SOUTH ASIA INSTITUTE OF ADVANCED CHRISTIAN STUDIES

THERAPEUTIC COMMUNITY:
AN INTEGRATED APPROACH TO PASTORAL CARE OF DEPRESSION

Submitted to

Dr. Chris Gnanakan

In Partial Fulfillment of the

Requirements of the Course

Theology of care and Counselling

I declare that this assignment is my own unaided work. I have not copied it from any
person, article, book, website or other forms of storage. Every idea or phrase that is
not my own has been duly acknowledged.

Signature:______________________

By

Tommy Liang

Registration #0620
 March 6, 2009

THERAPEUTIC COMMUNITY:
AN INTEGRATED APPROACH TO PASTORAL CARE OF DEPRESSION

Despite the crucial and causal role of depression in suicide has limited validity in
India,1 depression has been interpreted as a stigma.2 Many Indians today continue to
hold to this belief. But increasingly with the burgeoning of psychotherapy and the
advent of pastoral theology, more and more religious persons struggle to maintain this
belief. Depression as such no longer holds the kind of labeling effect that it once was
thought to have. Indeed, particularly with our capacity to mitigate its symptoms with
pastoral counseling, community of believers, and biblical images of hope, the belief
that depression is a problem seems to have lost its appeal. This paper examines and
challenges the underlying assumptions that continue to undergird Christian
communities that depression is effectively dealt with pastoral care, especially in a
faith community. To accomplish this goal I shall argue that pastoral caregivers are
facing crisis themselves. Moreover, I will attempt to illustrate how biblical and
theological perspectives are a fundamental dimension of understanding the individual
in the community. Furthermore, I will postulate a paradigm of integration of the
theological and the psychological as a process consisting of three characteristics in
therapeutic community: 1) expressions of God’s presence, 2) means of salvation, and
3) priesthood of all believers. Lastly, I will suggest that several barriers must be
overcome for a therapeutic community in pastoral care of depression to actualize
itself.

CRISIS OF PASTORAL COUNSELING

Eschmann argues that there is no satisfactory integration of the various concepts of
the theory and practice of pastoral care in spite of the advent in pastoral care in the
past three decades, and that the tension resulting from the unclarified relationship
between theology and the social sciences burdens pastoral caregivers with confusion
in the practice of their ministry.3

The issue is further complicated by widely differing opinions on the theological

1
Lakshmi Vijayakumar, “Suicide and its prevention: The Urgent need in India,” Indian J Psychiatry 49
(2007) 81-84, http://www.indianjpsychiatry.org (accessed 25 February 2009).
2
David Kohn, “Program trains layperson to treat depression in India,” International Herald Tribune, 11
March 2008, http://www.iht.com/bin/printfriendly.php?=10918910 (accessed 27 February 2009).
3
Holger Eschmann, “Towards a Pastoral Care in a Trinitarian Perspective,” Journal of Pastoral Care
54 (2000) 419.

2
understanding of depression. Historically, depression is seen as a sin to be fled, a
spiritual problem, and an affliction of the body-mind that oppresses the spirit of its
victim. Despite the difficulty to know if and when a person’s depression is mainly a
spiritual matter, it is later suggested that depression is the result of faulty thinking.4

Furthermore, it is clear that pastoral caregivers are also vulnerable human beings.
They are even susceptible to depression that may results in either acting in or acting
out behavior.5 Eventually, they can only survive by being honest with themselves to
the congregation. The most important dimension of pastoral care thus is the need for
communal acceptance.

BIBLICAL AND THEOLOGICAL PERSPECTIVES

Luke chapter 9, verses 1-4, summarizes very clearly the biblical challenge to a
commitment to the understanding of and involvement in the church's healing ministry:
When Jesus had called the Twelve together, he gave them power and
authority to drive out all demons and to cure disease, and he sent them
out to preach the kingdom of God and to heal the sick. He told them:
"Take nothing for the journey - no staff, no bag, no bread, no money, no
extra tunic. Whatever house you enter, stay there until you leave that
town".6
Accordingly, the challenge to the church today is a three-fold one. God's people are
being called to be healers, who proclaim and demonstrate a total gospel of forgiveness
and healing, of the whole person, and in a healing community. Luke 9:3-4, in
particular, demonstrates that the faith community cannot heal as isolated individuals
because they need one another. What distinguishes any local congregation from a
secular organization is a fellowship formed by the Holy Spirit, gifts of the spirit for
ministry, proclamation of the gospel as the good news of grace, teaching for Christian
growth, and prayer as our means of access to God.7

Eschmann suggests three dimensions of pastoral care in Trinitarian perspective

orientated by the structure of the Apostles' Creed. Firstly, the pastoral care in the field
of the doctrine of creation refers to blessing and healing. It is argued that in a helping
relationship of true understanding healing capacities of self-realization can become
effective in the individual. Secondly, reconciliation and conversion are regarded as the
pastoral care in the field of the doctrine of salvation. It is concerned with enlightening
4
M. D. Lastoria, “Pastoral Counseling and Spiritual Help,” BEPC 339-340.
5
R. L. Randall, “Ministers and Churches at Risk,” Christian Century 1093-1095.
6
Luke 9:1-4 (New International Version).
7
E. A. Allen, “What is the church’s healing ministry? Biblical and Global perspectives.” International
Review of Mission 46-50.

3
the human situation under judgment and the grace of God, with the proclamation of
the gospel, with human guilt, and with the unconditional acceptance of God. Finally,
sanctification and fellowship fall into the pastoral care in the field of the doctrine of
Holy Spirit. It reminds us that human existence retains a fragmentary character and
that the whole creation yearns for their perfection and completion.8

Furthermore, Guthrie proposes another three dimensions of therapeutic alliance in

Trinitarian perspective. Based on Christian doctrine of human beings and the doctrine
of Trinity, human nature and destiny are understood in relation to God the Father (the
Creator), Son (the Redeemer), and Holy Spirit (the Life-Giver). As a result, both the
pastoral caregivers and the counselees are regarded as first, creatures in the image of
God; second, sinners who contradict what they were created to do; and thirdly, people
who were promised a new humanity.9 Accordingly, human individuality is actualized
in human community, and human community protects and nourishes human
individuals.10

In light of these observations, I would like to present my understanding of the nature

of the ministry of therapeutic community in relation to depression, followed by an
application involving a specific case. Following this, I will address the issues of
therapeutic community in pastoral care of depression

THERAPEUTIC COMMUNITY: TOWARDS AN INTEGRATED APPROACH

TO PASTORAL CARE OF DEPRESSION
Therapeutic community may be compared to an encounter within a divine milieu in
which the group facilitates the healing of its member’s broken relationships through
acts of empathic understanding, unconditional positive regard, and congruence11.

Expressions of God’s presence

Shelp puts it best when he conceptualizes the ministry of the congregation as a
strength of the Care Team concept. The uniqueness of this approach lies in the
understanding of life in Christ as a compassionate life lived together as community in
which healing takes place. It is this compassion that draws members to offer care and
support to others who are vulnerable and broken. By their presence and care on behalf
of the community, they are expressions of God’s presence.12 This encounter allows
8
Eschmann, “Towards a Pastoral Care in a Trinitarian Perspective,” 424-426.
9
S. C. Guthrie, “Pastoral Counseling, Trinitarian Theology, and Christian Anthropology,”
Interpretation 130-133.
10
Guthrie, “Pastoral Counseling,” 134-136.
11
It was found that psychological changes occurred in the individual only when these three conditions
were present (Carl R. Rogers, On Becoming a Person (Boston: Houghton Mifflin, 1961), 60-63.)
12
E. E. Shelp, “Pastoral Care as a Community Endeavor,”

4
one to envision therapeutic community as a ministry-service to a person in need of
empathic understanding. In this way, the essence of ministry is not only human in
nature but also transcendent.

This transcendent character of therapeutic community undoubtedly constitutes the

aspect of mystery in pastoral care of depression that always remains beyond one’s full
comprehension. William A. Smith, having tapped the resources of those with whom a
depressed person has positive relationships and held Holy Communion with them,
concludes the role of therapeutic community in pastoral care of depression in this
way: “These reflections on the ministry to the depressed person have as their premise
that depression (whether mild or severe) can be the basis for spiritual transformation
and growth. This implies that depressive symptoms point to an inner spiritual stress
where new spiritual foundations in a person’s life are being formed because of the
breaking down of things previously relied upon. This suggests that depression, seen
from this point of view, has within it the possibility of loss of faith and a spiritual
dying, where one functions with a creed of hopelessness and survives by affirming the
meaninglessness of life.”13

Nevertheless, Randall reminds us of the common problems and conflicts within

congregations which are frequently rooted in the acting-in and acting-out behavior of
professional and lay caregivers at risk.14 Therefore, there is always a need to attend to
the self of each congregation when at-risk congregations are signaled.

Means of salvation
Despite the encounter with depression as a means of spiritual transformation is
inspiringly significant, the balance between increasing psychosocial maturity and
toward an all-encompassing spiritual integration is equally important . Lowe
eloquently describes this understanding: “The therapy provided by the fellowship of
the church is to be the means of salvation for its members who are estranged and cut
off from meaningful relationships with God and their fellow men”.15 This description
reconfirmed my strong belief that the faith community must invariably approach its
member as a psychospiritual being and thus pay special attention to both psychosocial
and spiritual dimensions of his or her development in order to obtain a comprehensive
view of that person. Pastoral care accordingly should address both dimensions as the
means of salvation.

http://www.parkridgecenter.org/Page516.html (accessed 10 February 2009).

13
W. A. Smith, “Ministering to the Depressed Person,” Journal of Pastoral Care 23.
14
Randall, “Ministers,” 1094.
15
C. M. Lowe, “The Healing Community: church and mental hospital,” Pastoral Psychology 20 (1969)
55, http://www.sprinngerlink.com/content/xn24663v6g821003/ (accessed 10 February 2009).

5
Myers sees the role of congregations to be a vital venue for consciousness-raising that
results in depressed persons and their caregivers getting help.16 Mindful of and
respectful of a member’s striving, the faith community embraces the whole of the
person indicating thereby that unconditional positive regard is essential to healing in
the therapeutic community.

However, Wolff gives us a word of warning: “the difference between psychiatric

treatment and advice given by a religiously trained representative of a church
organization should not be overlooked. Real psychiatric treatment belongs to the
trained psychiatrist, who knows the physical and emotional factors involved in an
emotional disturbance. Some emotional sicknesses, like psychoneurosis, require
special training in psychotherapy, and treatment may last a couple of years. The more
severely "mentally sick" patient should be handled by professionally competent
persons only, and unrealistic or untimely experiments in treatment might do more
harm than good. The psychological difference between a psychiatrist and a religious
therapist can, at times, be great.”17

Priesthood of all believers

James. A. Knight defines the congregation in this way: “The congregation is an
instrument of therapy. The message in the Gospels discloses that an intimate
relationship was taken for granted between physical, mental, moral, and religious
health. Incidents are recorded in which a physical affliction was healed and sins were
forgiven in one and the same act. Nobody attempted to split human health into a
multiplicity of functions, and likewise nobody attempted to promote the welfare of
one individual in abstraction from the salvation of the community. Each person saw
and felt the spirit of God working through the religious community and knew himself
to be a part of the priesthood of all believers.”18

Knight’s description of congregation as therapeutic tool certainly became real to me

as I personally experienced healing of depression in the context of a small group.
Pastoral care is by no means a specialized function of the professional clergyman, but
rather is a task of the whole church, laity and clergy, accomplished through small
groups.19 The mode of care of depression in small group is thus done within the
16
D. R. Myers, “How can I care when they don’t care: Congregational Responses to the Caregiver with
the Older, Depressed Family Member,” Journal of Family Ministry 60.
17
Kurt Wolff, “Religion and Mental Health.” Journal of Pastoral Care 43.
18
J. A. Knight, “The therapeutic opportunity of the clergyman and the congregation,” in H. J. Clinebell,
Jr (ed), Community Mental Health: the Role of Church and Temple. Nashville: Abingdon, 1970.
http://www.religion-online.org/showbook.asp?title=798 (accessed 27 February 2009).
19
C. H. Reid, “Pastoral care through small groups.” Pastoral Psychology 18 (1967) 14,

6
context of the genuine relationship between members. In this way, the condition of
personal change is seen to lie in the congruence of the congregation.

Anderson offers more heuristic insights into the dynamic relationships between
congregation and mental health. Ten theological principles are extracted: (1) The
health of the congregation and the mental health of its members are reciprocally
related; (2) Health is never an end in itself; it is always a penultimate goal; (3) A
congregation may work toward health, but that is not its primary purpose; (4)
Christian congregations cannot avoid the obligation to be agencies of healing; (5)
Sickness is not a private matter, and neither is healing; (6) Because health is never
fully possible, the ministry of healing is always an ongoing necessity for Christian
communities; (7) In order that a congregation might maximize its potential as a
healing and sustaining human community, some shift is necessary in the practice of
ministry; (8) The congregation is a natural mental health resource because it is a
bridge between the individual and society; (9) The relationship between the
congregation and mental health is an instance of the larger theological question of the
relation between salvation and health; and (10) This emphasis on the congregation as
a community of care presupposes that human nature is communal as well as
individual.20 In the perspective of therapeutic community, we accordingly learn how
to be and function as a reality of the priesthood of all believers.

By receiving basic trainings in mental health, laypersons are more able to develop
therapeutic alliance that is truly analogous to a specialist’s role in providing for a
patient’s needs and experiences with depression.21 It may be deduced from my earlier
statements regarding spiritual and psychosocial interdependency that one may talk
about the pastoral care of depression within the faith community.

However, the fact that clinical ministries are also part of the pastoral care should not
be overlooked. Anderson puts it right when he urges us to give more attention to
fostering an organic connection between congregations and clinical ministries: “The
support of persons providing pastoral care in specialized settings is an expression of
the congregation’s ministry of healing insofar as these persons continue to function in
the place of a local congregation to provide pastoral care for those life crises
necessitate special treatment.”22

http://www.springerlink.com/content/w4846385j2372965/ (accessed 10 February 2009).

20
Herbert Anderson, “The Congregation: Health Center or Healing Community,” Word & World 126-
128.
21
Kohn, “Program,” 1.
22
Anderson, “Congregation,” 129.

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The conceptual framework just presented can be seen in my personal experience: I am
reminded here of my failure to concentrate in my work and be passionate with people
for nearly six months before I came to India. As an infant aged six months, I was
abandoned by my divorced parents and was sent to my adoptive father and my
maternal aunt. It was until the age of fifteen that my adoptive father married my
mother and we lived together. As an adolescent, I had experienced an upsetting
disagreement with my mother and struggled and anguished over this before I went to
college. Later I told myself that I had forgiven my mother and at the same time kept a
distance from her. Since my adoptive father passed away one year ago, I started to get
more in touch with my mother. Although I perceived and empathized with her
loneliness, I realized later, through the similar struggle of a Christian friend, that I had
also failed to acknowledge the repressed anger towards my mother even though I had
worked very hard. What I had missed was my hatred towards her; I did not let go of
my frustrations in my adolescence. As I became conscious of this, I chose to share my
struggle in a small group of believers. In reflecting back over the experience, I realize
it was their empathic understanding, unconditional acceptance, and congruence which
led me to the experience of God’s presence, the transformation and maturation
resulting from salvation, and the involvement of a part of the priesthood of all
believers.

SOME ISSUES OF THERAPEUTIC COMMUNITY IN PASTORAL CARE OF

DEPRESSION
In spite of the fact that the community of believers is one of the overlooked resources
of pastoral care,23 the role of Christian social support in coping with depression is
open to criticism. White and others identify attributions as the key to determining the
depression-buffering role of faith community.24 As a result, obstacles to the
comprehensive interpretation of meanings are to be removed in order for a therapeutic
community to actualize itself. I have identified three sources of the obstacles.

Inadequacy of psychospiritual education

Earl D. Bland summarizes his attempt to overcome the barriers between psychology
and church: “The role I play is not of an expert or consultant who dispenses guidance
from a distance; rather, I strive to be a participant in the ongoing development of a
community of believers of which I am a part.”25 The strong sense of humility and
passion in the relationship between religion and social sciences allows one to find a
23
R. W. Fairchild, “Sadness and Depression,” DPCC 1105.
24
S. A. White and others, “Christians and Depression: Attributions as Mediators of the Depression-
Buffering Role of Christian Social Support,” Journal of Psychology and Christianity 49-57.
25
E. D. Bland, “Psychology-Church Collaboration: Finding a New Level of Mutual Participation,”
Journal of Psychology and Christianity 302..

8
new level of mutual participation. Nevertheless, the collaboration between church and
psychology is still under construction.

White and others believe that education about the nature of depression and its
symptoms and providing a Christian attribution about the cause and nature of
depression that helps elicit supportive behaviors from significant others are the crucial
components of treatment.26 Myers also sees the role of empathic ministry approaches
to be that of a psychospiritual education for caregivers, in which effective helping
skills are learnt so that emotion-sensitive atmosphere can be cultivated and
emotionally intelligent elements in existing programs can be developed.27 Yet without
collaboration, any promise remains empty.

Lack of a missiological mindset

On the one hand, despite many psychiatrists are seeking collaboration with religious
representatives and are firmly convinced that faith is an important factor in problems
of emotional health,28 there is still a gap between mission and renewal of the church.29
It is thus argued that mission should have a priority for renewal of the church. On the
other hand, although the churches of many developing countries have experienced
prayer-healing movements and some become healing churches, all of them are still
not widely accepted for their particular kind of witness and for their way of doing
theology within the ecumenical fellowship.30 What I believe is that the church has lost
the awareness of engaging its social millieu missionally and of witnessing against
injustice.

Challenge of cultural barriers

All of the above are important but each falls short of what is required. Authentic
integration will demand effective engagement of its culture. Peoples have always had
ways of responding to life transitions, but each ethnic group had its own method.
Ullrich discovers that depression is an appropriate response for the widow who was
regarded as responsible for her husband’s death in South India.31 Webster also shows
that fifty-six out of 175 Dalit Christians tend to turn their anger inward under adverse
circumstances.32 If we are to think constructively about the pastoral care of

26
White and others, “Christians and Depression,” 57.
27
Myers, “How,” 56-63.
28
Wolff, “Religion,” 41.
29
W. R. Shenk, “The Priority of Mission for Renewal of the Church,” Direction 102.
30
C. H. Grundman, “He Sent Them Out to Heal! Reflections on the Healing Ministry of the Church,”
Currents in Theology and Mission 372-373.
31
Helen E. Ullrich, “Widows in a South India Society: Depression as an Appropriate Response to
Cultural Factors,” Sex Roles 169.
32
John C. B. Webster, The Pastor to Dalits. (Delhi: ISPCK, 1995), 133.

9
depression, we need to recognize the cultural factors of therapeutic community.

CONCLUSION
In the light of the biblical and theological perspectives, I have sought to provide a
conceptual framework by which to understand how faith community can be of help to
the pastoral care of depression. It is my belief that it is crucial to understand the role
that conditions of change have in the lives of depressed individuals. This framework
further provides an explanatory rationale for how depression is regarded as a solution
to the disintegration between an adequate theological understanding of human nature
and a psychological efficacy of change within the church and among the community. I
believe that the proposed framework provides directives that might be followed in
future investigation within the field of theology and psychology.

For both pastoral caregivers and depressed individuals, the proposed framework
suggests the crucial need for clinical ministers to educate the congregation and the
community about theological understanding of human nature, psychological
foundation of depression, and social skills of helping. Within the church community, I
believe it is important to provide a missiological understanding about therapeutic
community and to develop a culture-sensitive approach to the care of depression. I
believe that empowering the faith community to develop an integrated approach to
pastoral care of depression is a crucial component of treatment that might enhance the
patient’s recovery and prevent the patient from collapse.

Bibliography
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perspectives.” International Review of Mission 90 (2001) 46-54.
Anderson, Herbert. “The Congregation: Health Center or Healing Community.” Word

10
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Pastoral Care 54 (2000) 419-427.
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1105.
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Herald Tribune. 11 March 2008. http://www.iht.com/bin/printfriendly.php?
=10918910 (accessed 27 February 2009).
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Caregiver with the Older, Depressed Family Member.” Journal of Family
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Smith, W. A. “Ministering to the Depressed Person.” Journal of Pastoral Care 26
(1972) 15-25.
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