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Ancient Pastoral Wisdom for a Therapeutic Age

June 11th, 2024 | 19 min read

By Michael Gembola

Some time ago a widely publicized comment online said something like this: we don’t need trauma counselors, we need BIBLICAL counselors. The comment was nonsensical and merited the criticism it received. Counselors who try to do their work within a biblical framework and focus on trauma care aren’t pursuing opposing goals.

Yet psychology-bashers aren’t the only ones oversimplifying or creating false choices. I also regularly hear this style of comment coming from the opposite end of the spectrum:

  • “PSA: pastors are not mental health professionals.”
  • “Friends don’t let friends go to a ‘Christian counselor.’”
  • “I don’t know who needs to hear this, but ‘Biblical counseling’ isn’t ‘biblical’ or ‘counseling.’”

Statements like these pop up frequently on social media from Christians with a significant following, and the posts are frequently met with lots of likes and interaction. A relatively stable script follows in the comments. One set of responses echo and affirm: it’s fine if the therapist happens to be a Christian, but it’s more important that the person is competent and qualified. You don’t want a “biblical surgeon,” just a good one! 

Then others tell stories. Hard stories. Heavy stories. Grievous stories. Wives sent back to violent husbands. Simplistic, harsh, over-spiritualized pastoral care or counsel provided to people in severe depression, or helpers with very little knowledge of complex problems giving highly specific directions, or missing big and important things. Helpers jumping in the deep end when they haven’t yet learned to swim, much less help another to safety.

In these public pile-ons, another set of voices tries to sidestep the critique: don’t lump us in with what you’ve heard about Christian counselors! Don’t be afraid of us, we’re the good kind!

Still another voice sometimes pushes back, somewhere buried deep in the comments: Yes, pastors and friends aren’t therapists, but isn’t there something valuable Christians can offer each other outside of professional contexts? And, don’t a lot of Christians really want good pastoral care? And wouldn’t we need robust pastoral thinking about the more extreme and complex forms of human suffering, like trauma, that psychology has studied so carefully?

From my vantage point as a licensed counselor, I’ll add, a lot of Christians want their therapists not just to check the box of being Christian, but to be able to meaningfully incorporate faith and spiritual interventions into their practice.

        Yet the fact that these debates happen in such a charged way, and that often they are framed in all-or-nothing ways, says much about the state of current Christian divides on pastoral care and counseling. The horror stories I’ve alluded to also make it clear that many Christians have not experienced evangelical pastoral care and counseling to be wise and helpful on complex problems. I am drawing here not from the attacks of angry outsiders, but from wounded insiders.

I’ve written soberly but appreciatively about the recent cluster of books written to shed light on the problem of abusive church leadership. The multiplied scandals have at times shaken my own confidence in the local church as a place where power is well stewarded and where robust care of souls could happen. That’s not out of a lack of desire on my part for the church to be a place of care and refuge. Even David Powlison, best known for his calls for the church to be the primary place for addressing many problems of life, said that churches were generally not prepared for this high and holy task: “It is fine to call Christians to practice and seek cure of souls in submission to the doctrine and life of the local church. But the church needs to become a far better place to come into and come under.”

So I’ve had to ask hard questions as a professional counselor. Can I in good faith collaborate with churches with widely varying abilities to help people in severe trouble–in light of the horror stories? Can I encourage people to utilize the structures of the church for complex matters when some are saying that churches, and church courts especially, aren’t built to help victims of domestic abuse or sexual assault? Can I, with integrity, offer my encouragement for pastors and friends in the church to try to meaningfully be part of the help? Is my effort at building church-based care teams on the right track?

On the other hand, from my vantage point as a minister I have another set of questions. How can I do anything other than work to make the church a hospital and help for the broken and battered, the wandering–and for the wicked? The pastor part of me can’t help but want better congregational care, and not give up. The professional counselor part of me can’t disagree on that point either, remembering the received wisdom that when a professional counselor and church leader are opposed, no one wins, and the client/parishioner loses. Further, although I won’t make this argument here, church is overwhelmingly good for people in every category of human flourishing.

My argument is this: yes, after all, we still need the church’s wisdom applied to the problems of life.

I’ve been motivated to write in response to a call for papers from a past UK convivium for the Davenant Institute, and more specifically, their invitation to consider how theological retrieval could correct evangelical imbalances and help form institutions. Their questions have stayed on my mind, as I’d been convinced for some time that the general loss of pastoral theology and the neglect of this tradition is a problem for the church, and that this is all relevant to Christian counselors, too. I felt that the questions raised in the call for papers deserved to be engaged from the angle of pastoral theology and applied to the institutional life of the church with regard to pastoral care.

In what follows I’ll draw from and expand upon some of the questions raised in the call for papers, but I’ll follow the outline of what Old Testament scholar Doug Green has called the arc of Psalm 23: the movement from good, to bad, to better. The church’s pastoral care tradition is certainly imperfect but it is good. The historical loss of this tradition is bad. Retrieving it will be ultimately better for the church.

This is not to put my head in the sand or join the psychology bashing. When I joined a church staff, the counseling training and supervision I’d received were only assets to me for the work. What I mean is that in church life we want to love, understand, and care for each other in Christian ways. And the church has thought for a long time about what it means to be a person and what it means to help people, and this tradition is worth holding onto, stewarding, and taking further. This work can sound simple, because in some sense it is for everyone, from our littlest children to our elders–we’re all called to love and bear burdens. Yet the task of robust pastoral care is also daunting, and it merits our very best efforts.

The Good: The Church’s Long-Standing Pursuit of Expert Care of Souls

So we start with the good, the church’s tradition of care that I am saying we should revisit, learn from, and take forward. It would be foolish to try to argue that church history contains a golden age of pastoral care to which we would hope to return. I am alternately challenged and disturbed sometimes by what I’ve come across in the tradition. How do I make sense of John Cassian, for example, who on one page is pointing me to profound connections between vices, such as addictive sexual behavior and destructive anger (and patience’s power over both); then on another page he is telling the story of a child being tossed into a river (and saved) to test whether the father had reached a sufficient level of apatheia? How can the same person help and horrify me? On that front Cassian’s not unusual. In the writings of Augustine, Aquinas, Calvin, Luther, and most anyone else in the tradition, there are comments that no one today with even a modicum of pastoral counseling wisdom would endorse. Of course, the feeling would be mutual if our spiritual fathers and mothers were reading what we write. But the point is that there’s no golden age to return to.

Yet I do see a discernable and basically good tradition cultivated from the earliest days of the church and maintained, if we follow the Protestant tradition, until the early 1800s or slightly later, depending on where you mark it. From Nazianzus, Chrystostom, Ambrose, and Theresa, to Baxter, Herbert, and Jeremy Taylor, and many in between, we can trace a line of tradition and find deep, thorough, and eminently useful pastoral theology on a wide range of topics.

If we look back at one particular early church tradition that runs from Evagrius and Cassian to Gregory, Dennis Okholm argues that in some cases “modern secular psychology has not progressed beyond the insights of these ancient Christian psychologists, and in a few cases reversed their theories only to ‘arrive’ at the conclusions reached by ascetic theologians 1,500 years ago.” He sees this especially true of this tradition’s work on anger.

For another example, church leaders morally failing is not a new thing, but I doubt it could be said that any denomination has really gotten a handle on what to do about it. Yet in browsing Medieval penitential manuals and tracing themes in their guidance for people who had fallen into adultery, I was impressed to see none of the paths to restoration lasting fewer than years, especially for church leaders. I have been contemplating this ever since, and it comes to mind when I see examples of the moral failure of leaders who then pop up six months later to start a new church or speak at conferences.

To give another example from a very different time and place, I often think of Richard Baxter when I am providing counseling to someone with Religious OCD, as his writings on melancholy make it clear that he knew this struggle very well–and was advising that wise counsel be paired with psychoactive medication in the 1680s. He coached helpers in how to answer accusations and spiritual anxieties with Christian comforts and a thoughtful biblical argument. He was also very practical, encouraging anxious people not to spend too much time alone with their thoughts, to find pleasant things to do, and take every opportunity to occupy their minds with something other than the worries–something I like to call godly distraction. I recommend it often. For troubles like these, my counseling has only been enriched by drawing from the pastoral theology tradition.

I’m challenged also as I consider the church’s structures of care. I think of the penitential tradition’s practice of auricular confession, of which Luther said, "I will let no one take away private confession and would not exchange it for all the wealth of the world, for I know what strength and comfort it has given me."' He continues, "I know the devil well. If you had known him as well as I, you would not [throw] private confession so quickly to the wind . . . it is a cure without equal for distressed conscience.” Or I consider Calvin’s Company of Pastors, in Scott Manetsch’s chapter on pastoral care worth the book’s purchase price, where he lays out the beauty and challenges of the Genevan system of pastoral visitation. Or I consider the German Pietists and the birth of small groups, Baxter’s house-to-house catechesis, or George Herbert’s beating the bounds. Pastoral theology cultivated wise conceptualization, methodology, and structures of care. So much of this is so good, and so helpful.

The Bad: How the Church Lost Its Expertise in the Care of Souls

The cultivation of this tradition was good for the church for centuries, and the loss of this tradition was bad. Even by the mid-1800s a Princeton Seminary professor could lament that robust pastoral theologies just weren’t being written anymore. What happened?

Pastoral theology was historically interdisciplinary, but to say this is anachronistic. This tradition and body of literature is not composed of separate disciplines brought together. The historical texts that most directly explain how to be a pastor, whether from Nazianzus and Chrysostom or from Ambrose and Gregory, all have the voice not of specialists of a single discipline distinct from the others. Knowing the Scripture deeply (biblical studies), understanding people in Christian ways (anthropology), pastoral paraenesis (ethics), a Christian fellowship of collaboration and debate seeking to answer the big questions (historical theology)--all these are connected in these works of pastoral theology. This is natural, because what we now know as distinct disciplines come to us connected in the pages of Scripture. Even Paul’s indicative-imperative structure does not flow in strict sequential order: knowing God and knowing what He intended us to do in light of that knowledge is all integrated. This integration prevailed for centuries. Consider the question of how to succinctly summarize who John Calvin was. A pastor? Bible scholar? Theologian? His writing bears the marks of all of what are now separate tasks and disciplines. His work, like the entirety of the pastoral theology tradition, is integrated. But we have separated what God has put together.

This post-enlightenment state of affairs is a mixed blessing. It is a particular challenge when it comes to the genre of self-help texts written by believers. But my critique does not require attacking the easy targets of popular Christian books that are theologically thin. It’s a challenge even with highly educated Christian scholars.

Consider that Christian scholars would never write at any length on the doctrine of the Trinity apart from reference to the church’s historic teaching and the various heresies that emerged over time. Yet Christian scholars often write whole books on major life problems that minimally engage or do not engage how the church’s tradition of care wrote about the problems over centuries. Theological retrieval more broadly has received needed attention in recent years, and there are good examples of this retrieval project gaining further strength in the fields of pastoral care and counseling, but there is generally still a striking lack of historical consciousness in evangelical counseling resources.

Here it seems relevant to point out the lament that I have read or heard from multiple major voices committed to the vision of integrating psychology and Christian thought: it has far too often been an integration of Sunday School-level theology with PhD-level psychology. Or, integration has largely been a task of bringing psychology to theology, and not vice versa.  

This trend has been observed for a long time, among both evangelical and Mainline Christians. Richard York shares the following:

The pastoral counselors' disconnection from their Christian roots was described by Paul Pruyser in his presentation at the Lowell Lectures at Boston University in 1975. . . . He discovered that the theologians acted as though they were 'sitting at the feet of the psychiatric Gamaliels,' while the psychiatric professionals thought that the ministers had their own concepts, traditions, and practices but did not talk about them. . . . When the theological professionals were encouraged to conceptualize patients' concerns in theological terms, they would either ignore the clear spiritual and faith issues or translate them in psychological language; they lacked the language to talk with people in theological terms. The theological professionals seemed to distrust people's faith issues and instead translated the issues into family therapy, conflicts with parents, or psychodynamic issues. . . . Pruyser was surprised that theological professionals no longer knew their basic science of theology."

In the Mainline church, it’s generally agreed that with few exceptions, after Anton Boisen the pastoral counseling movement’s major writers were not deeply engaged in maintaining and cultivating its pastoral theology tradition.

There are many ways to tell the story of the loss in Evangelical churches, too. E. Brooks Holifield, John T. McNeil, and Thomas Oden offer us the fuller picture, but it is not hard to trace a variety of influences in addition to the rise of psychology. In the revivalistic tradition of the Second Great Awakening, whose spirituality lives on to the present day, robust pastoral counseling just isn’t as necessary. Life problems are to be named and claimed, laid at the altar, and so the stronghold is broken, the second blessing received, and one’s life is dedicated or rededicated to Christ. There are theological reasons that evangelical pastoral counseling was not cultivated as the art of arts and science of sciences, as Nazianzus called it.

There are also practical reasons the tradition was not cultivated. During the early decades when psychology and psychiatry departments were being established and growing in major universities, many evangelical schools were in their earliest building stages after the losses of so many of their institutional homes during the Fundamentalist-Modernist Controversies. Even if Christians had maintained a vision for congregational care, their ability to institutionalize it was limited at the very time when its secular counterparts were exploding with growth.

This trend has not been true only in universities. For a long time, seminary curricula have not included the study of the problems of life with anywhere near the rigor given to historical theology and biblical studies. Anecdotally, I have rarely (never?) heard of an MDiv practical theology course with a reputation for being difficult. It should not be a surprise, then, that so many pastors are caught off guard when they are called upon to enter complex marital breakdown, major depression, or substance abuse. When these issues come up, it’s common to hear the phrase, “They don’t teach you that in seminary.”

Yet in some ways this all is the least of the church’s problems in pastoral care. The various forms of abuse, and perhaps even more so the mishandling of abuse allegations, are the gravest threat to churches existing as a refuge and hospital. The staggering mismanagement of major Christian institutions has led many to move away from institutional life of the church altogether, or to consider it a burning building that is safest to stay away from. And yet, as someone said, “It’s tempting to just let it burn. And then I remember: there are children inside.” Yet I am aiming not only for rescue missions and putting out fires, but for building better, fire-resistant institutions.

The Better: Where Pastoral Theology Take Us

Given these challenges and with the goal taking up the tradition and strengthening our institutions, one place to start is to reflect on our differing roles and professions.Our roles will give us different points of entry and different areas of expertise to bring to the table. This role-sensitivity opens up the possibility of leveraging the strengths of one’s context and working in view of context constraints. No one profession is trained to carry this work alone, so this requires a vision for collaboration.

Consider that professional counseling is isolating work, by its nature a hidden service. This is a constraint that is hard for the counselor and for the community. For counselors, burnout and compassion fatigue are constant concerns connected to the isolation, and they weigh heavily on my heart as I direct a counseling center and want our staff to avoid impairment and, I hope, even to thrive. For churches, it is easy to have wavering trust in these semi-hidden counselors. Word does get out when practitioners are particularly good or bad at navigating the troubles of life with people of faith, especially in smaller communities. Also, some counselors trained in primarily clinical contexts are gifted in helping Christians make incremental gains toward greater spiritual health and Christian connection. But there is often a significant separation, or a wall between the counseling center and church. I heard about a provider recently who told a client that he wasn’t interested in “co-counseling” with the person’s pastor. Far from being interested in collaborative care or being of help to the pastor, the therapist seemed to view the pastor as an avoidable complication. Sadly, the relationship between church and counseling center is far too often adversarial. It’s easy for me to say this, as a counselor and minister, but the responsibility really is mutual. As I’ve argued before, we have to do better.

I’ve also seen beautiful things. I’ve been touched many times as a counselor when I’ve been connecting with a pastor about the care of a church member (who has provided permission) and  I’ve had pastors offer to pray for me over the phone, and ask genuine questions about how I’m doing.

To recognize the strengths and weaknesses of the counseling center context makes it easier to leverage these strengths and work around the weaknesses. Although I love being a professional counselor, I’m quick to recognize the value of pastoral care, formal and informal lay counseling, and church connection. They provide things I never could in the one hour I have every week or two with the person.

Imagine that a couple in your church has a failing marriage, and one of the spouses is also very ill. Marriage counseling certainly can be a great help to them, but they need much more. On Sunday they need a place to hear the Word of God and be strengthened and reminded of their future hope. They need to sing songs that express their grief and reliance on God. They need people in their small group or Sunday School class to check in on them and pray for them. They need a skilled diaconate to coordinate care for physical needs. Then perhaps the diaconate can help share the costs for them to start counseling, or the elders can recommend a mentor couple from the church for additional support. The church is well-postured to provide this kind of holistic care.

Further, if the current crisis in mental healthcare of exploding need and insufficient numbers of providers continues, then we need all hands on deck. In the recent book Beyond the Clinical Hour: How Counselors Can Partner with the Church to Address the Mental Health Crisis, the authors make the case that the church can be a significant part of addressing the need. However, key protections must be in place, especially training and supervision. But as field leaders have long recognized, lay counselors–volunteers with less than 100 hours of training–can be quite effective in walking with people through most common problems.

There is great potential for shared work between counseling centers and churches. This collaboration requires humility and confidence, a sense that each really does have something to offer in their roles. Rather than condescending to one another, we can provoke and stimulate deeper engagement and ultimately better care for people. This can take the shape of continuing education in congregational care for pastors and members, and pastoral mentoring and counseling supervision being added to the ordination process. It also can include greater spiritual preparation for Christian graduate programs in counseling, and as Beyond the Clinical Hour argues, adding training in consultation and supervision to MA-level counselor training. This way each of these roles can be of greater help to one another.

Signs of Hope

The first step, for most, would not be to set up reading groups of Evagrius or George Herbert for counselors and pastors, and perhaps not even to draw a turn of phrase from the Ancient Christian Commentary here or there. We need wise guides to lead us through the tradition, helping us understand the value of writers from past times in their context. There are encouraging developments here.

 Significant recent appreciation of the pastoral care and discipleship structures can be seen in popular evangelical literature, especially in considerations of liturgies and rules of life.    

Some of my favorite examples of the retrieval of theology from the Medieval church for pastoral care and counseling–that is also accessible and engaging–come in works on the seven deadly sins. Dennis Okholm’s Dangerous Passions, Deadly Sins: Learning from the Psychology of Ancient Monks and Rebecca Konyndyk DeYoung’s Glittering Vices are excellent examples, both scholarly and readable as lay-level theology.  

John T. McNeil’s History of Pastoral Care has aged well, remaining a strong resource for Christians of various denominations to draw from for a basic orientation toward their own traditions. One book of noteworthy excerpts from the Christian tradition’s pastoral theology is Clebsch and Jaekle’s Pastoral Care in Historical Perspective. Recent work on the Puritans is also of use, including the compendium of Puritan quotations, Dale W. Smith, Ore from the Puritans' Mine and Matthew A. Deckhard's Helpful Truth in Past Places: The Puritan Practice of Biblical Counseling.

The wide reception of Harold Senkbeil’s Pastoral Care is evidence of a renewed appreciation of faithful pastoring. Edward Wimberly and Bob Kelleman have sought to articulate core principles from a distinct African American tradition of pastoral care.

Perhaps no one has completed as thorough of a project in this area as Thomas Oden, who built from his earlier work on Gregory the Great to a 4-volume compendium of Classical Pastoral Care and also his Ancient Christian Commentary series. If Oden’s contribution is in a class of his own, Eric Johnson’s work may come the closest in breadth and depth.

In a different vein, a further encouraging development is the flurry of books in recent years emphasizing the primacy of living faithfully within limits, such as Kelly Kapic’s You’re Only Human. This trend is relevant for pastoral theology if it signifies a reaction against the platform-seeking tendencies that many have been critiquing for years. Pressure to be big moves us away from the local and the particular, which is the essence of pastoral care. A hyper-local focus is a prerequisite for consistently good congregational care.

I say this anecdotally, but the emerging disciplines of spiritual formation and spiritual direction also appear to be making significant headway into training and professional events for Christian counselors. This training invites counselors to be more fully relationally engaged in discipleship and providing deeper relational help to Christian clients. This also helps counselors avoid being too clinical and detached, but points us toward the pastoral aspects of the role. This does not quite take us as far as what Thomas Oden wanted, but these are important developments.

Next Steps

There is certainly much work to be done. Although less true than it was when Oden first started his grand project, it is still generally the case that core writings from the history or pastoral care are so foreign that practitioners need wise guides to help them draw from the tradition. The professional development structures are still insufficiently suited to preparation for robust congregational care, both from Christian counseling programs and pastoral training programs. Some of the most important aspects of counselor training happen through regular individual and group supervision, which ministry leaders essentially never receive.

Church-oriented care does need to be trauma-informed. We have to do better in navigating allegations of abuse. We need to figure out how best to navigate church discipline in messy divorce situations. We need continued installments of fresh pastoral theology on power, leadership, and shepherding.

But there is a lot that is really good.

A pastor reached out to me recently to make a referral for a complex matter, but he wasn’t sure if he should also meet with the person. I knew him, so I was able to affirm him in his giftedness and offered him some structure and guidance if he did decide to have the meeting. I said that I felt that one of his gifts was that he could offer a steady presence that was free of the anxiety of forcing a fix onto the problem. He could sit with people in the heaviness, offer a word of encouragement from the Scripture that was concise without being a Bible bandaid, and pray. What a gift that is.

I have often seen pastors working through complex pastoral care situations with a kind of surgical precision, and I highly value this. Yet I can concede that conceptualizing the pastoral calling as surgery may not be the best metaphor. The best pastors, I think, are like general practitioners, experts in family medicine. Eugene Peterson’s words come to mind:

Pastoral work . . . is that aspect of Christian ministry that specializes in the ordinary. It is the nature of pastoral life to be attentive to, immersed in, and appreciative of the everyday texture of people’s lives — the buying and selling, the visiting and meeting, the going and coming. There are also crisis events to be met: birth and death, conversion and commitment, baptism and Eucharist, despair and celebration. These also occur in people’s lives and, therefore, in pastoral work. But not as everyday items.

This is not condescension but wisdom and practicality. If a pastor were to become an expert in OCD or Schizophrenia, it would not be wise time management, as these problems will be nearly irrelevant to the vast majority of the congregation. But it is a gift to have counselors in the area who do make those rarer problems their areas of great interest and focus. It’s wise to share our resources together.

To be effective stewards of a tradition, we can’t do it alone. We can’t do it as solo counselors, or solo pastors, we also can’t do it from siloed helping professions. In their current forms, pastoral training provides something that Christian counseling programs do not, and vice versa. Although I’ve framed some of the problem from the angle of academic projects, the basic task can be done on a local level where no one in the conversation has a PhD. We study together how to bring the good news to people amid the problems of life in role-specific ways, and we get better at this by working together in small and meaningful ways in the shared life of the church, over coffee, and over the phone talking over cases.

And, as a small closing encouragement, hyper-local collaborative work can be surprisingly easy when you both aren’t pouring gas on the social media fires. We feel much further apart the more we identify with or against big movements and famous people, and we feel much freer to engage when our hearts are not proud and our eyes are not haughty, and we are not concerned with great matters too wonderful for us, but calmed and quieted, and small.

Michael Gembola

Michael Gembola is an ordained minister (PCA) and licensed professional counselor. He is executive director of Blue Ridge Christian Counseling in Southwest Virginia and has taught counseling courses at several seminaries. His most recent book is Anxious about Decisions: Finding Freedom in the Peace of God (New Growth, 2022).