The Pastor as Counselor Lesson 7: Mental Health and Pastoral Care

We want everything we do as pastors to result in the spiritual development and personal flourishing of those under our care. This could be taken to mean that everything a pastor does is counseling. But it is helpful and appropriate to distinguish between things like: one another care between members, general pastoral care, formal pastoral counseling, and professional counseling.

In this brief, eight lesson series you will be equipped with the basic categories, processes, and skills of serving as a pastoral counselor. The intent is to equip you to utilize your current level of awareness regarding particular life struggles to your fullest pastoral potential.

You can download the free PDF handbook that accompanies these videos. Thank you to Ministry Grid for recording and making these videos available.

Take a moment. Try to define mental illness. For most of us, mental illness is one of those phrases that we use frequently but aren’t really sure what it means. It is a term like “beauty.” We know what we mean by it, but it’s hard to define. To add to the confusion, there is even disagreement amongst healthcare professionals about the best definition of the phrase.

For the purposes of this lesson we are not going to get tied down in a technical definition or nuancing the diagnostic criteria for specific mental health disorders. We will look to create a layman’s definition of mental illness that allows us to accomplish three things.

1. Determine when something more than directive or narrative reframing counsel is needed.
2. Discern the indicators that a pastor should look for in identifying a mental health concern.
3. Clarify how pastoral counseling should complement mental health counseling.

If you feel comfortable doing these three things after this lesson, we will have accomplished great deal. Let’s start by providing a lay-level definition of mental illness, by answering the question, “What do and don’t we mean when we use the phrase ‘mental illness’?” We will make four points on this question.

1. We mean that the mere passing of time is unlikely to resolve the life challenge.

• • Many life challenges naturally resolve themselves with the passing of time. If that is the case, you are not addressing a mental health challenge. That is one of the key differences between situational discouragement and depression that would qualify as mental illness.
  • If wise choices, well applied over time do not alleviate a struggle, this is an indication that the struggle may be an expression of mental illness. This leads us to the second point.

2. We mean that the life challenge is not primarily caused by an individual’s choices, beliefs, or values.

• • Directive counsel and narrative reframing primarily address choices, beliefs, and values. Later in this lesson we will discuss the four spheres of influence that can contribute to an individual’s life challenges: biological, psychological, social, and spiritual.
  • If an adverse emotional experience seems impenetrable to changes in beliefs and choices, this is an indication that the struggle may be an expression of mental illness.

3. We do not mean that the resolution to the life challenge is necessarily medical.

• • Often people can resist identifying a life struggle as mental illness because they don’t want to take medication; as if medication is the only possible remedy for a mental health concern.
  • When medication is the best option, sometimes it is a short-term intervention that allows work in the area of choices, beliefs, and values to be more effective. Other times it is a long-term option.
  • A responsible psychiatrist, physician, or counselor will discuss a variety of approaches that have a probability of creating relief and allow the individual to make an informed choice about what serves their needs and honors their values best.

4. We do not mean that the person is “crazy” or necessarily struggling with reality testing.

• • Too often mental illness is used as a synonym for reality testing impairment (i.e., the inability to distinguish factual thinking from fanciful or paranoid thinking).
  • If we use the term mental illness this way, we will create a sense of stigma that contributes to the tendency to only pursue help after things get “that bad.”
  • Pastorally, both in our public and private ministry, we have the opportunity speak of mental health concerns in a way that offsets this common stigma.

So, what have we said so far? If someone is trying to implement wise responses to their life challenges and not making progress, then we should consider mental health concerns as a possible contributing factor and recommend that an individual add a mental health professional to their care team.

There are two images that can help us bring more clarity and guidance to this discussion: (a) a four-legged stool and (b) a Venn diagram.

First, we’ll consider the image of a four-legged stool. If a stool is off balance, it may be attributed to any one or combination of its legs. Similarly, the origin of any given life struggle may be attributed to any one or combination of the following facets of personhood.

1. Biological – Our bodies impact our wellbeing. Blood sugar levels, sleep debt, hormones, physical injuries, illness, cardiovascular stamina, blood cell counts, neurotransmitters, and comparable biological factors contribute to our mental health. Therefore, it is wise to ask someone to have a checkup with their primary care physician and discuss their symptoms early in the counseling process. We want to assess and shore up the biological leg of the stool in any way possible.
2. Psychological – Our thinking patterns and personalities impact our wellbeing. In this arena we’re talking about “how” someone thinks or relates (patterns) more than “what” they think (content, which would fit under the category of beliefs). Patterns of thought and styles of relating may be necessary adaptations in one context (i.e., an abusive home or a high demand work environment) but create disruption in another (i.e., an otherwise healthy marriage or small group). When these kinds of factors are in play it is wise to meet with someone who is skilled articulating these patterns and at helping someone make an adjustment in their patterns of thought or styles of relating.
3. Social – Our social setting and relationships impact our wellbeing. Even when we are Christ-like, unhealthy relationships have an adverse effect on us. Even before we were saved, healthy relationships had a positive effect on us. The Bible acknowledges the effects of social settings (I Cor. 15:33). Often the mental health concerns that present in counseling can have sociological more than psychological roots. When this is the case, encouraging the counselee to invite a counselor trained in assessing, articulating, and responding to these dynamics may be helpful.
4. Spiritual – Our beliefs, values, moral choices, and sense of purpose impact our wellbeing. No one is more influential in your life than you are because no one talks to you more than you do. Beliefs, values, and choices are the wheelhouse of pastoral counseling. You understand the Christian worldview of your members more than other professionals. When you understand how your role complements the other roles that may be helpful, this optimizes cooperation amongst the team of people best able to serve your friend.

This second image is another way of saying the same thing, but whereas the four-legged stool emphasizes how contributing factors are distinct, this Venn diagram emphasizes the overlap that exists and clarifies that everything discussed in counseling (pastoral or professional) is not mental illness.

[The diagram for this section can be found on Page 32 of the free PDF handbook.]

In this Venn diagram we see three types of life challenges that lead someone to seek counseling: mental illness, problems in living, and meaning of life struggles. We will define and provide examples of each, but it should be noted that these categories overlap.

1. Mental Illness: We have spent most of this lesson defining and describing mental illness. Examples of life struggles that fit in this category include bipolar, post-traumatic stress, Asperger’s Disorder, various phobias, many experiences of depression, and struggles that can impact reality testing such as schizophrenia. Pastorally, the response in these situations would entail ministering to the suffering that a person is experiencing while providing social support and accountability to remain engaged in key parts of their care. For example, often those who experience mental illness resulting in mania do not like taking medication. Pastorally, we would encourage them that medication is a way to “love their neighbor as themselves” (Mark 12:30-31) and as a means of strengthening the social support around them which is likely deteriorating due to their irrational actions.
2. Problems in Living: These are struggles that emerge because life is hard, good priorities often exist in tension with other good priorities, and the consequences of sinful choices. Examples of life struggles that fit in this category include time management, self-control, debt reduction, stress management, blended family challenges, marital communication, and similar difficulties. Pastorally, we would point people to the biblical principles that undergird God’s design for life and godliness (II Pet. 1:3) and honoring God as the appropriate motivation for enacting these principles.
3. Meaning of Life: These struggles usually emerge during times of large transition when we are grappling with what is most important. Examples of life struggles that fit in this category would include: grief – as we face the brevity of life, mid-life crisis – as we wrestle with whether the things we’ve worked so hard for are “worth it,” and emerging into adulthood – as we realize the weight and responsibility of being a self-sustaining adult. Pastorally, we sympathetically help people interpret these challenges in light of a creation-fall-redemption-glorification worldview. We help people make sense of their struggle in light of their Christian faith, but with the realization that we can have a good theology, and life still be hard (e.g., grief still weighs heavy).

So now we are left to try to tie these strands of thought about mental illness and pastoral counseling together into some coherent and practical applications. Let’s do that by making four concluding points.

First, don’t be afraid of mental illness. Our pastoral calm and willingness to move towards someone who is suffering does a great deal to break the stigma and isolation of mental illness. Remember our guiding principle from Lesson One, we don’t have to be able to do everything well to be a good pastor. Let this emotionally free you up to do the following three things.

Our pastoral calm and willingness to move towards someone who is suffering does a great deal to break the stigma and isolation of mental illness. Click To Tweet

Second, understand the relevance of pastoral care for every area of life. Character formation and narrative reframing with the gospel is relevant and needed for mental health concerns even when other forms of care are beneficial. Pastoral care and caring Christian community are essential for mental health concerns even when other forms of care are beneficial. What the church does is vitally important.

Third, recognize and cooperate with relevant experts. The role of the church and a pastor can be highly relevant and essential without being exclusive. The short-term nature of pastoral counseling described in these lessons all but demands that we recognize this reality. Pastoral counseling and Christian community can have a fruitful and cooperative relationship with mental health professionals.

Fourth, think “team” in initial acute care and ongoing church care. When someone comes for pastoral counseling and mental health concerns are part of their struggle, it is unlikely that 6-8 sessions are going to create long-term resolution to their struggle. The kinds of questions you need to be asking are, “How can we create a community of support for this person? What interval of pastoral care interactions is going to be helpful long term?” A key part of pastoral counseling will be identifying settings where this person can serve and be served, care for others and be cared for by those who understand their story and challenges.

Conclusion: Do you now know everything you need to know about mental health and pastoral counseling? No. But hopefully you know enough to be comfortable learning alongside each person you counsel. Your church members don’t need you to be an expert in mental health in order to be a good pastor. They need you to be informed enough to lovingly and patiently fill your role as pastor and coordinate the care of the church in conjunction with other professionals who may be helpful.

Follow Up Resources

• If you want to learn more about the role of caring community in the long term effective of counseling mental illness, consider reading “The Therapeutic Benefits of Community.”
• If you want to learn more about helpful pastoral advisements for mental health concerns, consider reading “50 Good Mental Health Habits.”