Thomsen: What is the pastor's role in the mental health profession?
Hart: The pastor is the general practitioner of the counseling field. Study has shown that 42 percent of persons in emotional difficulty will first see a minister. Only 18 percent will go directly to a clinical psychologist, psychiatrist, or other mental health professional. The pastor is able and adequate to deal with 80 percent of the counseling needs of an average group of people.
Thomsen: Are pastors, on the whole, good counselors?
Hart: Generally speaking, pastors don't make good counselors unless they are trained. The pastor/preacher role is one of declaration, of proclamation, declaring the truths of God, and confronting the human condition in a rather raw manner. That style, which is somewhat authoritarian, is not compatible with the role of counselor. When people sit in the pew, they want to know the truth. When they sit in the counseling room, they want to be understood. There is a very important difference. If you were to ask me what it takes to be a good counselor, I would say the ability to communicate to people that you understand them. Nothing is more important for a good counselor.
Thomsen: How would you define good counseling?
Hart: First of all, good counseling is not preaching. By preaching, I mean talking too much and holding forth a position dogmatically. That is not necessarily helpful to the client. Second, good counseling is not advice-giving. I make it a rule never to give advice until I feel I understand the client and the client understands that I understand him.
Good counseling requires that you be absolutely authentic. Good counseling is not simply confession, although much of what I see, especially with Christian counseling and ministry, is in a sense confession. People want to display who they are and receive affirmation that they are OK.
Good counseling is an invitation for people to explore themselves, to explore new ways of thinking and being and understanding the self. The most important way we have for understanding the self is through the exploration of feelings.
Thomsen: Are there particular obstacles that pastors who counsel need to overcome?
Hart: Yes, there are many hazards. Something in the shaping of pastors gives them the idea that they are God's representatives. If they don't work a miracle--if they don't effect a cure--they feel they've failed. That's a tragedy, because much burnout results from this.
Another hazard is that the pastor has typically not resolved his or her own sexual-adjustment issues. Because counseling often involves individuals of the opposite sex, it can be very hazardous.
Thomsen: What about guilt? Do pastors convey more guilt to people than other counselors, simply because of their role as moral leaders?
Hart: Every time you as a pastor visit people, you leave them feeling guilty. You remind them of their failures. Your role as pastor always calls them to the highest and always leaves them feeling a little less than the highest. When you counsel with someone, the same guilt induction takes place. It is difficult for people to be honest with you. There are limits to what someone is going to share with you.
Pastors consciously or unconsciously encourage a whole complex assortment of transferences that can get in the way in counseling situations. They represent God for the counselee. Many people's consciousness of God is confused by an image of their father. And people often project onto their pastor unresolved guilt feelings, unresolved fears, unfulfilled expectations, demands, feelings about their own parents, and fears about God. Pastors are unique scapegoats. They can attract many transferences from neurotic people. When they counsel, a lot of irrational stuff may intervene between them and their counselees.
Thomsen: What do you consider to be the most essential skill for pastors who counsel?
Hart: The most basic skill of all is the ability to listen and to reflect what you hear in a way that helps the counselee come to understand what it is he or she is feeling.
Thomsen: What about the so-called therapeutic triad?
Hart: Carl Rogers has identified and articulated, perhaps better than any other theoretician, the essential qualities of a good human interaction. These are the ability to give unconditional acceptance; the ability to be congruent--that is, genuine; and the ability to respond with empathy. Pastors must understand the crucial difference between empathy and sympathy. Most laypeople think sympathy is what helps people, when in fact sympathy only destroys the helper and doesn't really help the helpee.
Thomsen: How do you develop those skills as a pastoral counselor?
Hart: It requires supervision--another person who can monitor and listen and then reflect back to you what you are doing.
Thomsen: Do you recommend that a pastor occasionally tape a session, with the permission of a counselee, for such feed back?
Hart: I think we have a serious problem with pastors and supervision. More experienced pastors could make themselves available to younger pastors. I also think that churches should engage professional consultants. Personally, I'd love it if I had a group of four or five pastors for group supervision on a regular basis.
Thomsen: What do you consider to be adequate training for a pastor who counsels?
Hart: I'm not suggesting a Ph.D. in clinical psychology, but I think there should be some understanding of the nature of psychopathology. The pastor who counsels should recognize psychoses, personality disorders, organic problems, and so on. Otherwise he or she is like a surgeon who doesn't know anatomy.
Thomsen: Should pastoral counseling be limited to spiritual problems?
Hart: No. I think a pastor who is appropriately trained can counsel people with all sorts of problems. Christian counselors, psychologists, and pastors constantly have to focus on the whole person. I think the real work of developing people and encouraging spiritual growth and maturity comes as naturally out of the counseling room as out of the pulp it.
Thomsen: Should pastoral counseling be limited to short-term counseling and crisis intervention?
Hart: Generally, I believe pastors should stay with short-term counseling four or five weeks at the longest. My reason for saying this is that the average pastor has too many people to care for. I think it's far better to be available to a lot of people for short-term problems than to restrict yourself to the limited number of people you can see on a long-term basis.
Thomsen: Some pastors do choose to see people on a long-term basis. Is that OK?
Hart: I think a couple of long-term cases are in order. Long-term counseling is completely different from short-term counseling. In longer-term counseling we have to overcome defense mechanisms and develop enough trust that the person will feel safe enough to drop his defenses. That takes a long time.
Thomsen: How can a pastor decide whom he is competent to counsel?
Hart: I think the most important thing a counselor can know is when to make a referral. There is a hierarchy of questions that every pastor, therapist, and counselor needs to ask. The first question is always "Is the problem organic?" If it is, obviously you've got to have the organic problem fixed before you can do counseling. Many biological disorders mask or present superficially as disturbed emotions and troubled feelings.
Next ask, "Is this a psychotic disorder?" I've known many pastors who got caught up in weeks and months of counseling with somebody who was obviously psychotic. If you're into demon possession it's easy to interpret psychotic behavior as demonic and then see it as a spiritual problem, whereas in fact there should be some treatment. What we refer to as psychic phenomena--hearing voices that are interpreted in some spiritual way--could be symptoms of some severe organic or psychotic disorder.
Then ask, "Is this a personality disorder?" Problems of this sort are not amenable to counseling or therapy either. I'm referring to angry personality, people with no conscience, and that sort of thing.
The next-lower level of the hierarchy includes the general run-of-the-mill neurotic disorders. The more classical neurotic disorders are a professional's job.
Last, there is the level of adjustment disorders. Here we find basically normal people who are having trouble living they're experiencing conflicts with neighbors, friends, or family, employment difficulties, and so forth. The whole range of adjustment disorders is an appropriate area for pastor counseling. There are clear limits and boundaries, and the pastoral counselor must understand them.
Thomsen: At what point should pastors say, "This problem is beyond my ability to help"?
Hart: A lot sooner than most of them do. Clearly, in the case of psychotic or organic disorders, pastors are out of their depth. In personality disorders it depends on severity. With the neurotic disorders, it depends on the intensity of the neurosis. The best guideline is: If in doubt, call for a consultation.
Thomsen: Are there any kinds of danger signals that a pastor can watch for in the course of counseling? Signs that would help him or her realize that a problem may be too deep?
Hart: Some psychotic disorders may not reveal themselves in the first session or two. Paranoid disorders, for example, can be highly specific and focused. Once I saw a client for six weeks before the obvious paranoia finally came out. This person kept complaining about discomfort in his stomach. Finally he got up enough courage to tell me that he was pregnant and that he'd been pregnant for two years. Every other aspect of his life was normal. You've got to be on guard for that. You are receiving another danger signal if the counselee is not getting better. You should also regard any poor rapport that you may feel with somebody as a signal.
Thomsen: You mentioned transference as another barrier to effective counseling. How can a pastor recognize that transference or countertransference an attraction of the counselor to the counselee is going on?
Hart: In my opinion, at the root of transference and countertransference is the phenomenon of idealization an exaggerated attachment to or interpretation or valuing of the other.
Thomsen: Where does that come from?
Hart: Pastors are particularly vulnerable because people stereotype them. Parishioners easily idealize them. Transference evidences itself in a number of ways undue affection, undue attachment, undue clinging. It can also take the form of a negative reaction unreasonable hostility, inappropriate or exaggerated anger.
Thomsen: Is it dangerous for a pastor to keep counseling with someone who has a transference problem toward him? Hart: It can be dangerous. That person could be a high suicide risk at a later date. The longer you let it go, the more invested the counselee will be in that relationship. You get into deep water. Unless you're willing to go through it and come out the other side, don't go into deep water. You also run the risk of lots of personal rejection. You have to ask, "Is this in the best interest of the client?" It isn't always.
Thomsen: If the pastor says Yes, he has to be prepared to deal with the needs that are causing the transference in the first place?
Hart: Yes. It's a long-term thing; and, frustratingly, understanding it doesn't reduce the transference.
Thomsen: What does?
Hart: The eventual working through and resolving of those needs.
Thomsen: How can a pastor refer a person with a transference problem so that the counselee does not feel abandoned?
Hart: You must do it very early in the counseling process. You need to do your homework ahead of time so you have another therapist's agreement to take the counselee. Then you present the person a package that is hard to refuse.
Thomsen: Is countertransference common?
Hart: Very common. We have a set of idealized images from our past, and suddenly, there is another person who matches them. He or she is the lock that the key opens, and the counselor is in trouble.
Thomsen: So the pastor has to be attuned to his own issues.
Hart: And that means that the pastor needs to have resolved a lot of his own sexual needs. Certain denominations are much more repressive and create a much more obsessional sexuality than others. People with an obsessional sexuality are more prone to sexual transference than others.
Thomsen: How can a spouse help a pastor deal with countertransference?
Hart: A minister and his or her spouse should set up a system of accountability as early as possible in their marriage. The couple needs to understand that countertransference is a very common problem. First, they should both become comfortable in talking in generalities about how easy it is to be attracted to someone else. Then they can begin to talk about experiences from the past, and finally current experiences. The level of transparency has to be a graded one. You reach a point of balance, a level of transparency beyond which you can't move without devastating the other. In the ideal marriage people should be able to be totally transparent. Those who work at it consistently over the years can accomplish a high degree of transparency.
Thomsen: What are the pastor's legal responsibilities when a person presents a problem of incest or other child abuse?
Hart: In many States everyone must report child abuse, even if it's divulged during pastor-parishioner counseling. This puts the pastor in an awful role conflict. How do you continue to be a pastor to someone you've just reported? It's far better for a pastor, if there appears to be some problem in this respect, to refer the case to someone else and have that person do the reporting so that the pastor can maintain a degree of neutrality and provide a degree of support.
Thomsen: You're saying the pastor should refer the person to another counselor before he knows for sure about child abuse?
Hart: Before the pastor knows for sure, yes. If the counselee says, "I have something very serious I need to tell you," the pastor should say, "Now, stop. Let's wait a minute. You understand that my privilege of holding our communication confidential ends if I learn that you're going to harm someone else or that you have committed a crime. Are you sure you want to continue to share this with me?"
Thomsen: Where must child abuse be reported?
Hart: The pastor can report it to the police department or to the Department of Social Services. Pastors have to understand that if it can be demonstrated that they knew of child abuse, or knew that a counselee was a danger to himself or to others, and they did not report it, they would be in serious trouble. They could be sued. It could even be a criminal offense.
Thomsen: Are there other legal liabilities for pastors who counsel?
Hart: They must maintain confidentiality or they could be sued. Only the counselee can determine to whom information can be divulged. Even the fact that a person is coming for counseling is privileged information.
Thomsen: That puts a burden of responsibility also on pastors' wives and church secretaries who may know the names of those seeking counseling.
Hart: Yes. They need to be instructed on how to handle this information. And it's not only the protection of confidentiality that is at stake, but also the altering of attitudes toward parishioners. The spouse needs to be protected, so as to be able to continue to relate freely and openly to people without having to carry the burden of knowing things only the counselor should know.
Thomsen: Do pastors who counsel need to experience therapy themselves?
Hart: All counselors who do counseling seriously should have had a period of therapy, primarily to develop some understanding of their own functioning and what their defense mechanisms are. I'm not suggesting that every pastor has to be in therapy before he or she can counsel, but it certainly helps. The more difficulties you have in counseling, the more likely you are to have a need for therapy. As a general rule, whenever possible, get some therapy yourself not necessarily because you have problems, but to develop a greater self-understanding.
