How to Avoid Getting in Too Deep: Don't ape the psychiatrist; you have a role all your own

* Reprinted by permission from the Christian Advocate (November, 1959). Copyright 1959, by Lovick Pierce.

---We are happy to reprint this article from the Christian Advocate. John M. Vayhinger is professor of pastoral psychology and counseling at Garrett Biblical Institute, in Evanston, Illinois, and we are sure that our readers will appreciate his balanced presentation of a much-discussed area of ministerial service. Here are set forth vital principles that will challenge the reader. It is an article that might well be studied. The tendency for some to set up counseling bureaus in their churches has doubtless prompted many of our readers to write us asking what is the general impression o£ such new tech­niques. While every case naturally would have to be considered on its merits, yet we must all recognize that a minister has a vital responsibility, larger even than the psychiatrist or psychologist, but he is able to make a stronger ministerial contribution if he understands the human mind and the principle techniques that have proved helpful. We are not called to ape the psychiatrist but rather to recognize the particular role that we have as ambassadors of Christ.—Editors.---

FOR centuries before professional psychology and psychiatry became disciplines in their own right, Christian pastors were counseling. Jesus himself dealt with anxiety, hysteria, de­pression, and guilt long before there were any "psychiatric" explanations. In fact, the very word "psychiatrist" comes from the Greek iatros tes psuches, which originally meant "the curer of souls."

The indifference of scientific medical psychol­ogy to things of religion, and the indifference of the religious physicians of the soul to skills and techniques of psychiatry, is not only a sad commentary on the training and motivation of both, but it often leaves the person in whom both are interested inadequately treated.

Fortunately, the climate of suspicion and at­tack has been modified in the last 20 years. Pastors and psychiatrists are learning to share the responsibility for the patient-parishioner. The ethical responsibilities and religious re­sources of the pastor, as well as the scientific research and psychological skills of psychiatry, are being molded together in pastoral care to serve the whole person.

As often happens when the pendulum swings, it travels far in the opposite direction. For some, the popularity of pastoral counseling has almost amounted to a fad. This constitutes a danger, because fads have their brief day and then fade away. For many pastors, however, the increased interest means a genuine deepening of insights into human behavior and an in­crease in their skills in helping persons in trouble.

While many books and journals skillfully dis­cuss this well-established discipline, few have examined thoroughly the hazards of a counsel­ing minister getting into situations requiring more skill than his training affords. Of course, the pastor deals with human material just as deep as any with which the professional psy­chotherapist deals. Religious motivation, con­version, ethical actions, and decisions—all come from the most complex of human character structure and dynamics. But, in counseling, the pastor handles the material on a different level and in a different relationship.

The pastor must have sensitivity first to the parishioner's need and then to his strength. In any counseling relationship, he quickly finds an empathic closeness with the counselee if his own maturity and professional interest permit. If he is alert, he quickly makes several clinical observations, just as the psychotherapist does in beginning therapy.

While not particularly trained to make a psychological diagnosis, the pastor must for­mulate certain opinions concerning who the person is, what he wants (both consciously and unconsciously), how he intends to achieve the goal he has set, and how he sees the pastor's part in that process of achieving.

At this point the pastor makes an estimate of the counselee's inner strength, or "ego strength" as the psychologist would call it. This "ego" is the term given to the partially conscious, learned personality center that attempts to use instinctive-biological desires (Id) and the per­son's learned conscience (Super-Ego) in accord­ance with the internal and environmental reality.

When the ego is relatively mature and strong, the person can handle both his internal needs and the external reality with some ease, and he can adjust to both. Here it is the pastor's job to permit this strength to assert itself and share in the person's learning how to handle the problem.

When, however, the ego is weak or immature, either the internal instinctive drives dominate (psychosis) or the superego dominates (psychoneurosis). While this is oversimplified, it suggests that the pastor can help best when the ego is relatively strong and the problems are somewhat real; but the psychotherapist is needed when the ego is weak.

This is where the pastor needs clinical ex­perience, under supervision, to develop this skill—if he is to do much counseling. Many pastors develop a psychological sensitivity in years of pastoral work, although they may call it simply "experience in working with people." We must always remember, too, that people get considerable help from pastors who are understanding and warm, though they have little formal training in counseling.

At this point, the pastor can help most if he knows something about the symptoms and dy­namics of abnormal psychology. For he may often be the key person in getting help for a parishioner at a time when treatment can be most effective. While this does not happen every day, it would be a shattering experience for the pastor to miss a developing psychosis in a parish­ioner.

It is here that close co-operation with a clin­ical psychologist or a psychiatrist is invaluable to the pastor. Personal friendships, consulta­tions, workshops, and seminars all provide op­portunities for the pastor to discuss either a specific problem or kinds of personal adjust­ments, with psychiatric personnel, and often it is to the mutual welfare of both.

Even if an overly weak or immature ego with symptoms of mental illness requires a re­ferral, our people need the continued atten­tion and help of their pastor. Referral must never mean the rejection of the sick one, only that responsibility for treatment has passed to the psychotherapist. The pastor is still the pastor for the needy one.

An area in which the naive pastor sometimes gets "too deeply involved" with a counselee is that called "transference." The phenomenon of transference appears when feelings and attitudes are transferred toward the pastor (or therapist) which were originally felt toward a parent or others early in life.

To some degree, to be sure, the pastor finds transference from his congregation and his com­munity under the most normal circumstances. Many persons transfer to him the dependence or hostility felt earlier toward imperfect fathers.

Others need the "motherly" care of the pastor, as they did with earlier motherly figures. Trans­ference is a useful tool in bringing to light childhood experiences, and the pastor may well use it for religious and moral ends, when he recognizes it and can successfully transfer those feelings to God with a mature acceptance of the deepest of all human relationships. But this requires skill.

Remember that the people would have wor­shiped Paul at Malta. And, after healing the cripple at the temple, Peter and John had to redirect the respect of the people toward God.

Then, too, transference cuts both ways. The pastor may find that certain kinds of people or experiences let loose counter-transference in himself, as when he feels furious, afraid, inferior, or hostile.

Pastor to Watch for Seven Symptoms

More specifically, there are at least seven symptoms or syndrome complexes the pastor may watch for: (1) severe and long-continued depressions, (2) extreme suspiciousness persist­ing over a long time, (3) delusions or hallu­cinations (hearing or seeing things which aren't there), (4) inability to make and keep a decision and overdependence upon the pastor, (5) threats of suicide, which sometimes lead to just that, (6) very strong and irrational hos­tility toward others, groups, or self, (7) physical symptoms (vague pains, fever and chills, dizzi­ness, asthma, severe skin eruptions, and so on) which may indicate to a physician a physical condition with emotions secondary.

Another danger point lies in the pastor's mis­use of confidentiality. Case material used for illustration should never come from the pas­tor's own counseling experience, unless it is used carefully for teaching purposes—and then only with permission of the counselee. No one but a charlatan would betray, for public curiosity, the personal experiences of a seeking person. The pastor must be as ethical as the clinical psychologist or the psychiatrist. He must find his satisfaction in helping persons, not in brag­ging about it publicly afterward.

In sex education with adolescents and in pre­marital counseling, the pastor needs to deal with the spiritual and ethical relationships. He is dealing with motivation and affection among loving persons, not thinly disguised opportun­ities to explore erotic material. It is easy to get in too deeply here even with the best of in­tentions.

When the pastor lets counseling take a dis­proportionate amount of his time, he is be­coming too involved. Seward Hiltner suggests that 8 to 12 hours a week is enough, without neglect of other pastoral duties, and that pas­toral counseling seldom ought to exceed four to six interviews with one counselee. If the pastor wants to specialize in counseling, he ought to seek specialized training and an as­signment that gives him time for this specialty. Or if he wishes to be a clinical psychologist or a psychiatrist, he will need to take the required training.

Seldom will a pastor get in too deeply if he keeps in mind these five things:

1.  One cannot give away what he does not have. The pastor's counseling ability is limited by his own personal maturity and his human understanding. He must be able to handle his own anxiety and anger, make his own adjust­ment to his family, dedicate himself in service to his God, before he tries to help others.

2.  His personal Christian experience must be strong and well-rounded. Because of his own stainless purity, Jesus could travel in the coun­tryside in a morally mixed company, without a breath of scandal. Through the depth of his personal consecration and continuing spiritual growth, the pastor can build an inner strength that will keep him stable even though he works with the maladjusted.

3.  Jesus always "treated" persons as person­alities, never as "cases." So, the pastor can de­velop an ethical sense of confidentiality cover­ing the information he protects. And he, too, deals with human needs, keeping his psycho­logical understanding behind the scenes as an aid, not as dressing in a show-window.

4.  The pastor will be able to use his under­standing of the dynamics of human relationships best if he keeps clearly before him his major task—that of being a good minister of Jesus Christ. Then, the temptation to use "psychol­ogizing" rather than the Christian pastoral re­lationship will diminish.

5. The pastor can develop a reasonable re­spect for the professional clinical psychologist and the psychiatrist, being neither afraid of them nor fawning upon them. He remembers that being a pastor does not teach him to do psycho­therapy (except in the broadest sense) any more than being a pastor makes him a skilled surgeon.

The pastor will do well to remember that he need not be Jungian, or Freudian, or Rogerian, important as schools of psychology are. For he is a pastor of Jesus Christ, crippled neither by an obsessive interest in nor a reaction against counseling with people.

Undoubtedly the pastor's greatest opportunity in counseling is, as Carroll Wise well says in Pastoral Counseling (Harper & Bros., $2.75), "in the normal crises of life where he has a natural relationship," and is identified centrally in "the relationship that the pastor creates with his people."

When he develops a counseling relationship with a person who has emotional problems, the pastor needs to remind himself that he is always a Christian pastor, dealing with spiritual resources or conflicts, even when he is aware of and using skills developed by specialists in treating mental illness.

The pastor has tools and resources that the clinical psychologist lacks. He has strength for meeting the deepest need in man, and for building the finest in character structure (Chris­tian sainthood) that the psychiatrist cannot match. He has, above all, the Christian com­munity in which to involve the whole person.

No one else can say as clearly or demonstrate so forcefully the supreme truth that Love never ends (1 Cor. 13:8). There is never a need for the pastor to feel inferior or left out in the treatment of people—nor to be diverted from his primary opportunity by trying to play the psychologist.