A Study of the Identity

of Pastoral Counselors
Carole A. Greenwald, PhD
Joanne M. Greer, PhD
C. Kevin Gillespie, SJ
Thomas V. Greer

ABSTRACT. This exploratory study examined the identity of pastoral

counselors, also the distinguishing characteristics of pastoral, Christian,
and biblical counseling. Data was collected from three focus groups to-
talling 67 participants affiliated with 12 religious denominations. Two
groups of clerics reported professionally trained pastoral counselors to
be the leading provider of pastoral counseling and the professionally
trained pastoral counselor to be the most qualified provider of pastoral
counseling. Although the clerics considered themselves to be one of the
leading providers of pastoral counseling, many could not classify their
activities between “pastoral care” versus “pastoral counseling.” Two fo-
cus groups of counselors highly agreed that the pastoral counselor is a
professionally trained clinician whereas the opinion-makers and clerics
disagreed. No participants could clarify the distinguishing aspects of
pastoral, Christian, or biblical counseling. [Article copies available for a fee
from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:

Carole A. Greenwald, Licensed Clinical Professional Counselor, is Adjunct Assis-

tant Professor, Loyola College in Maryland, and Minister, Church of the Nazarene. Jo-
anne M. Greer, C. Kevin Gillespie, and Thomas V. Greer are affiliated with Loyola
College in Maryland.
Address correspondence to: Carole A. Greenwald, PhD, 3585 Folly Quarter Road,
Ellicott City, MD 21042 (E-mail: pccounselor@erols.com).
The authors acknowledge the assistance of Professor Joanne M. Greer, PhD, in edit-
ing this article.
American Journal of Pastoral Counseling, Vol. 7(4) 2004
Available online at http://www.haworthpress.com/web/AJPC
 2004 by The Haworth Press, Inc. All rights reserved.
doi:10.1300/J062v7n04_04 51
52 AMERICAN JOURNAL OF PASTORAL COUNSELING

<docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com> © 2004 by

The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Biblical counselor, Christian counselor, pastoral care,

professional training

INTRODUCTION

The purpose of this study was to explore the perceptions held by reli-
gious laity, pastoral counselors, and clergy regarding counselors and the
types of services they provide. Emphasis was placed on the effect these
perceptions have on the selection process of mental health service pro-
viders and on the service marketing of pastoral counseling to religious
persons. Gale and Austin (2003) recently published an article on the
identity of professional counselors. They posit that “the occupational ti-
tle professional counselor [italics mine] lacks sufficient specificity to
secure its role in the eyes of other mental health professionals and the
general public.” They cite O’Bryant’s (1994) assertion that the counsel-
ing field is unable to explain how professional counselors differ from
other mental health professionals. They refer to professional counselors
as “suffering from an identity crisis.” This present study revealed simi-
lar findings regarding counselors who self-describe as “pastoral coun-
selors.” The title of pastoral counselor is not a legally protected job title.
Counselors, who self-identify as pastoral counselors, lay pastoral coun-
selors, Christian counselors, biblical counselors, or spiritual directors,
range from possessing no training or certifications to doctoral degrees.
Pastoral counseling, Christian counseling and biblical counseling are
interchangeable terms to some but mean different processes to others.
Some of the self-identified Christian counselors in this study described
their style of counseling to be an integration of psychology and religion
while other Christian counselors described theirs to be based on biblical
counseling principles, yet they were all members of the American Asso-
ciation of Christian Counselors. The education of the counselors varied
from little or no training to doctoral degrees in counseling.
The National Institutes of Mental Health has predicted that 20% of
adult Americans will have a mental or emotional illness during their life-
time that is severe enough to require treatment. Historically, people have
sought their clergy for assistance with a variety of life stresses and spiri-
tual guidance. The results of a 1957 study of 2,460 American adults
 Greenwald et al. 53

(Gurin, Veroff, and Feld, 1975) indicated that the 42% of the sample who
sought help for a personal problem went to a cleric, while 29% chose a
physician, 18% a psychiatrist or psychologist, 3% a marriage counselor,
and 8% chose another source. Since then the emergence of the profes-
sionally trained pastoral counselor has occurred. Mechanic (1978) cites
The President’s Commission on Mental Health’s recognition of profes-
sionally trained pastoral counselors as specialists who provide a signifi-
cant amount of cost-effective counseling and psychotherapy for people in
need of mental health services (p. 192-193).
Clergy have sometimes been referred to as “gatekeepers” for mental
health services. Many of the presenting problems they see are beyond
their training and should be referred to another mental health service
provider (Baldwin, 1978). One would expect that clergy would wel-
come the recent emergence of the professionally trained pastoral coun-
selor and that their acceptance would be reflected in higher referral rates
to them; that they would have joined forces. Research indicates that this
is not the case. Instead, these two groups are in competition for the same
market. Carter and Narramore (1979) assert that clergy might possibly
consider the science of psychology and the related mental health profes-
sions to be encroaching on the pastor’s role. Estadt (1988) maintains a
similar position, asserting that the conflict is fed by scientific advance-
ments and counselors’ desire to maintain professional standards which
are in the best interests of the public. He also believes that the situation
is fueled by concerns relating to power, money, and ignorance.
The literature abounds with research examining many variables to
explain the lack of interaction between clergy and mental health profes-
sionals. These variables include the clergy’s denomination, age, gender,
training, personality type, rural or urban location, diagnostic and assess-
ment capabilities, trust, role expectations, and financial considerations.
Studies have also examined not only the types of problems presented to
them, but to whom they refer their congregant. It is worth noting that
most of the research does not include the professionally trained pastoral
counselor as a member of the mental health profession. In many of these
studies the clergy’s decisions to counsel or refer could be related to the
lack of standardized definitions of counseling terms and providers. Al-
though the literature abounds with empirical research on clergy coun-
seling and referral patterns, the inconsistent use of terms hinders the
researchers’ ability to make valid comparisons and analysis of the data.
The literature uses the terms pastoral counseling, pastoral care, biblical
counseling and Christian counseling interchangeably.
54 AMERICAN JOURNAL OF PASTORAL COUNSELING

An apparent problem in analyzing the literature stems from a lack of a

clear understanding of how clergy define their interactions with their con-
gregants. Many use the terms pastoral counseling, pastoral care, and spir-
itual guidance or direction to describe the same activity. Burgess (1998)
identifies many of the pastor’s activities as counseling: specifically, ac-
tivities with individuals, couples, families or groups that involve a discus-
sion of a problem, giving advice or direction, or resolving a crisis. He
does not consider routine home, hospital or nursing home visits to be
counseling activities. Jones (1990) claims that “. . . it is common practice
to use the terms pastoral counseling and pastoral care interchangeably”
(p. 1, 213). Some researchers consider pastoral counseling as a subset of
pastoral care and others view pastoral counseling as an umbrella label.
It appears that many deeply hurting people seek a pastor but would
not consider going to a mental health professional because they do not
see themselves as having a mental illness. Also, many people perceive
their problems as having spiritual implications and do not see the need
for a mental health provider (Estadt, 1991). When someone experiences
mental health problems that have spiritual dimensions, they are con-
fused as to whom they should go to for help (Miller and Thoresen,
1999). Many clergy and spiritual directors do not possess the psycho-
logical expertise to handle both aspects of this problem. There is no
doubt that professionally trained pastoral counselors are required to
meet the needs of the religious community.

Definitions of Labels and Titles

The literature indicates a lack of agreement and understanding as to

“what is pastoral counseling?” and “who is a pastoral counselor?” This
lack of understanding and agreement pervades the public, clergy and
pastoral counselors.
Biblical counseling has different meanings and usages. Kent (1963)
defines it as the preaching of God’s word. Passantino and Passantino
(1995) state “Proponents [of biblical counseling] reject any attempt to
integrate psychology and a biblical approach” (p. 26).
Christian counseling has been defined as being largely concerned
with the solution or alleviation of day-to-day human problems, emo-
tional difficulties, or stresses, using a serious Christian content based on
the Gospel, and largely dependent on psychological and psychiatric
techniques (Thornton, 1990). On the other hand, Collins (1990) describes it
as a type of counseling conducted by theologically conservative Protestants
who accept three basic doctrines: the supreme authority of the Bible in all
 Greenwald et al. 55

matters of faith and conduct, emphasis on justification by the free grace

of God through faith in Christ as Lord and Savior, and belief in the uni-
versal priesthood of all believers; also called Evangelical pastoral care
(Collins, 1990).
Lay pastoral counseling is described as “ . . . a professional function
requiring of the practitioner a higher level of training and supervision
than that expected of ordained and lay ministers . . . ” (Sunderland,
1990, p. 634).
Nouthetic counseling is “a version of fundamentalist pastoral care
that . . . aims at personal change from sin to faith and righteousness
brought about by confrontation out of concern for the counselee’s bene-
fit” (King, 1990, p. 449).
Pastoral counseling has been defined as “. . . a psychotherapeutic ap-
proach which attempts to integrate theological/spiritual and psychologi-
cal/behavioral concepts in an intentional, unified manner” (Giblin and
Stark-Dykema, 1992, p. 362). Browning (1993) writes “[pastoral coun-
seling] . . . deals with the area of value confusion and/or questions of re-
ligious commitment” (p. 8). A recently published brochure of the
American Association of Pastoral Counselors describes it as “. . . a
unique form of counseling which uses spiritual resources as well as psy-
chological understanding for healing and growth” (AAPC, unknown).
Thorne is more specific in his definition; he posits it is a “counseling
practice which is explicitly shaped by a particular religious tradition or
which is explicitly associated with a particular religious institution or
organization” (Thorne, 2001, p. 437). Patton (1990) states it is

A specialized type of pastoral care offered in response to individu-

als . . . who are experiencing . . . pain in their lives and willing to
seek pastoral help in order to deal with it. Pastoral counseling is
not a profession but a function performed by persons in the profes-
sion of ministry. (p. 849)

In contrast, pastoral counselors are “. . . individuals who are not only

mental health professionals but persons who have had in-depth reli-
gious and/or theological training. Most . . . are ordained clergy or per-
sons otherwise endorsed by a religious faith group” (American
Association of Pastoral Counselors, unknown). Ewing (1990) asserts
that a pastoral counselor is “. . . a pastor who offers counseling to per-
sons in need . . . at a level of competence beyond that of the general prac-
tice of ministry and who skillfully integrates religious resources with
insights from the behavioral sciences” (p. 859).
56 AMERICAN JOURNAL OF PASTORAL COUNSELING

Pastoral psychotherapy is a specialized type of counseling, similar to

pastoral counselings that focus on the psychological dimensions of the
counselee’s problems, within a spiritual or religious context and con-
ducted by a counselor who has extensive training in both theology and
psychology or counseling (Browning, 1993). It is therapy “practiced by
professionals with a variety of credentials and in a variety of settings”
(Dickey, 1988, p. 3-4). The treatment of mental and emotional disorders
based primarily on verbal and non-verbal communication with the pa-
tient, the descriptive adjective pastoral denotes a formal office of lead-
ership in the church, usually achieved by ordination or consecration
(Hartung, 1990, p. 860).

METHOD

Research Design

This was an exploratory descriptive study with specific attention paid

to the lack of agreed upon definitions for pastoral counseling. It also fo-
cused on the perceptions of clergy, pastoral counselors, and consumers
(opinion-makers) regarding the various types and functions of provid-
ers of pastoral counseling. Nine focus groups were conducted, three
with each of three distinct groups. The participants completed two in-
struments, followed by a discussion of the questions contained in one of
the instruments. The first author functioned as the moderator.

Participants

The participants in this study were drawn from three distinct groups:
clergy, counselors, and selected members of the public, referred herein
as opinion-makers. Clergy and counseling participants were recruited
from advertisements in local advertising directories. Opinion-makers
were known personally by the first author and chosen because of their
involvement in their local churches. A convenience sample consisted of
67 participants, of which 23 were clerics with ministerial credentials
from the following denominations: Assembly of God, Baptist, Catholic,
Church of God, Episcopal, Lutheran, Methodist, Nazarene, Pentecostal,
Presbyterian, Seventh Day Adventist, and Non-Denominational Chris-
tian; 22 counselors who primarily self-identified themselves as pastoral
counselors, Christian counselors, and biblical counselors; and 22 opin-
ion-makers consisting of individuals from various religious denomina-
 Greenwald et al. 57

tions who were active in their churches as board members, teachers or

employed in positions that would provide them opportunities to influ-
ence the selection process of individuals seeking mental health services.
For purposes of this study “opinion-makers” are persons who are not di-
rectly offering to the public a product or service, but who indirectly influ-
ence the consumption of that product or service. This is the common use
of the term in marketing research.
Median age of the opinion-makers was 61.5, 32% male, with a me-
dian education of a bachelors degree. Forty-one percent reported a per-
sonal counseling experience with a professional counselor, 27.3% with
a Christian counselor, 22.7% with a cleric, 18.2% with a pastoral coun-
selor, and 4.5% with a biblical counselor.
Median age of the clerics was 51, all males, with a median education
of a masters degree in divinity. Fifty-two percent of the clerics reported
a personal experience with a professional counselor, 91.3% with a fel-
low cleric, 60.9% with a pastoral counselor, 43.5% with a Christian
counselor, and 34.8% with a biblical counselor. Ninety percent of the
clerics functioned as senior pastors of urban churches, one was an asso-
ciate pastor, and one was employed in the field of religious education.
Thirty-two percent pastored churches with a membership of between 25
to 100, another 32% reported 101 to 250 congregants, 13.6% stated 251
to 500 members, and 27% reported over 500 parishioners. The group re-
ported 18 years of median pulpit experience. One cleric possessed a
masters degree in pastoral counseling in contrast to the other respon-
dents who reported little or no formal counseling education, workshops
or CPE units.
Median age of the counselors was 56, 13.6% male, with a median edu-
cation of a masters degree; all were non-ordained. Ninety-six percent of
the counselors reported a personal experience with a professional coun-
selor, 54.5% with a pastoral counselor, 45.5% with a cleric, 27.3% with a
Christian counselor, and 13.6% with a biblical counselor. Sixty-eight per-
cent of the counselors reported counseling as their primary income
source. The entire group reported 7.5 years of mean work experience.
Forty-one percent self-identified as pastoral counselors and 13.6% as
Christian counselors although some of the latter held masters degrees in
pastoral counseling. One of the Christian counselors also self-identified
as a biblical counselor. One counselor self-identified as a spiritual direc-
tor and one as a lay pastoral counselor. The lay pastoral counselor held a
masters degree in pastoral counseling but clarified that she self-identified
as “lay” because she was non-ordained. This use of the term “lay” is not
typical among mental health professionals. Thirty-two percent self-iden-
58 AMERICAN JOURNAL OF PASTORAL COUNSELING

tified as “other,” e.g., addictions counselor. Fifty-five percent were mem-

bers of the American Counseling Association (ACA), 30% of the American
Association of Christian Counselors (AACC), 20% of the American Associ-
ation of Pastoral Counselors (AAPC), 15% of the American Psychological
Association (APA), and 25% reported membership in various other counsel-
ing organizations.

Measures

Two measures were developed by the first author. An initial pilot

group of 34 attendees at the American Association of Pastoral Counsel-
ors (AAPC) regional conference in Fall 2002 completed three Focus
Group Question Survey forms, which were later condensed into two
measures. Each form asked raters to rank on a scale from 5 (very impor-
tant) to 1 (not important) the importance of each question to them as a
pastoral counselor, for fellow pastoral counselors, for consumers (opin-
ion-makers), and for pastors. Their responses to these surveys indicated
a desire for marketing information from other pastoral counselors. They
wanted to know from consumers why people seek a pastor when feeling
distressed rather than another mental health service provider, also their
understanding of what is pastoral counseling and who is a pastoral
counselor. The initial raters also wanted to know the assessment process
employed by pastors, what their congregations expect of them in the
way of counseling services, their referral criteria, and ways to bridge the
chasm between pastors and the professional mental health community.
The raters were encouraged to suggest additional questions they felt
were important. None were suggested. The author analyzed the re-
sponses to these surveys and incorporated the highest-rated questions
into two measures, the Research Survey for Focus Group Participants
and the Counseling Survey.
The Research Survey for Focus Group Participants obtained infor-
mation on gender, age, religious preference, education, and personal
counseling experience. This survey contained questions specific to each
type of group as well as specific research topics. The opinion-makers’
version gathered information pertaining to their choice of the most ap-
propriate mental health service provider for 24 mental health problems;
and their perceptions of the competency of licensed professional coun-
selor, certified professional counselor, licensed clinical social worker,
psychologist, psychiatrist, and physician (general practitioner). The
clergy version also gathered information pertaining to their choice of
the most appropriate mental health service provider for 24 mental health
 Greenwald et al. 59

problems and their perceptions of the competency of various licensed

mental health professionals. They were also asked to identify various
pastoral activities as pastoral counseling, pastoral care, spiritual guid-
ance or other; who provides pastoral counseling and who is qualified to
provide pastoral counseling; their criteria for selecting a pastoral coun-
selor as a referral recipient; and the assessment techniques/resources
they employed when counseling. A list of 24 presenting problems was
provided to the clergy respondents, asking them to report the frequency
of those problems seen during the past 12 months, and their subsequent
decisions to either counsel or refer them. The counselor version of the
survey gathered information on their counseling practices, settings,
client preferences, business characteristics, business sources, marketing
and promotional activities.
The second survey entitled Counseling Survey contained items ad-
dressing the participants’ perceptions of counseling labels and provid-
ers; why people seek a pastor when feeling distressed; congregations’
expectations of the pastor regarding counseling; and the impact, if any,
that the confusion in terms has on their selection process of a mental
health professional. The items were worded specifically for the in-
tended group with all questions being essentially the same. Each re-
spondent rated his agreement to each item based on a seven-point
Likert-type scale. In addition to the rating scales, space was provided
for the respondents to make notes for reference during the subsequent
focus group discussion period. All surveys were completed prior to the
focus group discussion in order to insure that the respondents’ decisions
were not influenced by the discussion.

RESULTS

Counseling Labels

During the focus group discussion all of the groups voiced a variety
of opinions regarding the counseling labels. Several of the opin-
ion-makers and clergy commented that many of the labels were foreign
to them. The opinion-makers and clergy considered pastoral counseling
to be very different from psychotherapy. They also viewed counseling
to be short-term and therapy to be long-term “deep” work such as psy-
choanalysis. The opinion-makers did not consider a pastoral counselor
to be professionally trained, although all groups saw a difference be-
60 AMERICAN JOURNAL OF PASTORAL COUNSELING

tween a pastoral counselor and a lay pastoral counselor. They placed

great emphasis on associating the label “lay” with non-ordained.
Table 1 indicates the lack of agreement among the participants re-
garding the similarities between counseling terms. Median scores as op-
posed to mean scores more suitably reflect the participants’ opinions.
The clergy group identified the professionally trained pastoral coun-
selor as the leading provider of pastoral counseling, followed by the lay
pastoral counselor, themselves, and the Christian counselor. A compari-
son of who provides pastoral counseling versus who qualifies as a pas-
toral counselor indicates that although clerics recognize other providers
of pastoral counseling, they view themselves as being highly qualified
to provide counseling (Table 2).
The clergy were asked if the public was aware of the differences be-
tween pastoral, Christian, biblical counseling and spiritual guidance.
They responded with a score of 2 (not at all). They also acknowledged
in the group discussion that they shared this confusion as well.
The counselor subjects, on the other hand, voiced little concern for
possible business consequences resulting from the confusion surround-
ing job titles. During the group discussion they revealed that they were
basing their opinions on actual inquiries received from prospective
counselees, rather than considering the number of potential counselees
who did not call them due to possible confusion about the services they

TABLE 1. Participants’ Median Perceptions of Degrees of Similarities Between

Counseling Terms (N = 67) [1 = Do not agree, 2 = To a very small degree, 3 =
To a small degree, 4 = To some degree, 5 = To a great degree, 6 = To a very
great degree]

Counseling Terms Opinion Counselors Clergy Combined

Makers
Pastoral versus Christian 4.0 3.0 4.0 4.0
Pastoral versus Biblical 2.0 2.0 2.0 2.0
Christian versus Biblical 3.0 4.0 2.0 3.0
Pastoral Counseling versus Pastoral Care 4.0 3.0 4.0 3.0
Pastoral Counseling versus Spiritual Guidance 3.0 3.0 3.0 3.0
Pastoral Counseling versus Psychotherapy 1.5 5.0 2.0 3.0
Counseling versus Therapy 3.0 5.0 3.0 4.0
Pastoral Counselor is a Professionally 1.0 5.0 --- 1.0
Trained Clinician
Lay Past. Counselor versus Pastoral Counselor 1.0 1.5 2.0 1.0

Note. - - - = Question not asked of this group

 Greenwald et al. 61

provide. Table 3 reflects the cleric participants’ identification of selected

clerical activities.
All groups concurred that the main reason people seek a pastor when
feeling emotional distress is a desire to have their religious beliefs val-
ued. They considered the trusting relationship between pastor and
church member to be very important. It is worth noting that the counsel-
ors and clergy placed a higher degree of importance on financial reasons
than did the opinion-makers.

Expectations of Pastor Role

Opinion-makers and clergy were favorably disposed to pastors and

their families seeking professional counseling, yet when the question was
asked of clergy with the deletion of the reference to the cleric’s family,
clergy responded less favorably. Both groups agreed “to some degree”
that congregations expect their pastor to be a counselor, yet the groups
differed significantly in the degree of counseling expertise expected. The
clergy group considered counseling to be a part of their job to “a small de-
gree.” Both groups expressed a lack of concern or awareness of a poten-
tial ethical problem resulting from a dual relationship caused by the cleric
serving as both pastor and effective counselor. This points to the clerics’
lack of counseling education and the opinion-makers’ perceptions of the
counseling process.

TABLE 2. Clergy’s Perceptions of Pastoral Counseling Providers and Who

Qualifies as a Pastoral Counselor (N = 23) [Percents]

Title Who Provides Who is Qualified

Professionally Trained Pastoral Counselor 87.0 87.0
Lay Pastoral Counselor 78.3 43.5
Clergy 73.9 78.3
Christian Counselor 52.2 34.8
Biblical Counselor 43.5 21.7
Spiritual Director 13.0 13.0
Psychiatrist 0.0 0.0
Psychologist 0.0 0.0
Psychotherapist 0.0 0.0
Other 0.0 ---

Note. - - - = Not applicable

62 AMERICAN JOURNAL OF PASTORAL COUNSELING

TABLE 3. Clergy Classifications of Selected Clerical Activities (N = 23)

[Percents]

Activity PCoun PCare SG PCoun PCoun PCare All None

& SG & PCa & SG
Hospital Visit 4.3 69.6 0.0 0.0 4.3 8.7 13.0 0.0
Spiritual Interpretatn 0.0 4.3 56.5 4.3 0.0 4.3 13.0 17.4
Marital Problem 56.5 17.4 0.0 8.7 4.3 0.0 13.0 0.0
Pre-Marital Counsel 47.8 21.7 0.0 4.3 13.0 0.0 13.0 0.0
Unsched. Meeting 13.0 52.2 4.3 4.3 4.3 0.0 13.0 8.7
Appt. for Counseling 52.2 13.0 0.0 4.3 4.3 0.0 13.0 13.0
Home Visit 0.0 69.6 4.3 0.0 0.0 4.3 17.4 4.3
Funeral Service 4.3 69.6 4.3 0.0 0.0 8.7 8.7 4.3

Note. PCoun = Pastoral Counseling, PCare = Pastoral Care, SG = Spiritual Guidance

Table 4 reports the opinion-makers’ and clerics’ perceptions of con-

gregations’ expectations of pastors. The clergy acknowledged “to some
degree” that they were not equipped to counsel some of the problems
presented to them. This could be related to their lack of counseling
education and training and also to the assessment methods and techniques
employed. The clergy and opinion-makers did not view a “referral” as an
indication that the client was seriously mentally ill. Furthermore, the
clergy agreed “to a very great degree” that it was appropriate to refer
someone who is suicidal or needing long-term counseling. This position
is incongruent to the responses regarding their actual behavior (Table 5).
Clergy’s Referral Selection Criteria
During their focus group discussion, the clergy expressed a desire to
refer to professionally trained pastoral counselors that they knew and
trusted. They identified personal knowledge of the counselor was the
most important factor in making a referral selection, followed by the
counselor’s certification, and their reputation as a counselor, e.g., rec-
ommendations from former clients or fellow pastors. Least important
was the counselor’s religion and office location.
The opinion-makers and clergy ranked psychiatrists as the most com-
petent mental health service providers, followed by psychologists, li-
censed professional counselors, certified professional counselors, with
the licensed clinical social worker receiving the lowest rating.
 Greenwald et al. 63

TABLE 4. Participants’ Median Opinions of Congregations' Expectations

(N = 67) [1 = Do not agree; ...7 = Agree to a very great degree]

Opinions and Perceptions Opinion Clergy

Makers
Okay for pastor/family to seek professional counseling 6.0 6.0
Would not accept their pastor seeking professional counseling --- 3.0
Have high expectations of pastor as a counselor 4.0 5.0
Expect clergy to counsel all their problems 1.0 3.0
Clergy can be an effective pastor and an effective counselor with 5.0 5.0
the same person
Pastoral counseling is a major part of the pastor’s job --- 3.0
I sometimes feel "over my head" with some issues presented to me --- 4.0
Congregants would oppose a pastor referring the majority of peo- --- 3.0
ple for emotional distress
Clergy referral implies person is crazy 1.0 1.0
It is okay for clergy to refer someone suicidal or needing long term --- 6.0
counseling
Clergy prefer to refer to a pastoral counselor versus secular counselor --- 5.0

Note. - - - = Question not asked

Mental Health Service Providers

The clergy and opinion-makers groups selected the most appropriate

mental health service provider for 24 disorders. The clergy group indi-
cated their first, second, and third choices while the opinion-makers indi-
cated only their first choice. The choices were clergy, pastoral counselor,
biblical counselor, Christian counselor, psychiatrist, psychologist, social
worker, physician, and “other.”
The opinion-makers selected a psychiatrist as the most appropriate
mental health service provider for the psychotic disorders, e.g., hallucina-
tions/delusions and schizophrenia. For the neurotic disorders they se-
lected psychologists only for phobias, otherwise there was no selection
indicated. The lack of variations in their selections would seem to indi-
cate their confusion as to the various providers’ specialties and capabili-
ties as well as a lack of understanding of many of the disorders. Pastoral
counselors were not selected for any of the neurotic disorders other than
pornography and gambling addiction. Selections of providers for “prob-
lems of living” disorders indicate a perception of similar capabilities be-
tween pastoral counselors and clerics.
64 AMERICAN JOURNAL OF PASTORAL COUNSELING

TABLE 5. Clergy’s Counseling Activities During a 12-Month Period (N = 23) [in

percents]

Disorders Presented Frequency Counseled Referred

Hallucinations seen 9.0 0.0 9.0
Schizophrenia seen 4.3 4.3 4.3
Paranoia seen 4.3 0.0 4.3
Depression seen 56.5 43.5 43.5
Eating Disorders seen 0.0 0.0 0.0
Anxiety/Panic seen 47.8 26.1 39.1
Anger Management seen 60.9 34.8 34.8
Suicide seen 34.8 17.4 17.4
Pornography Addiction seen 13.0 8.7 4.3
Gambling Addiction seen 4.3 0.0 4.3
Sexual Identity seen 8.7 8.7 4.3
Phobias seen 17.4 8.7 17.4
Marital Issues seen 87.0 65.2 43.5
Pre-marital seen 78.3 73.9 13.0
Drug/Alcohol Abuse seen 52.2 26.1 39.1
Sexual Abuse seen 34.8 13.0 21.7
Physical Abuse seen 21.7 8.7 17.4
Family Issues seen 73.9 65.2 26.1
Crisis Situation 43.5 34.8 26.1
Child-Youth 56.5 43.5 30.4
Career/Job 60.9 60.9 21.7
Financial 65.2 52.2 21.7
Divorce/Separation seen 73.9 56.5 39.1

The clergy group selected psychiatrists and psychologists as the most

appropriate providers for the psychotic disorders, with physicians fre-
quently being their third choice. It is worth noting that pastoral counsel-
ors were their third choice for paranoia. Christian or biblical counselors
were not selected for any disorder. They chose pastoral counselors, psy-
chiatrists, and psychologists most frequently for neurotic disorders. The
clergy considered themselves to be the first choice for many of the
“problems of living” disorders, followed by pastoral counselors as their
second choice. They also viewed themselves to be the most appropriate
provider for spiritual or biblical issues, followed by a biblical counselor,
then pastoral counselor.
 Greenwald et al. 65

Clergy Counseling and Referral Patterns for Presenting Problems

Ninety-one percent of the clergy group reported they had not been
presented with any type of psychotic disorder during a 12-month pe-
riod. They also reported low frequencies of neurotic disorders pre-
sented. The clergy sample may lack the requisite knowledge to identify
these types of disorders. Clergy reported a plurality of “problems of liv-
ing” problems presented to them during the previous 12 months. The
most frequent problems were family issues, pre-marital, and marital
problems. They reported counseling most of these issues, sometimes in
contradiction of their assessments of the most appropriate mental health
service providers for these issues. In addition to their lack of diagnostic
training, the low referral patterns could also be associated with their
concern for preserving their pastoral positions. In many Protestant de-
nominations the pastors’ employment contract is reviewed periodically
by the congregation, who may expect a high level of personal service.
Additionally, the clergy group considered themselves to be highly qual-
ified to provide counseling more often than other providers (See Table
2). The clerics averaged only 6+ presenting problems related to spiritual
and/or biblical issues in a 12-month period. Table 5 shows the clergys’
counseling activities for a 12-month period.

DISCUSSION

The most important outcome of this study is its documentation of se-

rious problems in the marketing of pastoral counseling. The study re-
veals a three-fold problem: the lack of a distinguishable product
identity; the inconsistencies associated with the labels pastoral, Chris-
tian, and biblical counseling; and concern for meeting the mental health
needs of the religious community.
The opinion-makers, clergy, and counselors who participated in this
study were unable to identify differences among pastoral counseling,
Christian counseling, biblical counseling, and spiritual guidance. It is
notable that several counseling organizations’ websites use the terms
Christian counseling and biblical counseling interchangeably, notably
The American Nouthetic Psychology Association, The National Asso-
ciation of Nouthetic Counselors, The Institute for Biblical Counseling
and Discipleship, Christian Counseling and Educational Foundation,
and The Christian Counseling Center.
66 AMERICAN JOURNAL OF PASTORAL COUNSELING

Interestingly, the participating pastoral counselors did not identify a

preference for clients with religious or spiritual perspectives. Was this
merely an oversight? It is not clear whether pastoral counselors choose
pastoral counseling training because of a desire to serve the religious
community. These current data appear to confirm the observation of
Carroll Saussy (1986), who commented “Writer after writer laments the
fact that the pastoral counseling movement of the last half century sold
out to clinical psychology.” Maes (1988) offers another negative per-
spective on the pastoral counselor. He suggests that many pastoral
counselors possess both a theological and a psychological identity but
have very little contact between them. He believes that as they become
busier with their therapeutic practices, they may move away from wor-
ship, prayer, and liturgy so necessary to reinforce a commitment to
spiritual values and a continuing interest in them.
The sample clergy consider themselves to be the appropriate pro-
vider for many disorders. They often chose to counsel rather than refer
many of the presenting problems of their congregants. Their decisions
are inconsistent with their stated desires to refer rather than counsel and
with their evaluation of the competency of professionally trained pasto-
ral counselors. Additionally, it appears that clerics see few differences
in their counseling capabilities compared to those of pastoral counsel-
ors. The data indicates that clergy do not have the knowledge of provid-
ers’ specialties nor do they possess the training needed to adequately
access the presenting problem. It is worth noting that 87% of the clegy
reported relying primarily on their own intuition to assess the type and
severity of problems presented to them. Miller and Jackson (1995) sug-
gest that clergy increase their knowledge of contemporary clinical and
counseling psychology. The clerics cited a high priority for selecting an
appropriate referral recipient was the education and personal knowl-
edge of the counselor. This seems to imply that without the knowledge
of pastoral counselors’ advanced training and education, the clerics
view them as no more competent than themselves.
The sample opinion-makers selected a variety of mental health ser-
vice providers other than clergy for most of the 24 disorders used in this
study. It is not clear whether this relates to their comments regarding
pastors’ counseling limitations or an indication of their understanding,
or lack thereof, of mental health service providers. Many of the opin-
ion-makers expressed a desire for their pastor to act as a source of infor-
mation and guidance when seeking the services of a mental health
service provider.
 Greenwald et al. 67

Only 18.2% of the respondent pastoral counselors hold membership

in AAPC, yet this is the only organization of size that employs the term
pastoral counselor in the organizational name. Although 40.9% of the
sample counselors self-identified as pastoral counselors, only half use
that title on their business cards. This could possibly be related to their
membership in professional organizations other than AAPC. Addition-
ally, it could be their perception that use of the label pastoral counselor
indicates membership in AAPC. Some stated that the label did not pro-
ject their professionalism and expertise; and that it possibly deters
potential clients from seeking their services.
This study points to the need for establishing a professional identity
for pastoral counselors that denotes the level of their graduate-level ed-
ucation and clinical training, and clearly distinguishes them from Chris-
tian counselors and biblical counselors, as well as from clergy. There is
a clear need to create awareness in the minds of the public and the clergy
of the dual capabilities of the professionally trained pastoral counselor.
Miller (2001), who is sympathetic to the inclusion of spirituality and re-
ligion in counseling and treatment, writes of the “relatively isolated
field of pastoral counseling” (p. 6). If counselors, who value the contri-
bution of spirituality to well-being and personal growth and develop-
ment, want to become part of a dialogue with other mental health
professionals, they are not likely to have an impact from their current
position of relative isolation. If such isolation made sense in the past, it
is clearly no longer necessary. The American Counseling Association
and the American Psychological Association both include respect for
cultural and religious differences in their codes of ethics, and have divi-
sions focused on values and/or religion. In psychological research, as
well, there is new respect for the unique contribution of spirituality and
religion to well-being. The religious and spiritual world is no longer the
exclusive turf of clergy. The time of the professional counselor who is
also pastoral has arrived.

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Received: 10/10/03
Revision Received: 04/10/04
Accepted: 04/15/04