In pastoral ministry, your time loosely clusters around the public ministry (preaching and teaching) and personal ministry (pastoral care and counsel). Between the two, personal ministry is where you spend most of your time. It involves conversations after church, brief words of encouragement during hardships, hospital visits, planned meetings when troubles are stubbornly enduring, and more directed care for those who struggle with what we might call their emotional or mental health. Some of these people suffer from specific psychiatric problems.
When it comes to people who are really suffering, many pastors are tempted to feel overwhelmed and under-qualified. If that’s you, pastor, here five things to remember.
1. Human misery has become more complicated and more frequent.
Compared to our present time, our pre-modern past had more death, less legal protection of life, and endless uncertainties. But there are ways our present era stands out: massive breakdowns of the family unit, isolation, lack of larger purpose, and sexual license. These have intensified the misery that has always intertwined itself with everyday life.
Now factor in the rise of modern psychiatry, which means that medical matters often become part of pastoral care. Together, all this means that more people have more problems that need pastoral care and counsel, and these problems are more complicated.
2. There are good resources to help you.
The church has access to more resources for its pastoral care and counsel than ever before. This is good news for pastors. Now we need to sort through this growing literature and identify what’s most consistent with Scripture and most helpful. We should be looking for material that complements the regular preaching and teaching of the Word.
I’m most familiar with the literature within what has been called biblical counseling. The name can be misleading. We intend it not as a protected trademark but as a simple description or as a body of work to which we all contribute. It describes how we bring the truth of Scripture to the troubles of everyday life, particularly in relationships. In other words, biblical counseling is pastoral care. What’s confusing is that the word counseling suggests a formal, professional hour with an expert. Though biblical counseling can be done in that setting, we think of it in the more democratized sense that we are all called by God to help one another.
3. You already know the most helpful truths.
With all the new therapies and medications, pastors might fear they will mistakenly treat a medical problem as if it were only a spiritual one. But amid all that you don’t know, you do know this: our God is pleased—in Jesus Christ and through our proclamation of his gospel—to renew the entire cosmos (Col. 1:15–23). Nothing reaches deeper into the human condition. This message has been entrusted to ordinary people who wrap it in humility and love.
Here’s another way to look at it: even professional psychological literature observes that people get most of their help from non-professional friends who simply love, listen, and, in Christian relationships, pray for them. This is the recognized gold standard for care, and professionals merely aim to measure up to it.
4. A few principles can guide you about medical and psychiatric care.
Pastors aren’t expected to be medical professionals, but they must take into account that care for the soul and care for the body often overlaps. So as you counsel, here are a few principles you should remember:
- If there are noticeable changes in emotions or intellectual abilities after age 40, refer the person to a physician. By this age, our emotional and intellectual abilities will loosely follow recognizable patterns. If a person is suddenly depressed or has emotions that fluctuate wildly, and those changes are unprecedented, then you ought to refer that person to a physician. There are medical conditions and medication side effects that can precipitate these changes.
- If someone is taking psychiatric medication, it means something is hard. Your job is to understand their suffering and encourage the person’s relationship with Jesus in the midst of it. Psychiatric treatments are unlike most other medical care in that an underlying physical problem is unclear. This distinction, however, is not an important one for you. You don’t give advice about psychiatric medication. If a person seems to have more problems after taking medication, then encourage contact with the prescribing physician, but there’s nothing more you need to do. It’s enough to know that something is hard in the person’s life, and, as with other chronic sufferings, you aim to help them with regular, even if brief, encouragement and prayer. When the form of suffering is unfamiliar or unknown, don’t be afraid to ask for help from someone with experience.
- If a person might benefit from psychiatric medications, there’s no harm done in encouraging that person to speak with a physician. In our present environment, most people already know about psychiatric medications, and likely, a few friends have already made the suggestion. But perhaps your church members don’t fit the cultural profile, and perhaps they’re reluctant to consider psychiatric care. Would you ever suggest it? Wisdom demands that you simply seek advice when you are uncertain. Consult with those in your congregation who have experience, or consult with a trusted physician who can give you guidelines.
5. Given the increasing need for pastoral care, you must equip others.
The apostle Paul explained it this way:
He gave the apostles, the prophets, the evangelists, the shepherds and teachers, to equip the saints for the work of ministry, for building up the body of Christ. (Eph 4:11–12)
Lay ministry is an extraordinary happening and one of the premiere blessings of Pentecost. No longer do people need a special anointing to offer a prophetic word of direction and wisdom. In the new covenant, the Spirit has been given to all who have put their faith in Jesus. God is pleased to have the church build one another up and mature through the ministry of weak people who seem unqualified in the world’s eyes (1 Cor 1:27–29).
Most likely, this is already happening in your church. People share their struggles with each other. People pray with each other. This is almost certainly happening among the women in your church; sometimes, it’s happening with the men. As their pastor, you want it to happen more, and with growing love and wisdom.
As you set out to further equip your church, here are two questions to consider. First, how can you grow a church culture in which people are open about their struggles? This has implications even for the way you preach and how the leadership engages with each other. The mutual care of souls will only happen in a church that assumes we all have struggles and invites people to be open with them.
Second, what are the basic skills that everyone in the church should be growing in? Here are some possible essentials you could consider.
- Speak less and listen more.
- Follow the person’s feelings because they will usually lead to what is especially important to them.
- When you don’t know what to say—pray.
- Make meaningful connections between the struggles of life and Jesus.
This era is full of personal struggles. Some of these struggles are not new: anxiety, depression, addiction, shame, and anger. Others are more recent, such as internet addiction and some psychiatric diagnoses. But all of them can be helped by meaningful engagement in a wise and loving local church.
Editor's Note: This originally published at 9Marks.