Question 1: How do you distinguish between depression and burnout?
It is important to understand how these concepts are distinct, but related. “Depression” is an ongoing mental health condition characterized by changes in the way a person thinks, expresses his or her emotions, and physically functions (e.g., an increase or decrease in appetite, sleeping difficulties, and inconsistent bowel movements). Depression is commonly expressed by a person’s pervasive sadness, loss of interest in normally pleasurable activities, or increased irritability.
“Burnout,” on the other hand, is described as ongoing negative responses to emotional and social difficulties at work. These negative responses can include things like exhaustion, cynicism, and, most commonly, feeling ineffective and discouraged while on the job. Burnout seems to be most common in professions that involve helping others, such as ministry.
Although depression and burnout share the experience of negative emotions, it’s safe to say that depression reaches more broadly into peoples’ lives. Depression affects all aspects of a person’s life, whereas burnout impacts mostly a person’s work.
Question 2: How does a pastor know when they are out of their depth when offering help and needs to refer a person to clinical care?
There are two ways a pastor or church leader could make a quick and decisive decision about this. First, if a pastor has any concerns about a congregant’s physical safety, then that person needs “clinical care” (e.g. the emergency room, psychologist, psychiatrist, or counselor). The type of recommended clinical care depends on what level of danger to themselves or others a congregant is in.
Second, if there are any biological factors (e.g., thyroid disorders or traumatic brain injury) or complex systems (e.g., racism, sexism, classism) negatively affecting a congregant’s well-being, professional mental health services are recommended.
As a reminder, pastors, along with other professionals who work with vulnerable populations, are mandated reporters. Mandated reporters are legally required to report observed or suspected abuse to the proper authorities (e.g., Illinois Department of Children and Family Services). However, these requirements vary by state. Pastors, in a sense, are taking good care of themselves by referring congregants to mental health professionals if they feel overwhelmed by their needs. For example, by referring a congregant to a mental health professional, a pastor could more effectively focus his energy on caring for the congregation’s spiritual growth.
Question 3: Are there certain areas of counseling you would recommend the pastor NOT to engage in?
It takes humility to recognize that there are some places that some people are not well equipped to tread. First Corinthians 12:12-27 emphasizes that we are all parts of the body of Christ, and that we therefore each have roles we are best equipped to fill.
The National Association of Evangelical’s Code of Ethics for Pastors states that pastors should “facilitate fairness…with parishioners… [by assuming] responsibility for congregational health. When asked for help beyond personal competence, refer others to those with requisite expertise.”
Said differently, if a pastor does not have or doubts his ability, knowledge, or skill to address a congregant’s presenting problem(s), then it is his ethical mandate to refer the congregant to someone who is able to meet his or her need(s) appropriately.
Some examples of areas that pastors are not qualified to address in any professional capacity are medication management, intensive trauma processing, psychosis, disordered eating habits, and chronic suicidality. This is not to say that pastors do not have a vital and crucial role to play in supporting a person through the previously mentioned topics, but they simply do not receive the appropriate training to prepare them for it. In this way, mental health professionals can help support pastors more fully.
Question 4: Is there a series of check-in questions that is helpful when supporting another pastor’s mental health?
Two helpful questions pastors can ask each other when checking in with their mental health are: “How are you doing?” and “Do you feel like you can manage?”
Of course, it is important to consider by whom, where, when, and how these questions are asked as those all may impact the honesty of the answers one receives. Although seemingly simple questions, these two questions can have day, week, or even season-changing effects when answered openly and honestly.
Mental health is made up of three parts: one’s physicality (your body), psychology (your thinking patterns and emotions), and sociability (your interactions with others). Therefore, when checking in about your pastor-peers’ mental health, listen for these three topics (body, mind, social life) in their responses.
For example, if they are talking about someone else when you asked them “How are you doing?” this could be a sign that they may not be doing well psychologically; they may be out of touch with their feelings. You may need to redirect them: “That’s awesome Jasmine won third place at the science fair, but how are you doing?”
If you are a pastor talking to another pastor, and they sound hopeless or pessimistic, it may be time for a different conversation where you check in about suicidality (thoughts about suicide) and refer them to a mental health professional. You could say, “Seems like you have been feeling pretty down lately. I know sometimes people start having thoughts about hurting themselves or even ending their life when they are feeling really low or out of control of their lives. Have you had any thoughts like that?”
It can be uncomfortable and worrisome to ask about suicidality for fear of ‘planting’ suicidal ideas in their head, but the research is clear that simply asking people about suicidality does not increase or ‘spark’ suicidality. In fact, talking about suicidality reduces a person’s risk and stigma surrounding suicidality.
Question 5: How do you stand up for yourself (with a supervisor/employer/board of elders) in order to care for your mental/emotional health without coming across as selfish?
It can be very difficult for a person to advocate for him or herself to his or her superiors, especially regarding his or her mental health. I have heard from some that they are afraid to do so because they do not want to be perceived as “lazy,” “weak,” and “dispassionate about the Lord,” just to name a few.
However, there is a way to advocate for your mental health in a way that is not “selfish.” One way to advocate for your mental health is by giving your supervisor, employer, or elder board an other-oriented perspective. For example, a pastor could say that taking care of himself first will enhance his ability to take care of others. Biblically, one only has to turn to the gospel of Mark to see Jesus’ examples of self-care.
Jesus advocated for his own time of silence and solitude in order to become refreshed in his faith and relationship with God. This time, even at the expense of not healing others, resulted in increased wisdom, compassion, and power for Jesus’ ministry.
One helpful analogy of the importance of taking care of yourself so that you can take care of others is cabin air pressure loss on an airplane; when the pressurized air masks drop from above occupants are instructed to put on their own masks before helping others in order to ensure the health and safety of all persons. Simply put, people cannot be effective caretakers of others when they themselves are in need of significant caretaking.
Carson A.M. Tabiolo, M.A., is a doctoral candidate from Wheaton College's Clinical Psychology program. She will complete her doctoral internship at the University of Alabama Birmingham - Veterans Affairs Medical Center Clinical Psychology Internship Consortium in Birmingham, Alabama.
Amy J. Smith, M.A., is a doctoral candidate from Wheaton College's Clinical Psychology program. She will complete her doctoral internship at Pine Rest Christian Psychological Services in Grand Rapids, Michigan.
Dan Barnhart, M.A., is a doctoral candidate from Wheaton College's Clinical Psychology program. He will complete his doctoral internship at Tripler Army Medical Center in Honolulu, Hawaii and is entering the U.S. Army as an active-duty clinical psychologist.