Therapy from the couch to the pulpit

SEPTEMBER was a difficult month for Emma Presler. The 25-year-old graphic designer had recently moved back to New York City after an ill-fated attempt to relocate to California. Her job at an Internet start-up felt far from secure. And she was getting used to a new living situation after several months spent trying to find a place.

"I wasn't feeling like I was a full participant in my life," Presler explained. "Not being in control, and not making choices for myself."


Many would have headed for a psychologist's office to get the help they needed. But to Presler, the church seemed the best place to go. Coming from a deeply religious family, where both her parents are Episcopal ministers, Presler prefers to pour out her soul to a person who understands and respects her faith.

That's why she chose as her confidant a pastoral psychotherapist - a clergyman with training in psychotherapy.


"I was feeling vulnerable enough when I approached him that knowing there was a spiritual side to him helped," Presler said. "I thought, 'This is somebody who will see the totality and not just a laundry-list of psychosomatic or symptomatic things.'"

Presler is one of a growing number who are turning to the church for their mental health needs as well as their spiritual ones.

The American Association of Pastoral Counselors, founded in 1963, now represents 3,000 pastoral counselors across the country, and reports a tripling of its membership in the past 20 years. The organization estimates that pastoral counseling accounts for 3 million hours of treatment annually.

"It's actually not a new movement," said Harold G. Koenig, an associate professor of psychiatry and medicine at Duke University Medical Center in North Carolina. "Pastoral psychotherapy has been going on for millennia, probably."

The term "pastoral psychotherapy" and the use of the methods of secular psychotherapy are more recent, however. Proponents trace the movement to the 1930s, when Norman Vincent Peale, a minister and the author of "The Power of Positive Thinking," teamed up with psychiatrist Smiley Blanton to form the American Foundation of Religion and Psychiatry in New York City. The foundation is now the Blanton-Peale Institute, which trains those with religious training to be psychotherapists.

Pastoral counseling has gained national attention recently as public figures have used it in their own times of crisis. In 1998, then-President Bill Clinton turned to the Rev. Jesse L. Jackson for pastoral counseling in the wake of the Monica Lewinsky scandal.

Among practitioners who are certified by the American Association of Pastoral Counselors, most are Christian, and of the Christians, most are Protestant. Still, the organization says it is interfaith and inclusive. Catholic priests, rabbis and Buddhist practitioners are among the members.

The term "pastoral counseling" encompasses a wide range of practices. At its simplest, it refers to the kind of spiritual and religious guidance that clergy have given for centuries. New-style practitioners often have degrees in divinity and psychiatry, however, and centers such as the Blanton-Peale Institute offer a three-year intensive course involving a strict regime of clinical classes, hands-on training and personal psychotherapy.


Though the American Association of Pastoral Counselors has specific requirements for its members' certification, there is no centralized licensing board.

Pastoral psychotherapists can be based at churches or religious institutions or have their own practices. Some provide free services, but most charge fees based on a "sliding scale" of what their clients can afford.

Most pastoral psychotherapists say they help their patients with the same problems secular psychotherapists confront. The difference, say people in the field, is that therapists with religious training can relate to the spiritual aspects of patients' lives.

"A lot of people coming from a religious background have either an extreme amount of guilt or shame in terms of not being able to live up to standards they have set for themselves," said the Rev. John Bauman, a pastoral psychotherapist based at the Cathedral of St. John the Divine in New York.

People of faith face certain issues that nonreligious people are less concerned with. Crises of faith and issues around sexuality often come up, counselors say.

Bauman described one patient who has a wife and children but thinks he may be gay. Part of the problem, Bauman said, is that the man grew up believing that being gay is sinful.


"I try to give him an understanding of current thought," Bauman said, "that we as human beings are on a continuum in terms of sexuality. He needs to find himself on that continuum."

The American Association of Pastoral Counselors has been criticized by some for being too liberal on issues such as homosexuality, and abandoning the more orthodox beliefs of its member churches.

George Ohlschlager is the director of policy and professional affairs at the American Association of Christian Counselors, a group that has 40,000 members and is acknowledged to be more conservative than the AAPC. Though he considers the other organization a "fellow traveler" in the Christian counseling movement, he said his group has a more strictly scriptural approach.

"The AAPC is moving away from some of the orthodox positions that the scriptures and the church throughout history has maintained," he said. "Many of our members are, if not upset, at least disinclined to go with the AAPC in their positions."

Dorothea Crites, a Methodist pastoral psychotherapist, acknowledges that the content of some of her sessions may not fit comfortably with her church's doctrines. The United Methodist Church still prohibits its clergy from presiding over gay weddings, for instance, while Crites counsels a lesbian couple who are trying to have a baby.

"As a therapist, I don't bring my particular religious beliefs into the therapy," she said.


Presler sees her counseling with Bauman as related to her spiritual growth, though not as a religious exercise in itself.

"It's certainly awakened me to a sense of gratefulness, which feels like a kind of indirect prayer," she said. "I definitely see it as a journey. "Taking stock has sort of a profound quality to it - regardless of what you find there."

Indrani Sen is a master's degree candidate at the Graduate School of Journalism at Columbia University. This article was distributed by Columbia News Service.