The Hand-Off: When Pastors Should Refer

Not long ago, I gave a talk to a pastoral graduate class on when pastors should refer a member of their church to counseling through a licensed therapist. The process can sometimes seem like a crap-shoot in that it can be difficult to know who is out there and who to trust. But in discussing this issue with different pastors I found that, it’s not only difficult to know who to trust, it’s also a decision that involves more than just choosing a therapist “somewhere out there”, it involves three people: the pastor to be sure, the individual being referred, and the therapist to be trusted. Each party in the situation has individual considerations that must be looked after and weighed. In this way, we can go about making an informed, healthy, and competent choice for those we care for.

The Pastor:

For the individual pastor, taking on the role of shepherding a congregation is no doubt a profound and weighty task. There are those who will expect their leaders to have all the answers and equipment to tackle needs great and small. This can be both beneficial and detrimental to those leading the helm: Beneficial in having the trust of those they lead but also detrimental to the time, resources, and expertise one has. Pastors of large churches may have layers of staff to field a variety of issues, but the small to medium church pastor has only so much of himself to go around. This leads me to one of the more telling areas of my practice: that our gifts can also be our weaknesses. All of us have a variety of gifts that, if not continually connected to the giver (that is Christ) will ultimately drain and destroy us. The following are a few of the considerations pastors must make when referring out:

Boundaries: Pastors (and teachers, nurses and therapists!) have a true desire to help and be there for others (a gift); however, this desire can also lead to exhaustion when they are unable (or don’t know when) to say “no”. Oftentimes, drawing a boundary can feel like not caring or not doing all they should to serve the need. As such, pastors must be able to say, “Although I care deeply about what is going on, I have no time during this season of my life to focus on this”. I have heard many heartbreaking stories of pastors taking care of the flock only to neglect their own, and their families, health and time.

Ego and Identity: As pastors have a desire to help, they can also run into the idea that they are equipped to help in every situation. The gift in this area is that, in order to lead a group of people, (sometimes with very different views and attitudes) they must have certain confidence and conviction in their ability to do so. This can then become clouded in a “God must mean for me to take care of everything” type of mindset, which can further carry over to, “If I can’t do this it must mean I am incompetent or a failure”. This struggle with wanting to be seen as able and confident can either lead to an iron thick skin (in which case it will be difficult to consider other’s views) or continual questions and doubts about one’s ability; either way, this may not be good for those needing counsel. Part of an identity rooted in the One who saves involves realizing: “He is the Savior, I am not” which means being healthy enough not to take it personally when it is time to hand off.

Personal History: Each of us bring our personal history into a counseling session; therefore, having a variety of resources to refer out becomes vitally important for the health of the individual and pastor. Examples may include: the counseling of an abuse victim bringing up the pastors past abuse history; counseling women when the pastor is struggling with loneliness and/or pornography; counseling couples when the pastor and his wife are struggling in their marriage; and counseling anyone when doubt, depression and anger are constantly encroaching on the pastor’s own door. As a therapist of pastor’s, I can tell you this stuff happens all the time! But take heart, with a good therapist this can also be a stage of great growth and victory. And when it comes to personal stuff, pastors definitely need counseling themselves—just as therapists do!

Ideas and Philosophies About Counseling: In years past, there has been a great animosity between that of psychology and Christianity, and for good reason, many in the psychology and counseling field attempt to negate the God of the Bible. In more recent years; however, it has become clear, even in secular psychology, that (once again) the truths of God’s Word bring healing. As a professor of psychology at a Christian University I often ask students where God is in a secular textbook on psychology; to which I assure them that “He is everywhere”. Just as he makes His glory known through creation (Romans 1:20) and general revelation, He further shows Himself in our very behavior—which the study of psychology focuses on—not un-similar to the American astronaut who shared that he saw God, “everywhere” when in space. All this to say: yes, there are Bible believing counselors in the field that hold His Word as infallible, His power inexhaustible, and His love un-measurable.

Another aspect in the ideas and philosophies column centers on being equipped as pastors by knowledge of God’s Word alone (the Bible). The question is: “Does understanding and knowledge of The Word of God enable pastors to take on the many aspects of counseling?” Many use II Timothy 3:16—17, “16All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness, 17that the man of God may be complete, equipped for every good work.” I would submit that, although this verse in Timothy is absolutely true, there are aspects to its application that a good therapist will be better equipped to handle. There are also intricacies and layers to this verse and how it can most effectively be worked to people’s individual situation. I have seen many damaged and hurt individuals who went to their pastor and were told they didn’t have enough faith, have not prayed hard enough, or do not understand His Word enough which is why they were still suffering. Such an attitude tends to be less about the individual coming to see the pastor and more about the pastor and how he deals with individuals.

Vocation: Finally, as far as it relates to pastors, the aspect of vocation cannot be overlooked. Pastors have a church to run, people to visit, facilities to look after and sermons to prepare. As such, counseling can be one aspect of what they do (or have time to do). With a therapist, helping individuals, couples, and families work through their issues is all we do—it is what we study, ponder, connect the dots on, and teach. For me personally, a week consists of anywhere from 28 to 35 hours of therapy—with another five or so hours of instruction and preparation; consequently, I encounter many similarities, relate certain patterns, and apply curriculum to, what is going on in each person’s struggle. To be sure, there are many bright and insightful pastors out there who do excellent counseling work, but by vocation, counselors will tend to see a wider range of issues and have access to the resources needed to meet the need.

The Individual: 

For individuals involved in the counseling process, issues surrounding family background, coping style, level of need, and willingness to change all come into play when handling referrals. As shared in the supplemental hand out, “Pastors Referring to Clinicians: Questions” the pastor should weigh how much time this person will need and how much time they are willing (or able) to devote to them. The following include other aspects:

Boundaries: Just as pastors must take special care of their boundaries, those seeking counseling also have boundary needs. (See the excellent book “Boundaries” by Henry Cloud and John Townsend) Families with low boundaries tend to be reactive and expect others to take care of their emotional well-being; conversely, walled-off families tend to be uncomfortable with emotional display and will run or shy away from feelings. These patterns then translate to how the individual deals socially and can have implications on their church/pastor relationships. For regular church attenders the question can be: Will they be able to accept that there is a time of counseling wholly separate from time in church? Many have difficulty recognizing the lines; as such, conversations after a Sunday sermon can quickly turn into a vortex of personal and relational neediness. In this the pastor may find it best to simply ask: “Have you sought professional counseling?” and if you know they have then,“What does your counselor say?” This can create a healthy third-party relationship in where the pastor can affirm and model healthy boundaries to the individual while at the same time displaying concern and interest in the process; also, it separates the pastor enough to not be seen as the “enemy” when hard truths hit tender nerves. If both the pastor and the counselor confirm what is being said to the individual, they may be more accepting of change. Finally, if the pastor is relationally close to the individual then they may need to refer in order to separate the friend/counselor boundary. This can be extremely valuable when the waters get dicey in the upheaval of emotions.

Triage: On the emotional level, triage refers to what is practical vs. what is institutional. When touching on peoples emotional and relational issues, the practical tends to be an area that just needs an outside party to provide insight. In the mix of stress, emotions, and misunderstandings, it can be hard to see that we may need adjustments on a practical level. This can include easing off of work, adding exercise, or sitting down 15 minutes a day with our spouse. In this case, a competent pastoral counselor can point out that we need to slow down, relax by letting go, or take a vacation. These practical steps can work wonders for people’s stress levels and coping—allowing them to see that backing off really does feel great!

When we look at the institutional aspects of the individual counseling, we are talking about deep seeded, familial, historical issues that can be deeply entrenched. Such areas include sexual abuse, domestic violence, psychosis, severe depression, anxiety, and suicide—just to name a few. When navigating these waters, the counselor must demonstrate Gods truth in very sensitive and delicate ways. On the face of it, given whatever unhealthy background we have come from, we cannot begin to see what must be done different; as such, any correction can be interpreted as an attack on the help seeker. This part of resistance is not necessarily a rejection of direction as much as it is a continued fear within the heart of the individual. In these cases, it is imperative that a counselor unpacks such fear in order to get into the institutional holds and patterns of dysfunction practiced by the sufferer.

Resistance: The final area for individuals involves their desire and willingness to seek help and change. Many of us say we want to change but we don’t want it to cost us anything or are afraid of the discomfort of doing something different—which holds true for individuals and couples. Pastors can run into trouble when trying to help those who continue to be stopped by their own hidden barriers or unwillingness. This can cause hurt, confusion, disappointment, and resentment—from the individual and the pastor. In these cases, the pastor must ask a few more questions about whether or not those seeking help just want to be heard, want others (or the situation) to change, or are willing to do what it takes. This can include how much people are willing to buy in to the process; not infrequently, individuals will gladly accept free (pastoral) help and then dismiss what they are told outright—as it costs them nothing. This is why I encourage pastors who refer to me not have the church bear all the costs of therapy. This may include having clients pay a percentage of the hourly cost—or, at least, give of their time to help contribute. With no buy in people may not buy in.

The Therapist:

The final relationship in the referral process is with the therapist. Therapists, just like everyone, come in all shapes, sizes, temperaments, and personalities. Finding a person that is comfortable to work with will go a long way in helping church members. It would be great if we had all the time in the world to pick someone’s brain to find out where their philosophies lie, but we don’t. It may help to narrow down a few key areas that will help pastors make an informed decision:

Beliefs: Core to the pastor/therapist relationship is whether or not they believe and understand the Gospel of Christ. It seems like a simple question but we all know that the term “Christian” can be both cultural and relational. To me, a cultural Christian can be defined by the outward cultural displays of Christianity—gathering for the sabbath, reading of the Word, prayer, and even a little service. These areas are vital but may not provide the depth of the relationship. A relational Christian then goes below the visible practices of faith by understanding on a deep level that they are sinful from birth (prone to use the gifts God has given them for their own purposes—and destruction) and as such are separate from God; that Jesus Christ (Son of God) came down from the right hand of the Father to walk among us and give Himself up as a sacrifice for our sins; that by accepting Christ’s sacrifice and believing in the power of His name we are saved from ourselves, reconciled to God, and sealed with the Holy Spirit who works deep in our inmost being to move us further in closeness to Him which brings sanctification.  It is only after this is grasped that the acts of going to worship, prayer and meditation, and the reading of His word can be fully appreciated. In this it is important for therapists to ply their trade in accordance with the Gospel—first embracing that they themselves need a savior. This means having a full understanding that, without someone greater than us to save us from ourselves, all the empathy, technique, and experience a therapist can offer will go flat.

Boundaries: Much like pastors and the individuals we treat, a therapist must practice healthy boundaries. Just like pastors, therapists are in the helping trade; as such, it can be difficult to know when to say, “yes” and when to say, “no”. An example can include calls we get from clients to have a “five-minute question” only to lead to a side session. Though it may be tough, it is important to keep the counseling relationship friendly but professional; after all, the ultimate goal of a therapist is to help the client become their own therapist, not necessarily continue spoon feeding them. In this it is important to understand what type of therapist a pastor may be making referrals to: are they the super sensitive, incense burning, five-year therapy plan, “how does that make you feel?” type? Or, are they directive, short-term, and results driven? (there can actually be both!) Pastor’s need to find out which they prefer to work with and hand off to.

Relationship: Just like the exchange between client and therapist must be based on connection and shared values, so too must a good working relationship between a pastor and a therapist. It is not necessary (or legal) for a therapist to share everything with a pastor about a referral, but it can aid the pastor in how to approach the trickiness of some situations. Pastors should consider if they would send a family member or personally go to the therapist to whom referrals are being made. Can a connection be made with them? Do they share core values? Do they have good insight? What angles have they presented that have not been considered? There are many questions to ask the therapist that could help clear things up—are alright with being asked such questions?

Competency: The final area for therapists involves their competency in what they do. This can span both in the field of their profession and knowledge of the Word. Though good connection with the client is vital in this field it must also be backed up with real tools, insight, and knowledge of what the client is going through. We can find out more about a therapist by what they present on the subject matter—either by meeting with them or going through their website (if available). It will also help to talk to the individuals that are sent. Ask them how they are progressing and get their attitudes and feelings about the therapist. Those who are resistant to change may bristle at what therapy brings up (of course) but, collectively, there can be a good feel for what goes on in session and the ability of the therapist by following up with people.

Conclusion:

Whoever reads this, whether a pastor, individual, or therapist, allow me to finish by encouraging all to keep informed and hopeful when it comes to therapy. If a pastor refers to a therapist, it does not mean the individual is unredeemable or irreparably broken in some way. The truth is, we are all broken and in need of a savior. If we are confessors of the Gospel of Christ, then in whichever vocation we find ourselves, we must minister to all. Though the pastor carries a specialized title in what he does, it is important for him to utilize the tools available to have the greatest impact in his arena—whether finding the carpenter to work on the building, the doctor to work on the body, or the therapist to work on the mind. If you have any questions about referral or would like to have some time to talk, send me an email at chris@chrisoneth.com or visit my website and blog at www.marriagetherapistmodesto.com. 

Chris