Pastoral Care Limitations and When to Refer Out

Pastors and Lay counselors serve very important roles within your church body. While good pastors possess theological understanding, discernment, compassion and training in pastoral care, they also recognize the importance of referring individuals to mental health professionals when necessary. Pastors are often gifted at recognizing signs of emotional distress, depression, anxiety, grief, or other mental health concerns through their regular interactions with church members. They offer a safe space for individuals to share their burdens and provide emotional support rooted in their faith.

Know When to Refer

Carefully considering what type of counseling is outside of your scope and when to refer is a critical part of providing the best care for your church members. There are several important factors to consider regarding whether pastoral care or lay counseling is sufficient for an individual or family’s needs.

Scope of Pastoral Training: Most of the pastors we’ve talked to have shared that they received one class (if any) in their ministry training addressing how to counsel their members. This is not to knock Seminary, as pastors can’t be all things to their church bodies. Pastoral training typically emphasizes theological understanding, spiritual guidance and emotional support. If a client is seeking biblical counseling and wants to understand particular scripture and how they may apply to their situation, pastors are invaluable! However, seminary training may not encompass the depth of knowledge required to address complex mental health conditions effectively. When pastoral interventions have reached their limits, involving mental health professionals ensures that individuals receive evidence-based treatments tailored to their specific needs.

Severity of Symptoms: When an individual’s symptoms significantly impact their daily functioning, emotional well-being, or interpersonal relationships, it may indicate the need for professional intervention. Some pastors may feel equipped to handle more minor challenges such as life transitions, work challenges, and minor depressive or anxious symptoms for example.

When it comes to more serious and persistent mental illness, most pastors do not have the advanced training or experience needed to ethically and safely address psychotic symptoms such as hallucinations, delusions, paranoid ideation and the like. Similarly, while pastors are often a critical support for individuals going through substance use recovery, they may not be equipped to single-handedly help someone recover from a serious and sometime dangerous addiction.

Risk of Harm: If an individual expresses thoughts of self-harm, suicide, or harm to others, pastors should consider these as red flags that require immediate attention from a mental health professional. It’s important to fully consider safety factors as well such as suicidal ideation (which should always be referred to a mental health professional), self-harm, or even destructive behaviors such as anger that is being directed toward others within a family.

Diagnosis and Treatment: Pastors may lack the expertise to diagnose mental health disorders accurately. If there is a suspicion of a specific mental health condition or if symptoms persist despite pastoral care and support, involving a mental health professional is advisable. Professional assessment can lead to an accurate diagnosis and inform appropriate treatment strategies.

Complex or Chronic Conditions: Mental health concerns that are complex in nature or chronic, such as personality disorders, severe addiction, trauma-related disorders, or eating disorders, often require specialized therapeutic approaches and interventions. Pastors can support individuals in these situations but should collaborate with mental health professionals to ensure comprehensive care.

There are some treatment approaches which well-meaning individuals may attempt that are likely to do more harm than good. For example, when working with someone with a Personality Disorder, a person-centered approach (affirming and validating) can actually cause further deception for that individual and perpetuate their mistaken beliefs and harmful behavior. Another example is that trying to encourage an individual who has Obsessive Compulsive disorder to do something we would typically see as positive like pray a certain way, can backfire and lead to further compulsivity and anxiety for that person. Further in family dynamics, giving blanket suggestions that may be helpful for most, can have destructive consequences if the counselor doesn’t recognize abusive dynamics at play in the relationship. These examples are just some of the ways that acting as a counselor outside of your scope of training can have unintended and sometimes dangerous consequences.

Limited Progress: Despite providing ongoing support and spiritual guidance, if an individual’s condition shows little improvement or worsens, pastors should consider it a sign that professional intervention may be beneficial. In general, pastoral care is best suited for short term support models. If an individual or family seems to require more than 8 meetings with a pastor, it is likely that their condition requires support from a trained mental health provider.

Boundaries: Pastors do incredible work, but it’s also important to maintain boundaries and balance in that calling. It’s not healthy for one ministry leader (or counselor for that matter) to be all things to everyone. Just as each member of the Church is a part of the body, Christian Counselors serve one role and Pastors are called to serve another. If you find yourself feeling anxiety, dread, or exhaustion when approaching pastoral care, these may be red flags that you are doing too much or trying to work outside of your scope. Honoring your own boundaries will enable you to have more effective ministry and avoid burnout.

It is important to note that the decision to involve a mental health professional is not a reflection of pastoral inadequacy but rather an acknowledgment of the specialized knowledge and training that mental health professionals bring to the table. By collaborating with mental health professionals, pastors can enhance the support they provide and ensure that individuals receive the comprehensive care needed to address their mental health concerns.

Know Your Referrals

Pastors have an ethical and moral obligation to not only guide and serve, but also to protect their church members by doing their due diligence to not only refer out when appropriate, but to also vet their referral sources. Ideally, pastors should attempt to make personal contact with local counselors or therapists. While we know pastors can be incredibly busy and pulled in many different directions, making contact to learn about your referrals should not be overlooked. Many counselors would be happy to connect with Pastors looking for referrals.

When contacting a potential referral, here are some possible questions to consider: It’s important to ask questions about the potential referral’s training and expertise—not every counselor will be equipped to handle every type of client or issue. You may ask questions about their availability—ensure that your referrals can offer timely services to your church members who may not be best served by sitting on a lengthy wait list. You may inquire about payment processes—many individuals may need providers who can take insurance or who offer a sliding scale or need-based discounts; while other individuals may be able to afford private pay services. Lastly, its important to ask questions about how the therapists integrate faith into their counseling

If desired you can also ask about specific values in your Christian faith tradition and how the counselor would navigate that in their clinical work. For example, many pastors would be disheartened to send a couple to a counselor only to find that the counselor recommends divorce with little intervention based on their own values contradicting those of your church. While mental health professionals are ethically not supposed to impart their values on their clients, counseling is inherently values-based whether the clinician recognizes their own biases or not. There can be a big difference between sending someone to a secular therapist rather than a Christian counselor. (If you would like to learn more about the distinctions of Christian Counseling specific to our approach at Threads of Hope, check out this page: What do you mean by Christian Counseling).

Once you have vetted your referrals, (And you should know more than one!) make sure to keep this information listed and update it from time to time. It can be very discouraging for church members to be given a list of trusted referrals only to find that some of them are no longer in practice, have moved to a different location, or have long wait lists when they need them.

Collaborate with Mental Health Professionals:

Pastors should actively seek partnerships with mental health professionals to enhance the care they provide and ensure they have referrals that can be trusted to best serve their members and in a timely way. Through collaboration, pastors and mental health professionals can exchange insights, strategies, and resources, fostering a holistic approach to individual well-being.

A support team is always the best approach for individuals and families rather than one individual trying to shoulder every burden. Pastors provide ongoing spiritual and emotional support in conjunction with professional interventions which benefits the church members. In our practice at Threads of Hope, we welcome partnerships with local churches and deeply value to work you do in our communities and the lives of many of our clients. We have had pastors who engage in phone consults when they are unsure whether a referral to professionals is warranted. We have also coordinated care with pastors when the client needs more support and to ensure our approach is aligning with the teachings of the church. We love offering trainings to churches and pastoral leadership teams. Pastors and counselors bring unique giftings and all are valuable and can work together to improve the well-being of the Church!