My dilemma in life, as I cannot stop stating, is that pastoral counseling is not clinical counseling. And that teaching them as overlapping is dangerous and unethical. My dilemma is that telling people this can be really challenging. To say it is unclear.

I couldn’t illuminate it until recently.

When I wrote a complaint to CACREP about Colorado Christian University (CCU) creating counselors who were actually pastoral counselors, CACREP immediately asked CCU to redo their entire diagnostics and psychopathology sequence. I was floored. Mostly because that wasn’t even my complaint. But I understand now that it gave me my answer.

Because, well, I’ll now refer back to my experience.

When I was 17 (and through me being the earlier stages of 18), I went to a Christian counselor. She was recommended by a family friend. I didn’t really care. I figured if she was good, then her location of service (inside a church) shouldn’t matter.

I was struggling with my identity as a queer woman and a damn brilliant woman, who was unable to fit in with Christian spaces for being too queer, queer spaces for being too Christian, smart spaces for being too mentally ill, and something of an overlap in all of them for being too outspoken and assured in myself that I was okay existing.

My counselor, who we’ll call “Stacey” (as I have both forgotten her name and it is irrelevant what her name is), basically seemed to think I didn’t need counseling. I recall her seeing my overwhelming anxiety about not fitting in, and telling me the astute claim, “Well, you should try these vitamins/supplements” to ease your troubles.

And so, I harken back to the first time I was in therapy.

I was in middle school, maybe 13 or 14, and was experiencing horrible anxiety and wanted to get some help to make sure it didn’t spiral out of control. The therapist, who was very kind, basically said I had a “hormonal disorder”. Ummmm. Cool?

But Stacey…

She saw my dilemma as something that I just had to live through. She saw an intelligent young girl who was experiencing cognitive distortions and an inability to rationalize emotion from fact, and determined it was not a real disorder. I was so mad.

She said a lot of things that were awful therapy.

Maybe some people aren’t really in a diagnostic category. That’s fine.

Sometimes we just have life stressors, and it’s more “adjustment disorder” (a favorite catch-all diagnosis of mine) that deserves therapy, but it is really more a just symptom of overwhelming stress than an underlying disorder. That’s totally fine. It happens.

And a lot of times, the clinical counselors see the whole person.

Stacey heard me say “I feel like I don’t belong because I am queer” and assumed my other symptoms and distressful moments were hyperbolic or a result of being queer, rather than real assessments of my state of being. She didn’t look into those.

She considered problem-solving what to do about being queer.

I was never challenged, even when I gave all the other symptoms that indicated, while, yes, I was certainly struggling with my identity and being accepted, there was more to it, and it wasn’t me wanting counseling for being queer. It was me wanting counseling to stop freaking out that all these fears were so real and apparent all the time. What if not?

Most pastoral counselors do what Stacey did.

They look at what you say and if they don’t see that it’s distressing, they don’t hear your other symptoms and issues. It is one of the worst ways to diagnose and treat people. But at least it helps some, and that’s their argument. But it hurts many, and that’s mine.

To go on a slight circumvent, I liken it to my bogus domestic violence charge.

I had a neighbor who kept calling the cops on me for being mentally ill. The cops didn’t actually believe I was violent, was hurting anyone, or that I was being hurt. They just have to respond to what they are told. And sometimes the rules suck. Because I understand the situation to be that they didn’t understand why someone called them on a girl who was clearly in a mental health crisis when that’s not their area of training. I see them as trying their best, but also not understanding to tell the neighbor to stop calling them when they are the wrong people to call on someone in a mental health crisis. Because then they have to give an absurdly bogus charge to do something. And they know it causes more damage. And often the mentally ill person gets no recourse for it.

Stacey didn’t do anything out of malice.

That’s my whole point. I see that she was doing her best. She was following what she had known and learned. She learned that some distressing issues are better solved through compassionate problem-solving and providing alternative pathways. I didn’t see it as her being mean or unkind, or even necessarily an untrained or unethical counselor.

To me, the issue was always that she failed her diagnostics.

And a lot of clinical staff I’ve encountered fail their diagnostics.

I recently learned that the concept of “religious trauma” and its effects (depression, anxiety, PTSD, among others) has only come into widespread clinical knowledge in the past decade. It wasn’t until the last decade that an institute for studying, treating, and discussing the impacts of relgious trauma was created and implemented.

Maybe to me it isn’t that I see pastoral counselors as horrible.

It’s that they diagnose “reglious trauma” as something more like sin.

They almost see trauma based in relgious badgering as normal. To me, if that’s the take of your counselor, they are in an unhealthy space to be clinical staff. I don’t think everyone has to be upset by relgious doctrine, and I accept that it’s often comforting. But also, the people who have really been disowned by relgious communities don’t deserve to hear that’s a normal or deserved aspect of being a Christian, in any aspect. I promise.

To me, the difference in pastoral/Christian counseling and clinical is big.

Diagnostics is just where it’s really concrete and obvious.

The big difference is that, in clinical counseling, the hallmark is not just that counseling is client-led, but that the clinican’s worldview and biases are not relevant. It does not matter, because clinically, the client’s worldview and biases are the only relevant ones. To bring anything more into the clinical room is to admit you are not prepared to do the job.

To CCU’s credit, they covertly address this by requiring students to have five sessions of personal counseling before starting the practicum and internship sequence. I see a lot of flaws in this, mostly in that (often) nothing important happens in five sessions.

Trust me, as a clinician, I can assure you, sometimes even the first six sessions go absolutely nowhere. Sometimes it takes three months of background giving and world building (to give the clinican the client’s world and perspectives) before the therapeutic process can actually begin and the deep dive into an underlying issue can be done.

Hell, I even had one client who, after five months, still got nowhere, and we decided that meant we were not a good match. That’s cool too. Sometimes the thing is, we give clients the space to take their time to open up. And sometimes, we as clinicians want to scream at our clients, “I can’t help you when you say you have issues and keep talking about cursory dilemmas of a simplistic and kind of dumb nature!” And lord bless you. Because I really almost did that. But I didn’t. I stopped myself. And we ended the dynamic.

I often think back to it.

Not because I care that I said something stupid or lost a client who I could have helped, but because I wanted to teach a client how to resolve conflict. That’s one of the most beautiful components of the job. We teach clients how to work through therapeutic ruptures, even when it’s from us. I’m not opposed. I love doing that.

I have since learned that I pulled a Stacey several times.

Not because my diagnostics were bad. Not because my experience was faulty.

But because, like her, I can only treat what I see.

And getting conflicting messages of, “This is helping, but I have bigger issues,” when I have never been given knowledge of them is hard. And part of being a clinical intern is learning not to say the egregious thing in panic. It’s learning to say, “Then you should tell me some more about it. I haven’t been able to hear enough to ask anything. Can we try talking about it more directly, or in a way that brings it up?” Or some better way.

And I have had clients who told someone else in the agency, “She’s really nice, but I don’t know how to tell her it’s not always helpful what she says.” And so I bring it up with them, and I hear the sigh of relief when I say, “Hey, I respect so much that you stood up for what you needed. Can you tell me what I can do to better be in this role for you?”

Because often the client is afraid that standing up for themselves means they’ll lose a therapist who sometimes they really trust and like. It’s learning when to put some pride to the side and listen when someone says you’re not right, and learning when to put some pride on and push for a little more time to see if maybe it’s just hesitation.

Both situations are true. And both are really hard to navigate.

I am a lot better at taking direct critique. It’s an issue sometimes.

But I do know that I have been like Stacey, where I meant well and was listening to what I was told. But I couldn’t do anything. And so I almost felt stuck. We don’t always get clients whose goals are therapeutically solvable or mitigated. And that’s really okay.

Because part of what I am okay with is admitting where I’ve been wrong.

I don’t care if people know I’ve messed up.

It’s beautiful to know that some of the best people in the mental health field have made some of the stupidest mistakes. Because I’m a fallible human. I have said the wrong things to clients. I’ve laughed at clients. I’ve called them out. I’ve cried with them when they made breakthroughs. I was in it and not in it. I failed sometimes to separate and I failed sometimes in separating too much in response to knowing I invested too much.

There’s a balance in being a therapist.

None of those things I did were necessarily unethical or malpractice.

I was either fine in doing them or I was able to come to an agreed upon resolution with the client directly. Ethically, that’s the way. It’s malpractice if I didn’t think about what to do next or consider recieving more training or supervision on those dilemmas. I see making mistakes as a sign that you encountered an area that you were meant to be in.

The only way we can be better is to try and learn what we don’t know.

I wouldn’t know some of these things if I didn’t do more research or trainings.

Sometimes I thought it was inexperience.

I see that also, I only can treat the things I see. I can only treat the things in the ways I know they can be treated. Vast knowledge is helpful, then, and often great for clinical interns. My issue was often that I got such a vast array of disorders that my expertise of addictions, trauma, and dissociative disorders didn’t encompass everyone’s needs.

I knew enough to help personality disorders and ASD, as well as various anxiety and depression needs. But utlimately, those weren’t my focal areas of skill.

We treat what we see.

But we can only adequately help what we know.

And if we see it improperly, how are we to know if we can help? How are we to know if our expertise is really going to be enough? Is it enough to say we can help, or is it better to define who we can help so we best help those we encounter? And then what if the diagnostics department where we are doesn’t understand how to diagnose?

What about all of that?

What happens when things are too messy?

And can we be okay if the solution is to be still?

Because I learned being still is quite effective.

Try it sometime.

XOXO,

Dorothy B.