The Christian Church is searching for a true pathway to minister to persons in need without compromising her heritage or neglecting the advances of science. A healthy absorption of some aspects of psychotherapy with pastoral care should produce a type of pastoral counseling that does not neglect God or ignore man. Psychotherapy also can become more therapeutic if it will incorporate some elements of pastoral care.
There are essential differences between psychotherapy and pastoral care. Psychotherapy is the main therapy in psychiatry which is a branch of medical science. The psychotherapist seeks to influence psychically persons suffering from emotional disorder in order to effect a cure or remission of symptoms. He aims to promote physical and psychic health as these two may be interrelated. Psychiatric treatment uses the means of “catharsis, working through, re-education, the bringing about of emotional maturation, reassurance, and encouragement, suggestion, and manipulation of the environment” (George Frankl, “The Dilemma of Psychiatry Today,” Mental Hygiene, Vol. XXXIII, No. 4, Oct. 1949, p. 554).
Pastoral care is essentially a ministry of the Word of God to the individual by an ambassador of Jesus Christ. Its aim is to bring people into a right relationship with God through fellowship with Christ and to establish people in that relationship. It hopes that mental health will be an indirect but real secondary benefit consequent upon the achievement of its primary spiritual goal. Pastoral care utilizes the means of the Gospel and prayer to convey a message of forgiveness of sins and encouragement in sanctification.
Another relative difference between psychotherapy and pastoral care is that the former is more concerned with general revelation and empirical science in connection with the person’s relationships to himself and others. Pastoral care is more concerned with special revelation and the person’s relationship to God.
Despite the many differences, there is a close relationship between psychotherapy and pastoral care. Both want to see man in his totality. When psychiatry tries to have a total view of man, it necessarily becomes involved in the area of pastoral care. Sigmund Freud reacted against structural psychology and emphasized the importance of the instinctual in man because he wanted a total view of man. Alfred Adler felt that environmental factors must be considered if man is to be understood in his totality. The emphasis of Carl Jung on the “collective unconscious” and that of Karen Horney on “character structure” indicate the same scientific search for a total view of man. More recently Harry Stack Sullivan has emphasized the significance of interpersonal relationships. If psychiatry is concerned with depth psychology, it must also necessarily consider that which is in the depths of man’s being—his relationship with God. When psychotherapy examines the function of conscience and relates itself to conscious as well as unconscious guilt feelings, it reaches an area of pastoral care even if it does not wish to do so.
Pastoral care is also interested in a ministry to the total person, and when it seeks to do so comes close to the area of psychotherapy. The pastor is called upon to deal with many persons having a variety of problems. He encounters people who have compulsions, conflicts, tensions, and fears which restrict the development of the life of faith. When the pastor attempts to remove these barriers, he comes close to the area of psychotherapy.
In addition to the proximity of the two disciplines caused by an operational basis of a total ministry to the whole man, psychotherapy is closely related to pastoral care when consideration is given to the person of the psychotherapist. He is a person with interpersonal relationships, including a negative or positive relationship to God. Despite vehement protestations of objectivity, the therapist cannot free himself from the totality of his personality with its background material of faith or unbelief regarding God. The therapist has a philosophy of life. He is more than a technician even if he does not wish to be more that that. If psychotherapy aims to synthesize the various aspects of life, it necessarily becomes involved in spiritual concerns—which is the territory of pastoral care.
Psychotherapy aims to promote mental and emotional health. However, there is no universal agreement concerning a definition of a healthy person. For Freud health must be related to the norm of the pleasure principle. Adler believed a healthy person to be one who was well-adjusted to the community. Jung spoke about individual self-realization as essential to mental health. The Christian wishes to consider health in relation to a two-world-and-life view in connection with the teaching of Jesus about the more abundant life. On this basis, if psychotherapy is to promote health in the full sense of the term it must share in the purpose of pastoral care, that is, a concern about a right relationship to God. Partial overlapping of the two disciplines is a necessary good and not an evil.
A COMBINATION OF SKILLS
Psychotherapy and pastoral care may be combined in certain instances. Psychotherapy whose chief aim is to promote mental health should be concerned about the restoration of a right relationship to God. On the basis of the doctrine of the universal priesthood of believers, the exercise of pastoral care may be the privilege and duty of a Christian therapist. If a client were to ask in sincerity and without clever subterfuge, “What must I do in order to have eternal life?” the psychiatrist ought not to feel obliged to reply, “That is out of bounds for me—I shall arrange for you to see a minister.”
Even as psychotherapy must be concerned about spiritual health, so also must pastoral care be concerned about mental health and utilize the means of psychology and psychiatry in order to achieve maximum spiritual health. In all the necessary overlapping, there must be a close adherence to the primary specific which is unique to each discipline.
The necessity of combining psychotherapy and pastoral care in order to produce evangelical pastoral counseling is indicated by the weakness of the traditional methods of pastoral care. In the latter case pastors were exclusively concerned about the conscious life. There was a lack of understanding of the real needs of the person by giving easy answers which did not meet the need because of the tendency to generalize, dogmatize, and moralize. To illustrate: A teacher comes to complain to her pastor about an unreasonable hostility she has toward two boys in her class. If she is told that her attitude is sinful and that she must repent and resolve not to have such feelings again, the problem will be repressed and the teacher made to feel more guilty than she was before seeking pastoral counsel. By utilizing some psychotherapeutic techniques, the pastor may help the teacher to achieve insight into the perplexing situation and a consequent peace with God as she is helped to discover that she is projecting hostility which she feels toward the minister’s son who jilted her 20 years ago upon two young boys in her class who also happen to be sons of ministers.
The plea for combining psychotherapy with pastoral care does not imply the absence of referral procedures. Pastors are not equipped to treat persons who are suffering from a psychosis, a severe neurosis, or a serious personality disorder. Nonetheless a large number of so-called normal people with problems can be helped by pastoral counseling. One city pastor lists the variety of problems he has encountered in pastoral counseling.
1. Marital problems—threatened divorce or divorce, estrangement, unfaithfulness, adultery.
2. Sex problems—masturbation, perversions, illegitimate sex relations, ignorance, and anxiety.
3. Tensions and conflicts between parents and adolescent children.
4. Inability to find satisfaction in work, inability to find meaning in life, inability to love, insecurity, lack of trust in God, others, and self.
5. Problems of the unmarried.
6. Tensions in work situations—conflicts between employers and employees, people feeling threatened by job insecurity.
7. Theological questions—matters regarding biblical interpretation and prayer, doubts concerning God’s love and his existence. (E. Van der Schoot, Nieuwe Mogelijkheden Voor de Zielszorg, Erven J. Bijleveld, Utrecht, 1955, p. 7.)
Some may object to any combination of psychotherapy and pastoral care. Those who sharply separate the natural and the spiritual would maintain a dualism of these two disciplines. Others may fear that in the process of combination, psychotherapy will become inferior and pastoral care will become secularized. It must be admitted that the latter is a real danger, particularly where the pastors are exclusively concerned about this world and the problems of people here and now. When clergymen have a weak theology or allow psychology to be normative and dominant, pastoral counseling becomes mere humanism with a religious coloring. Pastoral care ought not to be replaced by psychotherapy. Spiritual health must remain its primary concern and psychic or mental health a vital secondary objective.
In combining psychotherapy and pastoral care, the pastor can use several psychotherapeutic techniques in addition to the primary means of the Word of God and prayer. Catharsis is a significant means in psychotherapy. Its use is based on the theory that certain thought processes are inhibited because they are associated with painful emotional experiences. Catharsis results when the experience is recalled into consciousness with the design of expressing the thought and feeling in order to obtain release. Catharsis resembles confession in the disclosure of the inner life and the elimination of resistance. However, catharsis is utilized to achieve emotional or psychic well-being whereas confession wishes to achieve spiritual well-being. In catharsis, the aim is to purge the unconscious: in confession one expresses conscious guilt. In catharsis, the psychotherapist acts on his own authority, but in confession the pastor acts on the authority of God.
Nondirective counseling, client-centered therapy, and directive listening have been caricatured by critics of pastoral counseling. However, it must be recognized that real listening is an essential in pastoral counseling. If a counselor cannot listen, he is powerless to help.
Even though he be wise in knowledge (including learning in biblical wisdom), the pastoral counselor must have sufficient openness and freedom to do the difficult work of listening in order to understand the counselee in his present problem. Only after the counselee has been understood can the counselor confront him with the Gospel which is relevant.
Suggestion is another means which may be employed in pastoral counseling. This technique undoubtedly has been used to excess and without discrimination, but its use in certain instances is legitimate. Suggestion is acceptance without insight—acceptance on the basis of the authority of another person. The pastor must be careful not to substitute his own ideas for the Word of God. He is obliged in his use of suggestion to bind people to Christ and not to “play God” as the authoritarian suggestor. Reassurance has probably been used too soon too often. If the unconscious were autonomous in man, all use of this means would be taboo. While rejecting the autonomy of the unconscious and accepting the existence of unconscious factors, pastoral counselors in specific instances may employ reassurance with profit. Encouragement and persuasion may be regarded as varieties of suggestion which have possibilities of therapeutic benefit when used as adjuncts to other primary means.
Must autosuggestion be contraband in counseling? Christians may with propriety tell themselves what God says about them—that they are new creatures in Christ (2 Cor. 5:17) and that God works all things together for good (Rom. 8:28).
There are two main requirements for successful pastoral care. The pastoral counselor must meet the counselee with the love which Christ gives. This implies respect and patience in interpersonal relationships and a confident hope in that which God can do. The pastoral counselor must also acquire skill for his highly responsible work by a right use of the Bible and prayer, together with a legitimate use of psychotherapeutic techniques. In this integration, God will not be irrelevant nor will human need become inconsequential for this life or for that which is to come.
CHRISTIAN PSYCHIATRY—“It is very common these days to see religion and psychiatry joined together with the conjunction a-n-d. Many articles and books appear under a title of that sort and their authors are concerned to show that religion and psychiatry can and should work together. The conjunction a-n-d suggests that religion and psychiatry supplement each other, that the minister and the doctor both have a part of the remedy for healing the mentally ill. The other conjunction o-r is not so commonly used in this connection. But the idea which it suggests is common, or at least has been. It suggests that psychiatry and religion are mutually hostile.… It is in our Christian hospitals that we have sought to eliminate this hostility. Here we have brought religion and psychiatry together, and we must continue to wed them ever more closely in a bond of meaningful relationship.… Has something been gained now that the doctor concedes that the patient is more than a physical organism and the minister agrees that insanity is more sickness than sin? To answer these questions and to evaluate the new cooperation we must look carefully at their doctrine of man and their concept of religion.… It may be true that a religious standard of values, no matter what that religion is, whether Christian or pagan, can organize a person’s life in such a way that he feels integrated and that his life has a purpose which is satisfying to him.… But when religion and psychiatry are joined together in such a context, with such a concept of religion, then we as Christians are bound to say that psychiatry and religion are allied for a temporary good at the cost of eternal and abiding doom.… For when we speak of religion we cannot and may not avoid the question, which religion?—the true or false religion.… In speaking about the healing miracles of Christ Dr. Paul Tillich says that ‘the healing power of the New Being in Christ, and not the miraculous interference of God in the processes of nature, is the religious significance of the stories.’ According to him, ‘the rapprochement between theology and medicine in our time’ has come about at the cost of biblical supernaturalism; cooperation has been achieved by an accommodation to naturalistic science.… He joins religion and psychiatry, but in doing so he abandons biblical Christianity.… If psychiatry can cooperate with religion only if that religion is not biblical Christianity, then that union is evil from our point of view.… What is left? The answer: two concepts joined together without barrier—Christian Psychiatry.… I am using the term ‘Christian’ in the sense of a large and comprehensive Weltanschauung, a philosophy of life and meaning based on a specific concept of God, man, and the universe. And I insist that psychiatry cannot be a healing science (making man whole) without such concepts.… We are engaged in Christian Psychiatry, not pagan-rooted psychiatry. The person we treat is the image-bearer of God. His functional sickness is related to the sickness of us all: our fundamental alienation from God, our proneness to hate God and our fellowman, the disintegration of the personal self, and the tension of a fallen world of nature and men. We must be more bold, nay, more godly, in applying clinically what we profess creedally.”—THEODORE J. JANSMA, Chaplain-Counselor of the Christian Sanatorium at Wyckoff, New Jersey, in an address delivered at the Fiftieth Anniversary Banquet of Bethesda Hospital, Denver, Colorado, August 24, 1960.
Samuel M. Shoemaker is the author of a number of popular books and the gifted Rector of Calvary Episcopal Church in Pittsburgh. He is known for his effective leadership of laymen and his deeply spiritual approach to all vital issues.
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