Pastoral care suffers from an inferiority complex. It is unfavorably compared to other theological disciplines, especially biblical studies and systematic theology, and it is often derided as “budget therapy.” The pastor, priest, or other spiritual caregiver is reduced to the psychiatrist’s adjunct. The classical image of the psychiatrist sneers at pastoral care as well. Cultural critic Philip Rieff, reflecting on the origins of modern psychiatry, observed: “Freud understood the dangers inherent in a situation in which the precious individual was vulnerable to the charge that his life had become meaningless. In answer, he asserted that no fresh access of doctrine could for long decrease that vulnerability. In such cases, the individual merely built his neurosis more deeply into his character, hiding it behind some unstable equilibrium of faithful action.” (1) For Rieff psychiatry proves that spiritual practice masks neurosis. Freud sapped religion of its salvific ability, reducing it to yet one more delusion. Not only is there no health in us, but Christianity has no health to offer.

The more significant crisis is that Mainline Protestants believed Freud. More so than other religious groups in America, the Mainline has been influenced by the clinical pastoral movement, the early twentieth-century groups which gave rise to Clinical Pastoral Education and the American system of healthcare chaplaincy. The clinical pastoral movement began in psychiatric hospitals, and although Anton Boisen, one of its founders, implored nascent chaplains to hold on to their spiritual grounding, the overwhelming influences on the movement’s development were psychiatric. Today, most Episcopal seminarians complete one unit of Clinical Pastoral Education (CPE), spending a summer learning to practice psychiatrist Carl Rogers’ “unconditional positive regard” in a hospital or other clinical setting. 

I dispute this account of pastoral care from my perspectives as an Episcopal priest, hospital chaplain, and CPE Educator. Pastoral care can be a vibrant theological discipline and a vital comfort to the suffering. If pastoral care is to live into its potential, it must be more than providing unconditional positive regard or parroting insights from psychiatry and sociology. Moreover, pastoral care as practiced in a parish setting—what is traditionally known as the “cure of souls”—functionally differs from interfaith healthcare chaplaincy. If creating a robust understanding of pastoral care is our goal, we must begin by understanding what it is not: therapy or chaplaincy. I shall begin by exploring the difference between pastoral care and therapy in this essay before differentiating between pastoral care and chaplaincy in a second. 

Therapy derives from the Greek word therapeuo, which relates to service, eventually becoming nearly exclusively service by a physician by the time the New Testament was written. (2) We can relate therapeuo to the healing function of psychiatry and other medical disciplines. In the Gospels, therapeuo generally is used in the accounts of Jesus’ healing miracles. Thus Matthew states: “Jesus went throughout Galilee, teaching in their synagogues and proclaiming the good news of the kingdom and curing every disease and every sickness among the people.” (5:23 NRSV) The evangelists use therapeuo when Jesus cures physical diseases as well as when he casts out demons and evil spirits. It therefore includes healing of the body as well as healing of the mind or spirit.

In contrast, the Greek word sōzō refers to being rescued from an enemy, including disease. (3) In Plato and later Greek philosophers sōzō begins to acquire a specifically religious connotation, referring to the immortality of the soul. (4) In most English translations of the Bible, sōzō is translated as “salvation.” The evangelists do use sōzō in their accounts of Jesus’ healings, but to refer to the healing of the entire body rather than one of its parts. Thus Jesus says to the woman with the issue of blood: “Daughter, your faith has made you well (sōzō); go in peace, and be healed of your disease.” (Mark 5:34 NRSV) Jesus frequently links faith and sōzō in this and other synoptic accounts. Sōzō may include therapeuo, or physical healing, but it cannot be reduced to it. Something more happens.

Psychiatry and other forms of therapy constitute modern versions of therapeuo. Pastoral care, on the other hand, represents a form of sōzō. In pastoral care, the caregiver does not merely utilize the techniques of the helping professions. Instead, the caregiver stands in persona Christi to assure the care receiver of God’s saving action in their own life. The Anglican pastoral tradition more typically speaks of “the cure of souls” rather than pastoral care, which is a more modern term. The cure of souls, as a form of sōzō, deals with what theologian Paul Tillich refers to as “ultimate concern:” matters of purpose, meaning, and being itself. Like all forms of therapeuo, psychiatry deals with the temporary relief of physical and mental symptoms of disease. Indeed, therapeuo denigrates the idea of ultimate concern. Rieff writes: “In the workaday world, there are no ultimate concerns, only present ones. Therapy is the respite of every day, during which the importance of the present is learned, and the existence of what in the ascetic tradition can to be called the ‘ultimate’ or ‘divine’ is unlearned.” (5) Here is where the clinical pastoral movement led Mainline pastoral praxis astray: it reduced pastoral care to a form of therapeuo. The primary focus of the cure of souls is sōzō or salvation.

However, we are beset by ultimate concerns. Dante Alighieri begins his Inferno with the memorable line: “Midway upon the journey of our life I found myself within a forest dark, for the straightforward pathway had been lost.” How easily we lose the straightforward pathway of life! While Dante’s sickness is not unto death, the cure the poet finds requires him to leave the everyday world behind. So it is also for us. We yearn for something more enduring than ourselves, and this is why we turn to priests and other spiritual leaders for counsel. 

Psychologist Paul Pruyser reminds us that people turn to religious leaders not because they cannot afford a therapist but because they see their issue as spiritual and requiring a spiritual solution! (6) I often hear priests claim that it is clericalist to tell parishioners how to respond to situations parishioners bring to their rector. I contend that the actual clericalist position is to assume that lay people are too uninformed to realize when they want psychotherapy and when they need to hear how the church’s teaching applies to their lived experience. The penitent wants to hear absolution pronounced. The seeker wants to hear that the Good News is for them. Those contemplating major life decisions want to hear how they can live faithfully during this transition. In pastoral care, the caregiver serves as the church’s representative as well as a caring individual. People intuitively know this, so they seek pastoral care as one answer to their issues.

The cure of souls is more than a mere subset of therapeuo, and our problems are larger than what medicine can solve. This is not to say that therapeuo offers nothing. The therapeutic offers healing; this is why it is therapeutic! What the therapeutic does not and cannot offer is salvation. Freud famously stated, “The aim of psychoanalysis is to relieve people of their neurotic unhappiness so that they can be normally unhappy.” Yet even normally unhappy souls groan with all creation as we wrestle with the futility of life. Therapeuo offers a material solution for material problems; it cannot resolve spiritual suffering. St. Paul reminds us: “The last enemy to be destroyed is death.” (1 Cor 15:26, KJV) We inevitably come to a problem which only sōzō can solve, because therapeuo’s earthly hopes ultimately prove insufficient. Pastoral care matters because God can save what Freud could not heal.

1. Philip Rieff, The Triumph of the Therapeutic, 40th Anniversary Edition (Wilmington: ISI, 2006), 42.

2.  Hermann Wolfgang Beyer, “Therapeía, Therapeúō, Therápōn,” in Theological Dictionary of the New Testament, ed. Gerhard Kittel, trans. Geoffrey W. Bromiley, vol. 3 (Grand Rapids: Eerdmans, 1965), 128-132.

3. Werner Foerster, “Sōzō, Sōtēría, Sōtēr, Sōtērios,” in Theological Dictionary of the New Testament, ed. Gerhard Kittel, trans. Geoffrey W. Bromiley, vol. 7 (Grand Rapids: Eerdmans, 1965), 965-1024.

4.  Ibid., 968.

5.  Rieff, 45.

6.  Paul W. Pruyser, The Minister as Diagnostician (Philadelphia: Westminster, 1976), 44-46.