be resolved,” I said. And so we knelt together, Dan and I, at the prie-dieu in my study. There in the quiet of that night before the image of the Crucified One, Dan gave voice to his remorse and guilt—not just to me but to the Lord who by his blood had blotted out every sin. And there that night, Dan heard with his own ears not just me but the Savior who commissioned me to forgive all sins in his name and stead. Dan stood forgiven before God himself in heaven.
Not only does a physician of souls need a thousand eyes in terms of spiritual discernment, as John Chrysostom put it, but he needs to be well practiced in the art of faithful and effective cure, applying the word and sacrament to the underlying ailments of the soul in a manner intentionally tailored to bring optimal health and healing in Jesus. He bled and died to purchase people as his own, and he has placed them into your care and keeping to tend them in his name and stead. He knows full well you have no resources whatsoever to give them; that’s why he puts his own Word into your mouth to speak and gives you his sacraments to administer to make the wounded whole, to bring hope and healing to despairing and broken souls.
Harold L. Senkbeil is an executive director of DOXOLOGY: The Lutheran Center for Spiritual Care. This article is adapted from his book The Care of Souls: Cultivating a Pastor’s Heart (Lexham Press).
