When to talk to your pastor and when to see a counselor

This page is not medical or religious advice. Do Not Lose Hope is not a clinic or a crisis line. If you are thinking about hurting yourself, call or text 988 now.

Many of us turn to God and our church first when life gets hard. That is a good instinct. Your pastor knows you, prays with you, and can gather people around you. But some struggles need more than a pastor is trained to give. Seeing a counselor is not stepping away from your faith. It is using every good gift you have.

What does a pastor do, and what does a counselor do?

They do different jobs. Both can help at the same time.

A pastor or faith leader can:

• Pray with you and listen
• Help you find meaning, hope and forgiveness
• Gather practical help: meals, rides, child care
• Keep you connected to your church family
• Walk with you over many years

A licensed counselor or therapist can:

• Find out what is going on, such as depression, anxiety or trauma
• Treat it with proven methods
• Work with a doctor if medicine might help
• Help you build skills to cope day to day
• Spot danger and act on it

The American Psychiatric Association Foundation, in its guide for faith leaders, puts it this way in plain terms: faith leaders give spiritual care and support, and clinicians diagnose and treat. Good faith leaders are clear with people about that difference.

How do I know which one I need?

Talking with your pastor may be enough when:

• You are facing a hard decision, a loss, or a season of doubt
• You need prayer, comfort or someone to listen
• You are sad or stressed, but you still sleep, eat, work and care for your family
• Things get a little better after you talk

It is time to see a counselor too when:

• You have felt sad, empty, worried or numb most days for two weeks or more
• You cannot sleep, or you sleep all the time
• You stopped eating, or cannot stop
• You struggle to work, go to school or care for your children
• Drinking or drugs have become a way to cope
• You pull away from people who love you, or feel you have no one
• Grief has turned into hopelessness or constant guilt
• Your home is full of conflict you cannot fix
• A child or teen is changing in ways that worry you
• You saw or lived through something terrible, and it keeps coming back
• You have talked with your pastor for a few weeks and nothing is changing

Not sure what you are feeling? See Signs of depression and anxiety or Why you feel overwhelmed all the time.

Is seeing a counselor a lack of faith?

No. Many people of faith see a counselor, and many counselors respect faith. We go to a doctor for a broken arm and still pray for healing. Mental health works the same way.

If someone tells you counseling means you do not trust God, here are things to keep in mind:

• Depression and anxiety are health conditions. They are not a sin or a punishment.
• Hopelessness can be a symptom, not a sign that God is far away.
• Medicine and counseling can be part of how healing comes.
• You can ask for a counselor who will respect your beliefs, and you can talk about your faith in sessions if you want to.

What should I know about privacy?

With a licensed counselor: what you share is private under federal and California law. There are limits that apply to everyone. A counselor may share to protect someone in serious and immediate danger, and must report suspected child abuse or neglect. Your immigration status counts as private medical information in California. See Will my therapist share my information?

With a pastor: California lists clergy members as mandated reporters of child abuse and neglect. There is an exception for a confession or other talk meant to stay secret that the clergy member's church requires them to keep private. That exception does not cover what they learn in another role. If privacy matters to you, ask your pastor plainly: "Is what I tell you private?"

How do I find a counselor I can trust?

1. Call your county line (numbers above, or your county on the DHCS list). County lines serve people with Medi-Cal or no insurance and can connect you to care in your language. More options, including community clinics, are on Mental health care without fear.
2. Check the license. In California, the Board of Behavioral Sciences licenses marriage and family therapists (LMFT), clinical social workers (LCSW), professional clinical counselors (LPCC) and educational psychologists (LEP). Look anyone up on the DCA License Search to see whether the license is current and whether there is any public discipline.
3. Be careful with titles. In California, a pastor, priest or rabbi may counsel people as part of their pastoral duties without a therapist license (Business and Professions Code 4980.01). A title like "Christian counselor" or "life coach" does not tell you whether someone holds a state license. That can be fine for encouragement, but for depression, trauma or danger, look up the license.
4. Ask questions. "Do you work with people of faith?" "What language can we use?" "What does it cost?"
5. Give it a few visits. If it does not feel right, it is OK to ask for someone else.

For pastors: how do I refer someone well?

You are often the first person someone tells. That is a gift and a responsibility. The APA Foundation guide for faith leaders suggests:

• Make it a shared decision. Talk it through with the person, and their family if they want.
• Explain the difference between spiritual care and clinical care.
• Promise to stay involved. "I will keep praying with you. I am not handing you off."
• Name the barriers. Fear, shame, cost, language, papers. Help solve one.
• Have a list ready before you need it: the county lines, nearby clinics and the 988 Lifeline.
• Offer to help make the call or set up the first visit.
• Follow up, and welcome the person back to church life.
• In an emergency, do not wait to finish a referral. Call 911 or go to the emergency room.

Want to grow your ministry's skills? San Mateo County's behavioral health department has a Spirituality Initiative that works with faith leaders and helps congregations welcome people living with mental health or substance use challenges. See also Free suicide prevention training for parents, teachers and pastors and How our church can help neighbors.

A quick check you can print

Questions people ask

Can my pastor come to a counseling session with me? Some counselors welcome it, with your permission. Ask the counselor.

What if my church does not believe in counseling? Your health matters. You can get care privately, and many people find that counseling and faith grow stronger together.

Can I see a counselor if I do not have papers? Yes. County lines and community clinics serve people with or without papers. See Mental health care without fear.

I am a pastor and feel burned out myself. Where do I go? The same places. Pastors carry heavy loads. Call your county line or the Warm Line, and let someone care for you.

You can have both: people who pray with you, and people trained to help you heal.