Responding to Emotional Distress in the pastoral setting:
Each and every one of us will become emotionally distressed at one time or another; it is a perfectly healthy and normal reaction to negative external or internal conflicts (those things that oppose our happiness/nurture/security). Pastoral carers will inevitably find that the condition of ‘distress’ is the catalyst to many of their pastoral encounters. As Pastoral Carers it is our business to be excellent at interpreting the levels of distress that a client is presenting and discern the most appropriate intervention (if any) that may be required.
It is a mistake for any of us to assume that emotional distress is a ‘bad’ thing in itself. If we look at the New Testament we see that Jesus himself became emotionally distressed, particularly over the death of his friend Lazarus (John 11:35) and in the Garden of Gethsemane before his crucifixion (Luke 22:44). Bereavement and anxiety relating to future suffering (emotional or physical) remain two of the most common and natural catalysts of emotional distress. Within its frame, emotional distress holds together powerful emotions of loss and fear. These can be anticipated or realised: “I am not coping without him!” or “I won’t be able to cope without him!”
In whichever circumstances you encounter emotional distress, it nearly always expresses the same sense of deficit: The human spirit has identified that it does not (or will not) have the resources to cope with a particular challenge.
How can we respond to Emotional Distress as pastoral carers?
I use this term because professionalised ‘listening’ skills are too passive for this work. Clients who are distressed need to be heard as the first intervention, regardless of what subsequent supports are offered. Hearing is certainly not presuming that the words they are offering you encapsulate the whole reasoning for their current state. Neither is the activity of hearing a complete end in itself.
Hearing in this context is as much about hearing their physical and spiritual self as it is listening to the rational (or irrational) thoughts of their minds. “The subconscious is ceaselessly murmuring, and it is by listening to these murmurs that one hears the truth.” (Bachelard)
It is at this stage of the encounter that we are quietly hearing the Holy Spirit for discernment as to how we sift and value the material they are offering us.
Attentive hearing is an interactive process. Reflecting back is the activity of representing the material we sense has significance for confirmation by the client. The purpose of this activity is to organise the client’s thoughts for them. In so doing they are enabled to make new qualifications of their fears, feelings and resources. This is a direct counter to the confusion and catastrophising that emotional distress propagates.
Repression, Suppression and Denial: Emotional distress sits in the shadow lands of revelation. Very often it is the first indication that the self is realising whichever conflicts or deficits it has attempted to deny. The pastoral carer’s work is not to collude with the client in artificially reducing these conflicts. Neither is it to bluntly force revelation of the client’s deepest fears. Instead it is to honestly and patiently lead the client to face the truth of themselves and their feelings. Only when things have been honestly explored (possibly over several meetings) can further progress be made.
Many people experiencing emotional distress suffer from strong and disorganised feelings of guilt. Understanding this emotion is often central to uncovering the core conflict behind the emotional distress.
Unfortunately Christians can feel most assured of the appropriate action. However, false guilt does not respond to confession and absolution, since it is not about actual sin. It is instead often a psychological inversion of the anger an individual feels toward the conflict they are facing. For example the mother diagnosed with cancer feels inconsolably guilty not because she has done wrong but because she is deeply conflicted over the care of her children. The grief stricken child feels deeply guilty over the death of his father because he is conflicted by the anger he feels about abandonment he has experienced.
It is essential that the pastoral carer does not misread these clues and absolve the client of their false guilt, but instead explore where roots of these guilty feelings actually lie.
We have already mentioned several different styles of prayer in this short response to emotional distress: It should underpin the whole entire pastoral encounter implicitly. However we need to be aware of how our explicit prayers with clients can either help or hinder their journey through their ‘dark night of the soul’.
Inviting the comforting presence of Jesus into the pastoral encounter is always an excellent approach to take when dealing with emotional distress. However, as just mentioned, praying that Jesus would ‘take away’ the distress the client feels, is a refusal to grow. God is in the business of heart surgery not sticking plasters. On occasion the presence of emotional distress will mark the beginning of a life-changing journey and not something we should ever divert someone away from.
There is, therefore, some danger in using the prayer language of healing inappropriately. Grief is not (in my opinion) something to be healed from, but something to journey through. Emotional illness is far more likely to come through its suppression than through its embrace. With that in mind, I have often found that explicit prayers for courage in the face of pain, and courage to face those things we would rather avoid are by far the most effective.
Equally, in the school of a very experienced pastoral mentor of mine, I have taken to asking direct questions of God with the client in the process of reflecting back e.g. “Father God, would you show us if this ‘fear of humiliation’ is at the centre of this distress?” In this way we are bravely and openly seeking revelation from God. As Thomas Merton said, “Just remaining quietly in the presence of God, listening to Him, being attentive to Him, requires a lot of courage.”
For those in distress, the sense of isolation and loneliness are often the most painful emotions. Even if you make a subsequent referral, sharing their journey of revelation and restoration is one of the greatest gifts you can offer them. However journey with the following things in mind:
• Their journey is theirs. Be aware of the dangers of transference.
• Retain your boundaries and keep the setting defined.
• Don’t have a time frame for them, but have one for you.
• Keep accountable and avoid co-dependence.
When to refer:
As I have just mentioned it is important that you don’t have a time frame for your client’s recovery. I have worked with people whose grief has lasted years and others whose distress has lasted weeks. God will have a time frame for each of them. However in terms of your own professional management it is essential that you have a time frame for you.
I typically will have an initial contact where there may be discussion and prayer. Sometimes that one encounter will be enough to refer on to a more appropriate team member. However, for those in significant emotional distress I will offer three 50-minute meetings on alternate weeks. Very often these will prove sufficient in helping the client make significant steps on their journey and mean they do not need further defined work. However, it is sometimes clear after the second session that a longer counselling journey would be most beneficial. (It is, in my opinion, essential that the Pastoral Carer does not undertake this work themselves.)
As Pastoral Carers it is also essential that we respect the confidences of both the pastoral and the counselling settings. I always encourage the client to avoid divulging the detail of their counselling work with me since this can lead to divergent approaches being exposed and an undermining of the benefit of the work. As a church leader I invite my pastoral leaders to keep me informed about whom they are working with (largely for their own welfare) but referral responsibility is theirs.
If you are in a church setting, there may be heightened concern expressed by family and friends about the client. It is essential that the Pastoral Carer avoid breaching the confidence of the client, since it may well be that the basis of the distress is rooted one of these relationships. Taking authority in this setting is about reassuring those concerned that their loved on is ‘in process’. They too must be encouraged not to force a return to normality, since this could simply supress the issues that need to be addressed.
When might emotional distress be an indicator of a mental health issue that needs a GP’s referral?
It is not the work of the Pastoral Care Team to make medical diagnoses. This can be exceptionally tempting, especially for those who have experience of a psychological disorder (e.g. depression) or some medical training. At the same time every pastoral carer should be equipped to suggest a GP referral should they suspect that a clinical condition might be presenting.
Emotional Distress is the common cold of the majority of neurotic mental health issues, however we must be aware that its presence is NOT sole evidence that a mental health condition is present (e.g. grief, relationship breakdown, response to trauma or work stressors). Again it is the pastoral carer’s role to pick up the clues that are offered in the pastoral interaction and attempt to assess whether, on the weight of suspicion, a GP referral be recommended.
What might we be looking for in grading Emotional Distress significant enough for such a referral?
Physical clues often give us the clearest picture about the likelihood that a more serious condition is present. Has the client lost a considerable amount of weight over recent weeks? Has their appetite greatly diminished (or even increased)? Are they struggling with early morning waking (2 hours before they wish to wake)? or are they struggling to get of bed during the day? Are they complaining about physical aches and pains, digestion issues or chronic headaches? Whilst any of these physical clues may point to the existence of depression, anxiety, or other neurotic disorder, they may also point to the existence of an unrelated physical condition that may be contribution to the client’s emotional state.
Psychological clues can be far harder to interpret as the nature of emotional distress is itself a disposition of confusion and anguish. However there are a few indicators that pastoral carers should look out for:
Many of those suffering from undiagnosed neurotic disorder describe their thought speed as having dramatically increased. This may be framed in terms like, “I just can’t switch off.” “I feel like my mind is constantly racing.” These thoughts may be uncharacteristically bleak, frightening or strange. Clients may also describe partnered emotions like hopelessness, despair, deep sadness, tearfulness, or even intense anger.
Obviously, alongside these common emotional clues be aware of indicators of other underlying mental health problems: Word salad; where speech is jumbled or confused, grandiosity or paranoia, hallucinations or any reference to suicide or intention to harm.
Only a trained medical professional is qualified to make a diagnosis so please refrain from offering one regardless of how ‘sure’ you feel. Labelling a client as ‘depressed’ may cause them far greater distress than they previously felt. At the same time, should you have concern that a mental health issue is present it is essential that you do suggest a medical referral as a matter of urgency. If your client is concerned about making the appointment of attending alone it is often helpful to offer them your support should they require it. If the client is willing, GPs are generally very happy to include a supporter in consultation and this sort of partnership can have very positive clinical outcomes.
Rev’d Will Van Der Hart is Vicar of St Peter’s Church West Harrow and a founding director of Mind and Soul, an organisation that works on the interface between Christianity and Mental Health. (www.mindandsoul.info)
Recommended reading on Pastoral Care for the emotionally distressed:
Listen to the voice within, Christopher Perry, SPCK, 1992
Reflective Caring: Imaginative listening to pastoral experience, Bob Whorton, SPCK, 2011
The Wounded Healer: Ministry in Contemporary Society, Henri J.M. Nouwen, Darton, Longman & Todd, 1994
Finding Hope and Meaning in Suffering , Trystan Owain Hughes, SPCK, 2010