Risks of Confusing Religious Guidance with Psychotherapy

Psychotherapy is often shunned by religious people in favor of pastoral advising. They may see ministers as more relevant to their spirit or see therapy as a sign of sickness while pastoral input as a sign of health. They may fear showing vulnerability outside of their community or be xenophobic towards individuals with different personal beliefs, and so miss out on the goodness that therapy brings.

Pastors and religious elders have a wealth of life experience and are usually well-intentioned, but in a specialized society, they fall far below the counseling standards of experience and expertise obtained by psychotherapists. While religious leaders study Hebrew, evangelism, and theology, psychotherapy requires significant education in psychology and treatment with years of supervised training. While qualified to advise on religious matters or provide one or two interventional sessions, pastors and elders are not qualified to counsel individuals needing mental health or relationship support. Let's examine the reasons.

Interior de Iglesia. La Confesión, Raimundo de Madrazo y Garreta

Differences Between Ministers & Therapists

Qualifications

One of the primary reasons pastors and elders should not be visited for psychotherapy or marriage therapy is their lack of formal training. Psychotherapy and marriage therapy are complex disciplines that require a deep understanding of human psychology, emotions, and behavior, as well as specific techniques and approaches for addressing mental health and relationship issues. Licensure requires approximately 2500 hours of psychology classes and 3000 hours of individual therapy support. A good portion of this work is also focused on helping the psychotherapist remove biases and projections which may impede client development.

In contrast, most pastors receive just one masters-level course (40 hours) on counseling and elders receive none, so they do not have the knowledge or skills necessary to provide effective treatment of issues such as depression, anxiety, and compulsive behavior, and many times cannot effectively address guilt, shame, fear, or hidden thoughts. Priests absolve their patrons of sins which may provide cathartic relief, but does not remove the anxiety of sin, change behavior, or address damage from the behaviors themselves. Oftentimes, heuristics, aphorisms, or proverbs drawn from personal experience and religious knowledge can be helpful or soothing to struggling people; one or two meetings to discuss the loss of a loved one and thoughts about the afterlife can be encouraging and assuage grief, especially when the leader is trusted. Pastors and elders can also model healthy psychology, recapitulate negative parental projections, or consult on spiritual matters. However, they are not equipped to manage that transference, facilitate behavior change, or support modification of existential beliefs causing their patron suffering.

Bias

While therapists train to remove their biases, pastors and elders are encouraged to bring personal biases and values into the counseling setting. This can interfere with their ability to provide objective support. Pastors, in particular, have strong religious beliefs typically intermingled with cultural beliefs that may influence their approach to counseling and are often unable to separate their personal beliefs from the needs of their clients. This can be useful if one is seeking to become a pathological follower, but psychology (and most religions) holds that the development of the individual (and not deference to leader opinions) is important to mental health success.

This unmitigated bias can damage people’s lives. I often hear that individuals were counseled to give up significant college scholarships, educations, or jobs because a religious leader asserted God was calling the individual to reject their vain arrogance and serve the Lord. This is a classic moment of a leader projecting onto a vulnerable follower, causing them to introject (take to heart) the minister’s beliefs and serve the minister’s talents or values. Although this life surrender worked for the religious leader, it often fails other individuals. Instead, they lose connection to their strengths, sense of self, and ability to strive to do their best. They eventually fall into despair and self-loathing, drinking to excess and becoming violent with resentment towards life or becoming isolated with no life outside the church. In contrast, a psychotherapist can help these people negotiate their ego while honoring their spirituality, allowing them to use their gifts and have self-respect, success, and spiritual humility – without sacrificing their talents, future, or soul.

Elders are even less likely to understand or empathize with the unique challenges that different people or couples may face. I knew of an elderly couple that learned the wife would lash out in anger when her husband stayed late at his prestigious college position. They related this in counseling to a younger married couple by saying that "Your partner is hitting you because you are not loving them well enough.” While we all want to believe in the power of perfect love that can transform people, this advice was used by the female partner to justify female-on-male intimate partner violence and abuse with blame. The husband eventually suffered a catastrophic emotional collapse.

A psychotherapeutic intervention was desperately needed to help the couple recognize the abuse and act accordingly. Many practices, such as the Gottman program, differentiate between character-based violence and the heat of the moment. They often refuse to offer couples therapy if one of the partners is habitually violent and recommend divorce. If they do offer counseling support, they may require separation and the violent partner acknowledges sole responsibility while enrolling in individual anger-management therapy as well as a support group. The elder and his wife ended up doing more harm than good.

Knowledge

This story of bias brings up another issue with viewing ministers as counselors – they rarely have the specific knowledge needed to address the mental health or relationship issues that clients face. Personal experience does not provide effective treatment for problems based on unfamiliar circumstances. They also cannot adequately support clients in their journey towards healing and growth due to the demands of their professions and community intermingling (dual relationships).

Psychotherapy and marriage therapy involves working with a wide range of issues. Individuals in family, community, and religious systems tend to suppress thoughts and emotions to align with the orthodox position accepted by the group. This causes issues such as trauma, addiction, abuse, and communication problems to remain unresolved or addressed. It also produces lingering anxiety or depression. Religion can be useful for emotional stability but when the repressed thoughts and feelings become too great, “surrender” or “letting go and letting God” or “keep trusting and praying” fall short of resolving internal conflicts. Failing to address these problems can even produce personality disorders in the long term.

Therapy Can be Risky

Pastors and elders should be advised to refer rather than counsel for more than a session or two. This is to protect the minister and client on several fronts. Attempting to counsel people on issues they are unqualified to support can take up a significant amount of pastoral time, especially because the individuals most likely to seek support from pastors and elders are those with severe mental health challenges. These individuals are also often seeking to recover something lost in childhood, heal a trauma, replace a parent, or save a marriage, problems that try to draw in and conquer counselors with recurrent patterns of hopelessness or recalcitrance. Our traumas most want companionship, not resolution. Fear wants to be proved right. These individuals can often become physically or socially aggressive when nearing the edge of change, jeopardizing the community's stability. This often results in church divisions and leaders leaving.

Proper Roles

There is a proper role for elders and religious leaders in psychology and mental health beyond Sunday teaching, and that is to provide consultation focused on spiritual development or personal perspectives, followed by an educated referral out into the community. Ideally, this will be across communities and not within the same community, as seeing one’s therapist at church events can be unsettling for some or pose boundary problems for the therapist. It is useful to know what someone with degrees in theology thinks about religion and God; it is useful to know how individuals who have been married for years have negotiated their marriage; it can even be helpful to learn how to negotiate with a spouse, or how to pursue personal religious development. These things pertain to mental health, but they differ significantly from counseling, psychotherapy, healing, behavior change, or even spiritually relevant existential therapy. An educated referral is essential.

In conclusion, while pastors and elders may have a wealth of life experience and be well-intentioned, they are not qualified to provide psychotherapy or marriage therapy to individuals in need of mental health or relationship support, even under the guise of counseling. It is important for them to refer quickly, authoritatively, and often. It is important for individuals seeking this support to seek out qualified professionals who have the necessary education, training, and experience to provide effective treatment. Their pastors and elders can still support them, but as teachers or consultants, and not as counselors.