In my previous essay I explored the differences between therapeutic care and pastoral care. In doing so, I drew a distinction between therapeuo, healing through the application of medical and psychiatric techniques, and sōzō, the working out of salvation through the church’s ministry. While pastoral care can draw insights from therapeuo, its salvific function points us toward what theological Paul Tillich describes as “ultimate concern:” the mystery of being itself. Psychiatry and other forms of therapeuo often deny the existence of ultimate concerns because they are materialistic disciplines. However, there is also another discipline which is adjacent to and often confused with pastoral care: chaplaincy or spiritual care.

Pastoral care and chaplaincy unite in their attention to ultimate concerns, making both forms of sōzō. The two fields differ in terms of content, even as they share the same aim. As a representative of an institution rather than a religious tradition, the chaplain rightly has a professional ethical injunction against proselytizing. Chaplains encounter care receivers who are members of every religious tradition or none at all, often in times of intense vulnerability such as hospitalization, imprisonment, or active deployment. At the same time, professional chaplains are endorsed by and required to maintain good standing with specific religious groups. Chaplains function in the world of therapeuo while pointing those for whom they care toward sōzō. Even as professional chaplaincy moves beyond its roots in Roger’s unconditional positive regard toward a focus on evidence-based practice, it maintains a non-directive focus. The chaplain works with the patient’s faith (or lack thereof) rather than the doctrinal propositions of her own faith. Chaplains help their care receivers explore ultimate concerns, but they do so in a very different way than priests, pastors, or lay pastoral caregivers.

This is the key distinction between spiritual care and pastoral care. The chaplain deals with spiritual matters and often does so in a way that removes them from their traditional religious context. The priest, however, considers a person’s spiritual concerns in the context of the Christian tradition. This distinction becomes readily apparent in the disparate ways chaplains and priests deal with guilt. For the chaplain, a patient’s guilt becomes a question of coping strategies. Do the patient’s beliefs about their guilt support what psychiatrists refer to as “positive religious coping?” In other words, do the patient’s beliefs help them accept responsibility for wrongdoing while also allowing them to make amends and move on with their life? An example of positive religious coping is a belief that God forgives sin. On the other hand, a belief that God punishes sin, rather than forgiving it, can leave a patient stuck in their spiritual distress, becoming negative religious coping. The chaplain works to enhance the patient’s existing positive religious coping while minimizing their negative religious coping, regardless of the chaplain’s personal evaluation of the rightness of the patient’s belief. Chaplains evaluate all beliefs functionally. The priest however, approaches a person’s guilt from the perspective of the church’s ministry. Within the church, the answer to guilt is absolution rather than improved coping strategies. When a penitent approaches their priest, she responds by helping her parishioner examine their conscience. Sin evokes guilt, but guilt may be evidence of scrupulosity, rather than sin. For the scrupulous, the confessor’s role is to assure the penitent, in the name of God, that there is nothing to forgive. If the penitent does confess sin, the priest responds by pointing toward Christ’s atonement. Forgiveness comes from outside ourselves rather than a courageous act of self-affirmation. The gospel teaches us to accept ourselves because we have already been declared acceptable by God.

Sōzō ultimately resides in the church’s pastoral ministry, which aims to point persons toward Jesus Christ. In the Anglican tradition, this certainly includes what the Book of Common Prayer refers to as “pastoral offices:” confirmation, marriage, thanksgiving for the gift of children, reconciliation, ministry to the sick and dying, and the burial office. Each of these offices revolves around a lifecycle event. Pastoral care helps people locate the church’s teaching in the lived reality of their lives. The Anglican pastoral tradition, a rich and sometimes neglected part of our heritage, reminds us that this ministry also occurs outside the church’s formal worship. George Herbert, writing of the country parson’s ministry of visiting his parish, said: “For there he shall find his flock most naturally as they are, wallowing in the midst of their affairs; whereas on Sunday it is easy for them to compose themselves to order, which they put on as their holy-day clothes, and come to church in frame, but commonly the next day put off both.” (1) Pastoral care reminds people that the Gospel is relevant to their lives because it locates God “wallowing in the midst of their affairs,” to borrow Herbert’s evocative phrase. In other words, pastoral care is incarnational theology.

Of course, priests and others can insensitively draw upon the propositional truths of our faith. Catechesis is generally ill-received in the midst of a crisis. Michael Ramsey charged ordinands in the Church of England: “You will care about people for themselves, and not only as potential confirmation candidates. To have a solely religious interest in people is not only to be a bad pastor, it is also to be turning the true God into a sickly caricature of himself.” (2) Generally speaking, the grieving do not need a lecture on theodicy; they need a tangible reminder of God’s enduring love and faithfulness in the face of unimaginable loss. We are called to care about people for themselves, as themselves, because God does. In time, these tangible reminders of God’s presence become experiential proof of the truth of the Gospel. 

The cure of souls, the ministry of a specific priest in a specific gathering of God’s people, must be profoundly theological. Yet the working of the cure of soul’s theology should not mimic systematic theology. Our lives are not systematic. Like Dante, we often lose the straightforward path. In pastoral care, someone who imperfectly loves us helps us to the find glimpses of the God who is Love’s all-encompassing presence in our lives. This is a theological task. Each time the priest pronounces God’s absolution or a lay Eucharistic ministry brings communion to a homebound parishioner, something profoundly theological occurs. 

Therapeuo can and should inform the cure of soul’s working out of sōzō. The genius of the Anglican pastoral tradition is that it locates theology wallowing in the midst of everyday life, just where therapeuo occurs. Psychiatry can provide helpful insights into how people experience traumatic events or structure our complex interpersonal interactions. A wise pastoral caregiver draws insights from other helping disciplines, using them to help understand the world. However, the ultimate emphasis of pastoral care remains theological. The priest must not become a poor man’s psychiatrist or social worker. Psychologist Paul Pruyser observed the dangers of this approach: 

“these pastors all too often used ‘our’ psychological language, and frequently the worst selection from it—stultified words such as depression, paranoid, hysterical. When urged to conceptualize their observations in their own language, using their own theological concepts and symbols, and to conduct their interviews in full awareness of their pastoral office and church setting, they felt greatly at sea. When clients clearly sought pastoral answers to questions of conscience or correct belief, the pastors tended either to ignore these questions or to translate them quickly into psychological or social-interactional subtleties.” (3)

When pastoral caregivers ignore theology, they sap pastoral care of its vibrancy and helpfulness. The only good we have to offer those who come to us for care is theological. We must not forget this, even as we are informed by other disciplines.

Instinctively, people know that religious caregivers provide important answers which no one else can. When I was a parish priest, people turned to me to help them process their grief over a loved one’s death, even when they were not parishioners. The same was true during my ministry as a hospice chaplain. Following patient deaths, caregivers often turned to me, rather than my social worker colleagues, to work through their grief precisely because they had theological questions. Although professional ethics prompted different responses when I functioned as a chaplain rather than as a priest, people approached me expecting their ultimate concern to be taken seriously as a theological issue. The response of a priest or other pastoral caregiver must be the proclamation of the gospel, interpreted for the individual’s circumstances. My social worker and grief counselor colleagues utilized therapeuo to help family members process the loss of contact from their loved ones and to chart a new identity now that they were no longer caregivers. In contrast, those who turned to me sought an assurance of forgiveness. They wanted to hear from a representative of God that they cared for their loved one well and had not unduly hastened their loved one’s death. Where my colleagues dealt with coping, I offered an assurance of the love family members had for their deceased loved one and the love God has for all who mourn. 

Since the second half of the twentieth century, much of Mainline Protestant thinking about pastoral care has focused on technique. I do not deny that technique is important; pastoral caregivers are responsible for handling the issues people bring to us sensitively and respectfully. Technique, including techniques borrowed from the realm of therapeuo, can help us do this. However, what makes pastoral care unique and effective is its content. Pastoral care synthesizes and applies other theological disciplines to the lived experiences of God’s people. In receiving pastoral care, we are invited to see ourselves as part of God’s ongoing action in the world and are assured of God’s love and concern for us. The content of pastoral care must be deeply theological. Anything less deals lightly with the wounds of God’s people (cf Jeremiah 6:15). 

1.  George Herbert, The Complete English Works (ed. Ann Pasternak Slater; New York: Everyman, 1995), 217.

2.  Michael Ramsey, The Christian Priest Today (London: SPCK, 1972), 23-24.

3. Paul W. Pruyser, The Minister as Diagnostician: Personal Problems in Pastoral Perspective (Philadelphia: Westminster, 1976), 27. Italics original.