Your first interdisciplinary team meeting has finally arrived. Anxiety builds to the verge of panic, as you increasingly feel a step behind. The physician and registered nurses discuss diagnoses. The psychologist outlines treatment goals, and the licensed clinical social worker reviews discharge planning.
When it is your turn, you hesitate. A prayer before surgery suddenly feels less substantial than cognitive behavioral therapy or systems theory-informed planning. A bedside blessing or non-anxious presence seems difficult to express clinically alongside measurable interventions. Determined to demonstrate your value and impress your colleagues as you move through your caseload, you subtly begin adopting the language of psychotherapy.
Tyler Parry
A few weeks pass by, and you notice yourself offering interpretations that belong to clinicians and gradually setting aside the practices that first drew you into ministry. It is an understandable response — but it is a vocational mistake.
As behavioral health becomes increasingly integrated into hospitals, prisons, hospices and other care settings, chaplains face this subtle temptation. We begin to measure our effectiveness and competence by how closely we resemble behavioral health clinicians. Collaboration is essential, but confusing our vocation with theirs is not.
“Collaboration is essential, but confusing our vocation with theirs is not.”
Chaplains work alongside therapists as members of the same interdisciplinary teams, charting in the same medical records and caring for many of the same patients. Clinical language carries institutional credibility because it promises measurable outcomes. Pastoral care can begin to feel difficult to defend by comparison, but the answer is not to become amateur therapists.
The same temptation appears wherever faith leaders feel pressure to justify their work by adopting the language and methods of neighboring professions. Pastoral care exists because human beings ask questions that psychotherapy, by itself, is not designed to answer.
What does my suffering mean? Has God abandoned me? Can I be forgiven? How do I pray when I cannot find the words? Is reconciliation still possible? What hope remains when death is near? These questions deserve more than psychological insight. They deserve spiritual companionship, because they speak to mysteries to inhabit rather than simply problems to solve or wounds to heal.
This distinction does not diminish psychotherapy. Skilled therapists help people process trauma, regulate emotions, understand destructive patterns and build healthier relationships. Chaplains should celebrate that work and collaborate closely with those who provide it. The vocations overlap without becoming identical.
A therapist may help someone understand the sources of overwhelming grief. A chaplain may help that same person lament before God or rediscover hope. One attends primarily to psychological functioning, while the other attends to meaning, transcendence, community and relationship with God. Both forms of care matter because they answer different needs.
I learned this most clearly in prison ministry, where people often spoke about guilt and shame, anger and despair. Of course, a therapist or a counselor could help them understand the experiences that shaped their lives, give them tools to face their challenges, provide relief through a variety of therapeutic approaches and reorient them to behaviors that might contribute to healthier lives.
My work centered on a different question, grounded in the same realities. We often were discussing the same events, and so the difference lay not in the facts but in the lens through which those facts were seen and understood. Many wanted to know whether redemption remained possible after terrible choices, wondering if God still loved them. They struggled to believe they were more than the worst thing they had ever done.
No diagnosis can answer whether grace is real.
“No diagnosis can answer whether grace is real.”
Hospice offers similar lessons. Patients frequently ask whether dying has meaning, how they can bless the family they are leaving behind or if God will receive them.
They ask, “What will it be like to die?” The most faithful pastoral response is always presence, drenched in love, saturated with compassion and occasionally augmented with prayer or confession or the sacramental laying on of hands. Those acts are pastoral practices, not therapeutic substitutes.
Most people seeking care are not interested in professional boundaries. They simply know they are suffering and want relief. Someone struggling with trauma deserves a therapist equipped to help them heal. Someone struggling to believe they are forgiven deserves a chaplain who can accompany them in faith. Many need both.
When pastoral care becomes indistinguishable from psychotherapy, something is lost. Patients lose the assurance that their deepest questions are genuinely spiritual and worthy of reverent attention. They also lose someone willing to receive them as sacred mysteries to be honored, someone who can pray without embarrassment, speak honestly of God and pronounce words of blessing and hope.
Modern health care understandably values measurable outcomes, and clinically trained chaplains have benefited from stronger documentation, clearer standards and better research demonstrating the importance of spiritual care. Those developments have strengthened the profession, but they never should define it. This does not mean pastoral care should reject evidence or accountability. Chaplaincy has benefited from insights developed by behavioral health professionals.
“Chaplains collaborate best with behavioral health professionals when we stop trying to become them.”
The most important realities we accompany often are known through faithfulness and trust, and such concepts defy numerical evaluation. Hope restored through loving presence cannot be fully quantified. Neither can forgiveness, sacramental reconciliation or the peace that accompanies a dying person as the sense of the holy pervades the space.
Ironically, chaplains collaborate best with behavioral health professionals when we stop trying to become them. Therapists and social workers who recognize spiritual needs know when to invite a chaplain into the conversation. Chaplains who recognize significant mental illness know when behavioral health expertise is essential. Mutual respect grows when each profession understands its own vocation.
Patients are served best when every member of the interdisciplinary team brings a distinct gift. The chaplain’s calling is theological before it is clinical and extends beyond mere emotional support. It is helping people locate their pain, their hope and their meaning within a larger story of God. Our work is not to imitate therapists but to offer the gifts only pastoral ministry can provide.
Patients need excellent behavioral health care; they also need someone who can pray, bless, reconcile and bear witness to hope when medicine reaches its limits. Pastoral care is not therapy. That is precisely why it matters.
Tyler J. Parry is an Episcopal priest and chaplain whose ministry has included hospitals, prisons, hospice and military service. He teaches theology at the University of Scranton and Marywood University. He is the author of Art that Heals and The Gift of a Holy Death and lives in northeastern Pennsylvania.