This chapter explores how pastoral counselors might work with queer-identified persons. It reviews theories of sexual orientation and literature establishing gay/lesbian-affirming approaches to pastoral counseling. The chapter considers emerging theories regarding “queer” identities and how such identities are related to prevailing constructs of gender and sexuality in psychotherapeutic discourses. Pastoral counselors working with queer-identified persons especially in couples and family therapy are challenged to critically reflect on and intentionally deconstruct the ways in which dominant discourses of gender and sexuality have become embedded in operative psychotherapeutic approaches. It is critically important for queer-affirming pastoral counselors to clearly identify the theological, scientific, psychological, anthropological, and sociological conclusions about human sexuality because each of these assumptions shapes the clinical practice. Pastoral counselors are encouraged to seek continuing education and specialized training before working with persons who are transgender, especially those who are actively seeking gender transition.

This chapter discusses how pastoral counselors are different from other counseling professions. Pastoral counseling exists in a substantial community of related disciplines and professions. The two theoretical bodies of knowledge that combined to create pastoral counseling were the disciplines of psychology and theology. A review of pastoral counseling’s professional heritage sets the stage for the discipline’s contemporary identity dilemma. The formative nature of pastoral counseling training shapes the pastoral counselor’s self and is the rudiment from which the distinctive interventions of pastoral counselors organically emerge. Among the elements of training and formation most salient to shaping pastoral counseling interventions are clinical integration, pastoral formation, and the development of a spiritual orientation. The unique training and formation of pastoral counselors lays the groundwork for the development of interventions. Pastoral counselors share distinctive interventions that are born out of particular ways of being and a particular set of goals and objectives.

This chapter explores the diversity of professionals engaged in pastoral counseling, the characteristics of those professionals within the ever-expanding landscape of mental health care, and the settings in which pastoral counseling most often occurs. It describes the plurality present within the discipline, summarizes the discipline’s use of the adjective pastoral, and offers a broad, fluid understanding of pastoral counseling. Pastoral counselors at the center of practice in the 1950s to 1970s may have claimed to speak in a singular tongue and envisioned a monolithic tower representing the theory and practice of the discipline. Pastoral counseling is an approach to mental health care that draws on the wisdom of psychology and the behavioral sciences alongside spirituality/religion/theology. Pastoral counselors are bicultural because they have graduate training in both religious/spiritual/theological education and a mental health discipline. Religiously endorsed pastoral counselors are, like all pastoral counselors, bilingual and bicultural.

The Dictionary of Pastoral Care and Counseling identifies pastoral counseling as a 20th-century phenomenon. E. Brooks Holifield (1983) highlighted how early American pastoral care reflected social and theological issues of the time. Pastoral counseling in liberal congregations began to shift away from cognitive, intellectual answers and toward helping parishioners surrender to a “wider self” that would lead to transformation. For pastoral counselors and theologians, psychoanalysis raised awareness that human emotional, spiritual, and volitional life was more complex and mysterious than supposed by earlier theological anthropologies. The Association for Clinical Pastoral Education standardized clinical pastoral education (CPE) as a professional education program for ministry with a focus on pastoral identity, interpersonal competence, and chaplaincy skills. Pastoral counseling specialization gained credibility partly through academic interest in seminaries and graduate schools. Although racial and multicultural tensions contributed to slow growth in the United States, pastoral counseling gained strength in Asia and Africa.

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.

This chapter focuses on the common themes of meaning and the sacred that emerge in pastoral counseling practice. It elucidates explicit and implicit spiritual content that is commonly presented by clients. The chapter explores the explicit spiritual content commonly raised by clients within the Abrahamic traditions. It also explores implicit spiritual content, which is seemingly inherent to the human condition and often occupies the subtext of a client’s presentation. Grounding the exploration of explicit and implicit spiritual content in pastoral counseling is the belief that competent practice requires counselors to be spiritually and theologically flexible. Pastoral counselors employ a diversity of treatment modalities and are not limited to one model or school of psychotherapy. Responding to explicit and implicit spiritual content within mental health practice is a hallmark of pastoral counseling. Whether spiritual content is explicit or implicit, one primary goal of pastoral counseling is to facilitate spiritual growth.

This chapter explores pastoral counseling assessment through an integrated interdisciplinary framework. Religious and spiritual assessment within pastoral counseling is an interdisciplinary practice insofar as it understands the human being from both theological and psychological traditions. The primary aim of the tacit dimension of assessment is to identify the theological and philosophical lenses through which pastoral counselors understand the sacred narrative of their clients. Context-independent pastoral identities tend to assume that one particular way of being spiritual and religious is sufficient for all people. Pastoral counseling is characterized by the formational experience of developing an identity capable of practicing spiritually sensitive and theologically integrated assessment. Pastoral counselors should engage in explicit, formal assessment of religiousness and spirituality when clinically indicated. The pastoral counselor must develop a sophisticated pastoral identity to offer a sacred space able to encounter the mystery of the client’s world.