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I made a comment on Twitter the other night that went something like this:

Feel blog post coming on about how dangerous it is when pastors ignore serious mental health issues & blame it on spiritual problems

And from that I received a lot of interesting feedback–mostly people saying, yes, I agree. Blog about it. But after sitting on the topic a few days my post is hopefully more helpful to you than the initial rant that ran through my head that night.

Why Pastors Don’t Refer
As pastors we have lots of things going for us. Usually we are good with people and that’s how we ended up in ministry in the first place. People feel safe talking to us, and want to talk with us.  We are told we are good listeners and have helped solve their problems.   A lot of times we have a great education with a variety of gifts that manifest itself in the ministry we serve in. I think one of the two, or that combination can trick us into believing that we can and should help everyone who comes to us. And this is where I think pastors fall into trouble when it comes to knowing what to do with someone, or why they should refer out to a professional therapist and counselor.  Here are some of the roadblocks I think pastors face:

  • Ego/Naivete: We have certain gifts; we have been told we have those gifts, therefore we think we can help anyone.  We become/or think we have become a wonderworker.  This happens because of ego, but I also think because of naivete.  We fail to operate within limits, or even acknowledge we have limits.
  • Confusion: We aren’t sure what the counseling/therapy process looks like, nor who to send people to see.
  • Don’t Care for Themselves: Pastors often don’t care for themselves, so it’s not surprisingly they are unable to help others seek care also.
  • Time Constraints: Pastors have a lot on their hands, and though caring for the congregation is supposed to be important, that task usually falls through the cracks or is assigned to only one person.  Often the time constraints remove the pastor from the process of helping that person seek the proper help.
  • Fear of Unknown: Like confusion, many pastors just have a fear of the unknown. They are unfamiliar with therapy practices, or who the people in their community they can refer people to are.  They also might not truly believe in therapy and counseling, and so there is a fear of sending people to see someone.

One of the reasons I’m passionate about this topic is because I have been a pastor for the last 12 years, spent my youth volunteering in the church, and I’m a PK myself, so I have been around the church a lot.  And this is an area that I think we sometimes are weak in, or rather, need more education in.

For example, if someone needs help, who should you send them to?  Who you send them to will probably be indicative upon your theological beliefs and assumptions about therapy.  There are lots of resources and a variety of options:  For example:

Do I send them to someone who is AAPC, certified? Or maybe they need to belong to the American Association of Christian Counselors or the Association of Biblical Counselors? Or maybe they need to be trained in Nouthetic Counseling? Or maybe they should be licensed through the state such as an AAMFT or an LPC? Or what about seeing a Spiritual Director (i.e. Shalem Institute)?

Questions Pastors Should Ask Themselves
As pastors I believe we all share a responsibility in caring for those in our congregation and those that specifically come to see us for help. We have been gifted in many ways to do that, but we also have to be responsible and discerning, and ask ourselves some questions. I asked myself similar questions during my time as a college pastor (2001-2008). And during that time I realized that I was dealing with student issues that were way beyond any type of training that I received in seminary or anywhere else. And even though I felt competent to do many things with an MDiv., I ultimately went back to school to get an MFT. I figured that way I could better help those who came to me, and if I couldn’t I would still continue to refer out as I had been doing.

So, I’m not suggesting you go back to school (though some basic counseling/therapy classes can be very helpful), but I’m at least asking that you acknowledge your limitations and refer out if necessary. And here are some reasons why:

  • Scope of Practice: What are you able to do with your ministry license, or counseling license, etc.? Are you working within the scope of practice you have been designated to have? Just as some denominations don’t allow you to baptize or administer the sacraments without being ordained, some ministry/pastoral licenses limit your ability to practice counseling.
  • Training: Do you have the training that is required to deal with the issue before you?  For example, if someone is dealing with severe depression or Bipolar, are you equipped to work with them and provide for them what they need?
  • Liability: Do you fully understand the law in your state and what you may be liable for when entering into counseling with someone (whether it’s a written or verbal contract)?  I think a lot of pastors fail to realize that they are putting themselves in positions of liability, and perhaps great danger when counseling is undertaken.
  • Mandated Reporting: Do you understand what the law of your state requires of you as a mandated reporter?  Many things come out in counseling/therapy, so you must be aware of what you are required to report to the state.  If you aren’t comfortable with the requirements, then maybe you want to refer out to someone else who can counsel to avoid being in that situation.  Many states don’t give anonymity or immunity to clergy anymore when it comes to not reporting.  This is a real vital subject especially for youth ministers who are often more likely to be in positions to have to report.
  • Objectivity: Can you maintain a stance of objectivity in the counseling situation?  This is not to say that counselors/therapists don’t brings biases into therapy, but there are tricky issues when counseling someone in your congregation, or someone you may know.  That brings up the last issue.
  • Boundaries: What would be the right thing to do to maintain healthy boundaries?  This gets really trick in a church setting where many people come for help, or where there might be a counseling center.  But can healthy boundaries really be maintained if you are counseling for example, an elder on your board?

I have the opportunity to sit on both sides of the fence being a pastor and a therapist.  So what I’m saying here has only come out of my own working through these issues–real life stuff.  And as a therapist, one of the things that pains me the most is when people end up in my office because of neglect, or harm that was done to them by their pastors and church, often during attempts to treat them, yet failing to know how.

What Should You Do?

  1. Determine your policy or stance on this subject.  What does your church do?  Is there a procedure in place?
  2. Collect a list of therapists/counselors in your area that you can refer congregants to.  You should choose based on your church’s stance/belief on what kind of therapy/counseling you believe in.  That way you feel comfortable recommending congregants there.
  3. Meet with those therapists in your referral network on a regular basis.  This helps you to get to know them better, and to make the referral process much more of a smooth transition.
  4. Maybe consider taking a counseling/therapy class.  Or read up on the subject.