Pastoral Counseling in Small Churches: When to Help and When to Refer

For a biblical framework for handling conflict well, see our church conflict resolution guide.

For guidance on protecting yourself and those you serve, see our guide to pastoral counseling boundaries.

Pastoral Counseling in Small Churches: When to Help and When to Refer

Knowing when to help and when to refer is one of the most important skills a small church pastor can develop.

By Brent Lacy

Someone calls the church. They are struggling. Their marriage is falling apart. They are dealing with depression. They have not slept in weeks. They need help.

And they called you.

In a small church, the pastor is often the first and sometimes the only mental health resource available to congregation members. That is a significant responsibility. It requires wisdom about what you can offer and honesty about what you cannot.

1 in 5
Americans experiences a mental health condition each year (NAMI)
40%
of people with mental health needs first seek help from clergy (NAMI, 2023)
3 sessions
is the appropriate limit for most pastoral counseling situations

What Pastoral Counseling Is

Pastoral counseling is the ministry of listening, prayer, Scripture, and spiritual guidance that a pastor provides to people in their congregation who are struggling. It is not therapy. It is not clinical mental health treatment. It is pastoral care applied to personal crisis.

Pastoral counseling is appropriate for:

  • Grief and loss
  • Spiritual struggles and doubt
  • Relationship conflicts that have a spiritual dimension
  • Life transitions: job loss, retirement, empty nest, illness
  • Mild anxiety or discouragement that is situational
  • Pre-marital counseling

What Pastoral Counseling Is Not

Pastoral counseling is not appropriate as the primary treatment for:

  • Clinical depression or anxiety disorders
  • Trauma and PTSD
  • Addiction and substance abuse
  • Personality disorders
  • Suicidal ideation or self-harm
  • Domestic violence or abuse
  • Psychosis or severe mental illness

These situations require professional clinical care. A pastor who attempts to treat them without clinical training is not helping. They are potentially causing harm.

Warning: If someone expresses thoughts of suicide or self-harm, do not attempt to handle this alone. Stay with the person, contact emergency services if there is immediate danger, and connect them with a mental health professional immediately. This is not a pastoral counseling situation. It is a crisis.

The Three-Session Rule

A practical guideline for pastoral counseling: limit yourself to three sessions on any given issue. If the person has not made meaningful progress after three sessions, refer them to a professional counselor.

This guideline protects both the pastor and the person seeking help. It prevents the pastor from taking on a therapeutic role they are not trained for. And it ensures that people with serious needs get the professional help they require.

Practical Tip: Build a referral network before you need it. Identify two or three licensed counselors in your area who share your values and are willing to work with church members. Know their specialties, their fees, and whether they accept insurance. When you need to refer someone, you want to be able to make a specific recommendation, not a vague suggestion.

How to Conduct a Pastoral Counseling Session

A pastoral counseling session is not a therapy session. It is a structured conversation with a spiritual dimension. Here is a simple framework.

Listen first.

Spend the first half of the session listening. Ask open-ended questions. “Tell me what has been happening.” “How long have you been feeling this way?” “What have you tried?” Resist the urge to offer solutions before you fully understand the situation.

Reflect and clarify.

Summarize what you have heard. “It sounds like you are feeling overwhelmed by X and struggling with Y. Is that right?” This communicates that you have been listening and gives the person an opportunity to correct any misunderstanding.

Bring Scripture and prayer.

Offer a relevant Scripture passage and pray with the person. This is what distinguishes pastoral counseling from secular counseling. You are not just a listening ear. You are a spiritual guide who brings the resources of faith to bear on the person’s situation.

Identify next steps.

End every session with clarity about what happens next. What will the person do before the next session? What will you do? When will you meet again?

Confidentiality and Mandatory Reporting

Pastoral counseling conversations are generally confidential. But there are legal exceptions. In most states, clergy are mandatory reporters for child abuse and neglect. Know your state’s mandatory reporting laws before you begin pastoral counseling.

Also be aware that confidentiality has limits when there is a risk of harm to the person or to others. If someone discloses plans to harm themselves or another person, you have both a moral and often a legal obligation to act.

Free Resource: Pastoral Care Resources

MinistryPlace offers free pastoral care guides, visitation templates, and bi-vocational ministry resources for small churches.

Browse Pastoral Care Resources

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