This chapter examines the development and organization of pastoral care within the context of managed care. It illustrates an approach that has been effective at engaging a medical system while providing quality care to patients. The chapter provides a potential plan on how to further establish a training program in the context of educational systems and licensing boards. Pastoral psychotherapists have historically been well educated and trained in diverse counseling and psychotherapy clinical theories and methodologies. The term pastoral in pastoral psychotherapy typically connotes a specificity of education, training, supervision, and experience. The Integrative Psychotherapy Training Program (IPTP) offers a useful model for how pastoral counseling and psychotherapy is self-differentiating while extending its influence into the complexities of a very large health care delivery system. When developing an integrative psychotherapy service center and training program, the program must discern the service needs of the health care system.