This chapter describes how pastoral counselors draw on religious and theological studies along with psychological studies. Pastoral counselors can be described as bilingual and bicultural. The near history of American pastoral counseling in the 20th century generated several distinct ways of relating psychological studies with religious and theological studies. Pastoral counseling by religious leaders has been going on for centuries. Psychologically informed pastoral counseling and chaplaincy became specialized vocations as religious leaders pursued education and training in psychological counseling. Clinical pastoral education (CPE) within psychiatric hospitals was recognized as a form of clinically based theological education and was required by some seminaries and denominations as preparation for ministry. Pastoral counselors using a theistic worldview will likely retain a more conformist religious identity, especially religiously endorsed pastoral counselors who feel responsible for explicitly representing the cornerstone beliefs of their religious tradition.