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Let’s be honest. Most of us stepped into ministry because we genuinely want to help people. We see hurt and we want to bring comfort. We see confusion and we want to bring clarity. We see someone struggling and we want to walk with them.
That’s a good thing. That’s a God thing. We all want to help. That’s why we’re here.
But here’s where it gets tricky. Somewhere along the way the lines between spiritual care and clinical therapy got blurred in the church. And when we can’t tell the difference people can get hurt even when our intentions are pure.
I’ve been there. I’ve sat with teenagers who told me things no twenty something youth director should have handled alone. I thought I was helping. Looking back I didn’t know what I didn’t know.
So let’s untangle this.
What Spiritual Care Looks Like
I talked about this with my guest Katie Quigley, a licensed mental health counselor who also happens to be part of a small church. She defined spiritual care this way.
Spiritual care is present focused. It’s very goal oriented and solution focused in the best sense of that phrase. And it absolutely can and should incorporate someone’s faith and spirituality into the conversation.
This is what most of us are already doing when someone comes to us after a service or emails us during the week. We’re sitting with them. We’re praying with them. We’re opening Scripture together. We’re pointing them toward Jesus because we genuinely believe Jesus helps and we do believe that.
Spiritual care involves support, empathy, care and compassion.
That’s spiritual care. That’s what the church is supposed to do.
The problem isn’t that we’re doing this. The problem is when we think this is enough for everything.
What Clinical Therapy Actually Involves
Therapy goes to a deeper level. Katie described it this way.
Clinical therapy means diving to a deeper level, reprocessing past trauma, giving more coping skills and being more in the body and more in the nervous system.
Most of us in church leadership have zero training in any of this. And that’s okay as long as we know the difference.
Why Knowing The Difference Matters
I think we started missing the mark when we started getting into territory we don’t have enough training and expertise in. That’s where Katie sees the biggest problem too.
Here’s what I mean.
When Spiritual Care Is Enough
If someone comes to you and they’re walking through a hard season like a job loss, a marriage struggle, a prodigal child or a faith crisis, spiritual care might be exactly what they need.
They need someone to sit with them. To remind them God hasn’t abandoned them. To pray with them. To walk alongside them.
When To Consider Therapy
But if someone comes to you and they’re describing things that sound like trauma responses, panic attacks, dissociation, suicidal thoughts or an anxiety disorder that’s disrupting their daily life, that’s different. That’s not a discipleship conversation. That’s a clinical conversation.
And here’s the hard truth I’ve had to sit with. I am not qualified to have that conversation. Neither are most of us.
Katie put it this way. “If we’re getting into things like processing trauma, suicidal ideation, panic disorders or anxiety disorders, anything that’s coming with an element of risk, that’s where we need to say okay hang on a second. Do I have the skills and capacity to deal with this or do I need to get some extra help for this person?”
She also said that if there’s risk involved that should be a red flag. “Okay hang on I might need some more help with this.”
What This Looks Like In A Small Church
Most of us in small churches don’t have a licensed therapist on staff. We don’t have a counseling center in our building. We have us. Volunteers and leaders who love Jesus and love people and want to help.
That’s okay. That’s actually beautiful.
But we have to know our limits. Being aware that professional help exists and knowing when a conversation has moved beyond spiritual care is the first step.
Katie actually works out of an office inside her small church but her practice isn’t affiliated with the church. She gets to see clients come in through church doors from all different faith backgrounds. She said it’s a really cool opportunity and use of a small church.
Most of us won’t have that setup. But we can still know the difference between walking alongside someone and stepping into territory that requires more training than we have.
When To Refer Someone To A Therapist
So how do church leaders tell when something is over their head?
Red flags that signal it’s time to refer:
- Processing past trauma
- Suicidal ideation or self-harm
- Panic disorders
- Anxiety disorders
- Any situation with an element of risk
- When you feel completely in over your head
Katie explained that when someone is dealing with any of these issues, they need clinical help not just spiritual support. Someone who doesn’t know how to handle these things can cause more harm without meaning to.
Here’s something I’ve learned the hard way. We don’t have to be the smartest person in the room. We don’t have to have all the answers.
Sometimes the most helpful thing we can say is, “I’m so glad you told me this. I think you need someone with more training than I have and I want to help you find that person.”
That’s not failure. That’s doing no harm.
We only scratched the surface on trauma, on listening well and on what healthy church care should look like. In the coming posts we’re going deeper into each of these areas.
For now, the goal is simple: know the difference between spiritual care and clinical therapy. Know when you’re in over your head. And know that referring someone to a trained professional isn’t failure. It’s love.
If you’re trying to figure out how to support people well you’re not alone. We’re all learning this together.
The goal isn’t to have all the answers. The goal is to do no harm while we’re figuring it out.
Want to keep learning alongside other small church leaders navigating these same tensions? Join us in the Small Church Ministry Facebook group where we have real conversations about ministry mental health and doing no harm.
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