For Therapists and Clergy: When to refer to an affirming Pastoral Counselor
Long before pastoral counseling made its formal introduction into both the pastoral and therapeutic worlds, clergy were caring for souls with spiritual tools, and therapists were caring for psyches with clinical tools. Pastoral counseling combined the two for those clients wanting an integration of their spiritual and mental well-being in coping, healing, growing and redeeming the usual sufferings of life.
Transgender clients who are religious and value their affiliation with church or shul, benefit from working with pastoral counselors competent in gender dysphoria. Secularly oriented clinicians cannot understand or appreciate the rich resources of religion for spiritual health, and pastoral counselors without clinical expertise in gender dysphoria cannot see where God could possibly be part of transitioning the body to fit the gender.
A mutual task for clergy and therapists, then, is to honor both the spiritual resources of a client’s religious tradition, while healing trauma toward transgender people of faith that religious have historically imposed. Clergy have not only a counseling role, but a liturgical and communal role in making a repair. Jewishly we call that a tikkun. Christians call it reconciliation: bringing back together what has been rendered apart.
Secular therapy has often scoffed at the religious client as immature, dependent, and lacking in personal responsibility for managing life. Secular therapy champions self-mastery; we see it in excess emphasis on “me”: independence, fulfillment, and individualism, fear of codependence, of needing anyone, of guilt or regret. Happiness is valued more than inner peace and is an entitlement, and suffering is mere pathology.
But religious counseling can error in the other direction. In its demand that people behave, think and feel only what is allowed, much religious counseling values obedience above all. The unintended result is not spiritual perfection, but the development of shadow, the closet where our best intuition hides next to our real flaws. Neither one ever sees the light of day again, unless pastoral counseling steps in.
Pastoral counseling is a hybrid of the healthiest goals of a mature use of freedom and alignment with one’s interpretation of spiritual destiny.
If a transgender client presents to your counseling office, my suggestion is that you routinely conduct an intake process that probes for indicators that a referral to a pastoral counselor trained in affirming care for transgender people is needed for the best therapeutic outcome:
- They were raised in a religious home, went to church/shul or religious school,
- They are agnostic or atheist (often indicating an experience of religious trauma rather than a true intellectual decision that religious activities like prayer, affiliation or beliefs are not useful to them),
- They describe concepts of God or their religious peers in negative terms, especially toward themselves: “God hates me,” “I’m going to go to hell if I transition,” “”My church friends tell me they love me but that I am sinning”,
- They describe God in positive terms but not their religion: “When I was a child I prayed to God to make me a girl,” “I think God is OK with me being transgender (but my church is not”),
- They have not found a new spiritual home that practices real inclusivity, and have given up on their religion even though they miss something about it,
- They spend much energy in anger at religious bigotry they have experienced,
- They express spiritual yearnings-which are sometimes hard to recognize.
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