The document outlines six therapeutic directions for addressing psycho-emotional problems in pastoral care, including biophysical, intrapsychic, behavioral, socioeconomic, meaning, and morality. It highlights the role of different specialists and emphasizes the importance of faith, community, and trust in providing pastoral support. Additionally, it discusses the three tiers of spiritual assessment—faith, hope, and love—along with diagnostic and treatment approaches in pastoral counseling.

1. Pastoral Diagnosis
Bukal Life Care
2017

2. Consider 6 Possible Therapeutic
Directions for Psycho-emotional
Problems
1. Biophysical. Problems stem from problems with the
physical body.
2. Intrapsychic. Problems stem from bad mental
processes going on within the mind.
3. Behavioral. The problem is bad learned habits that
must be unlearned/replaced.
4. Socioeconomic. The problem is the environment the
person is in. Setting change is needed.
5. Meaning. The problem is that the individual has failed to
gain a sense or purpose or meaning in life.
6. Morality. The problem is conflict between actions and
sense of moral obligations and social responsibilities.

3. Who are the Specialists in these Problem
Areas?

Psychiatrists specialize in the first area (biophysical)

Psychologists specialize in the 2nd
(intrapsychic) and 3rd
(behavioral) areas

Social workers specialize in the 4th
area.

But who specializes in the 5th
(meaning) and 6th
(morality)
areas?
These areas would normally be thought of as the
specialization of chaplains and other pastoral counselors.
(Mahony, 1975)

4. Psychological Diagnosis deals with the
patient's physical, behavioral, socio-economic
and intrapsychic characteristics.
Pastoral Diagnosis, however, focuses more on
meaning and ethics/morality. These two are
more in the realm of spiritual or religious or
theological concerns
<Note: Pastoral Diagnosis may also be termed
pastoral or spiritual assessment>

5. “The Minister as Diagnostician:
Person Problems in Pastoral
Perspective” by Paul W. Pruyser (1963)
This book gives 7 dimensions consider in a
client/parishioner.
− The Holy
− Providence
− Faith
− Grace/Gratefulness
− Repentance
− Communion
− Vocation

6. We will look at them Somewhat
Differently

7. Bottom Tier: Faith (Sources of
Change)

“The Holy”/Sacred

Communion/Community

Providence/Trust
These are the relationships and support system
outside of ourselves that can motivate us to
change, and sustain us through difficult times.

8. Bottom Tier: Faith
These are the concerns that a chaplain should
investigate on the initial visit.
• Who or what is god in the patient's life?
• Who are able to provide a support structure for
the patient (family, friends, church, etc.)?
• How important are each of these to the patient?

9. “The Holy”

Who or what is sacred to the client?

What does he or she revere?

Does the person have a sense of awe for
something beyond him/herself?

Does the individual have a sense of being a
limited (created) being?

10. “The Holy”
This matters because it seeks to discover “idols”
in the persons life. Such an idol may include:
•
A specific person, idealized
•
A personal dream or goal
•
Anything that one places one's energy and
resources... one's personal treasure.
Recall: Where one's treasure is, is where one's
heart is also.

11. Communion/Community
Communion “has to do with embeddedness,
reaching out, caring, and feeling cared for.”
•
How connected or disconnected/estranged
from others.
•
“Others” can include specific individuals,
groups, mankind as a whole, nature as a whole,
and God.
•
While estrangement (disconnectedness) may
be bad... connection to the point of being
“encapsulated” can be bad as well.

12. Communion

Communion is tied to SHAME and
ALIENATION.

Shame leads to feelings of disconnection from
others.

Feelings of alienation from others often means
that the support network that can help the client
grow and heal is missing.

13. Providence/Trust

What does the person believe is God's (divine)
purpose with respect to him or her?

Is the universe a benevolent place or a cruel
one? Do things happen because of Luck?
Justice? Natural forces? Fickleness?

Does God have a plan or not?

14. Providence/Trust
Providence ultimately is a question of TRUST.
•
Can I trust God?
•
Can I trust the pastoral care giver?
•
Can I trust those around me?
•
Can I trust that there is something to place my
hope in?
Trust in the Lord.... and He will make your paths
straight.

15. Note:
The bottom tier tends to line up with what is
often called “Spiritual History.” This is a series
of simple questions that are used in the hospital
(particularly) to quickly evaluate the patient.

16. Spiritual History Example: FICA
F -- Faith and Belief . "Do you consider yourself spiritual or
religious?" or "Do you have spiritual beliefs that help you
cope with stress?" IF the patient responds "No," the health
care provider might ask, "What gives your life meaning?"
Sometimes patients respond with answers such as family,
career, or nature.
I -- Importance. "What importance does your faith or belief
have in our life?" "Have your beliefs influenced how you take
care of yourself in this illness?" "What role do your beliefs
play in regaining your health?"

17. FICA
C – Community. "Are you part of a spiritual or religious
community?" "Is this of support to you and if so, how?" "Is
there a group of people you really love or who are important
to you?" Communities such as churches, temples, and
mosques, or a group of like-minded friends and family can
serve as strong support systems for some patients.
A -- Address in Care. "How would you like me, your
chaplain/pastoral care provider, to address these issues in
your care?"
“FIC” are the foundational tier or sources of change.
The “A” is the transition to the 2nd
tier.

18. Spiritual History: HOPE
H – Hope Sources (meaning, comfort strength,
peace, love). What gives the patient internal
strength, support, and meaning. Who are what
does the patient turn to in times of difficulty or
crisis?
O – Organized Religion. What is the patient's
organized religion (if any)? How important is it
in the patient's life. What aspects of this
religion are helpful? Unhelpful? Is the patient
involved with a religious or spiritual community?
Is it helpful?

19. Spiritual History: HOPE
P – Personal Religion/spirituality. Does the patient have
personal beliefs that are independent of organized
religion or divergent from his/her own religion? What
are they? What is the patient's view of God and
relationship with God (if any)? What specific personal
spiritual/religious practices does the patient find
helpful?
E-- Effects on Medical Care and End of Life Issues. Has
the patient's situation had an effect on doing things
that shape him/her spiritually? Is there anything the
pastoral care provider can do to help with
spiritual/pastoral/religious concerns? Are there
conflicts between medical care and the patient's
religious beliefs?

20. Spiritual History: FAITH
F Do you have a Faith or Religion that is
important to you?
A How does your faith/beliefs Apply to your
health?
I Are you Involved in a faith group or
community?
T How does your faith/beliefs affect your
Treatment?
H How can I Help you, especially regarding
pastoral concerns?

22. The Second Tier is About Hope

Openness

Vocation/Plan
What limits do we place on ourselves that keep us
going in one direction or limiting ourselves to
one place or plan?
How much flexibility will we allow ourselves to
consider something new?

23. Openness
<Pruyser calls this “Faith” but this is not about
“saving faith.” It is more to do with one's stance
regarding life. It is more about hope.>
•
Does the client embrace life and experience or
shy away from it?
•
Does the client have the courage to explore,
learn, and grow... or not?
•
What self-imposed boundaries does the person
place on his/her life?

24. Openness
•
Are they open to change... the unknown?
•
Are they able to leave their comfort zone?
•
Can they overcome doubt?
Recall Peter walking on the water...

25. Vocation/Plan
This term is a bit misleading. The point here is not
about having a career. Rather it is the feeling
that one is part of God's plan in the world--
having, perhaps, a feeling of “divine calling.”
• One feels part of an overall movement by God
to make the world more right... better.
• Life is a pilgimage... having meaning and
direction.

26. Vocation/Plan
One's plan or path has to do with purpose or pilgrimmage
or calling. What is the client's sense of what they are
meant to become. Path is an important Biblical
concept. Psalm 23 describes sheep following the Lord
on the “paths of righteousness” even if it involves going
through the “valley of the shadow of death.” Jesus' call
to His disciples was to “Follow Me.” Jesus further
speaks of the Wide and Narrow Paths. In fact, early
Christians described themselves as being members of
“The Way.”

28. Third Tier: Love (or Tools of
Change)

Grace

Repentance
Both are primary tools of change in the life of any
person.

29. Grace/Gratefulness
Grace, ultimately is about “kindness, generosity,
gifts, the beauty of giving and receiving, or
'getting something for nothing.'”
Grace involves giving grace or receiving it
(gratitude).
It can involve God, others, or self.

30. Grace/Gratefulness
This factor is strongly related to GUILT and
FORGIVENESS.
•
How does one handle guilt?
•
How easily does one forgive? How easily does
one accept forgiveness?
•
Is the client able to forgive him/herself.

31. Repentance
Repentance has a moral sense... correction from
wrong to right. More generally, it is the intention
and action of going to a place of greater well-
being.
•
Is the client aware of his/her own role (call it sin
or something else) in the problems faced?
•
Does the client have remorse, a desire to
correct, and to fix what went wrong?

32. Repentance
Repentance is strongly connected to CHANGE,
or the willingness to change. A desire to
change, a recognition of the need and ability to
grow.
Note: many want things “to be better” but are not
willing to repent... take responsibility for one's
own role, correct what was wrong, and do
better.

33. How to Diagnose?
Actively listen!!
Don't push “churchspeak.” Their thoughts will
come out in normal conversation.
”No God-talk is needed in the pastoral diagnostic
interview although there should be no ban on it.
What is needed is theological alertness-- the tacit
guidance the pastor receives from his basic
discipline while he deals with a concrete individual
who may talk about bereavement or anger or great
disappointments.” (p. 63)

34. Additional Terminology
Going back to the Three-tiered diagram:
• As noted before, the bottom Tier (Faith)
essentially lines up with what is sometimes
called “Spiritual History” such as is often done
by a chaplain in a hospital.
• All three Tiers (Faith, Hope, and Love)
essentially lines up with what is sometimes
called “Spiritual Assessment” such as done by a
pastoral care provider in a counseling center.

35. Systematic Versus Pastoral
Theologies
For many there is a seen a huge difference between systematic
theology and pastoral (or practical theology) .
Yet, ideally, they are linked. Consider several major branches of
systematic theology (Reference: Dr. Doug Dickens)

Theology Proper (Trinity)

Anthropology (Study of Man)

Ecclesiology (Study of the Church)

Eschatology (Study of Last Things)

Soteriology (Study of Salvation)

Cosmology (Study of Creation)

Epistemology (Study of Knowledge/Revelation)

36. Systematic and Pastoral
Theology

37. Systematic Versus Pastoral
Theologies
Rather than systematic and pastoral theologies competing or being
disconnected, systematic branches can provide insight for
pastoral theology questions... especially for self-reflection.

Theology Proper (Who or what matters most to me?)

Anthropology (How can I be more human or genuine?)

Ecclesiology (Who or what is my community?)

Eschatology (What happens when I die?)

Soteriology (How can I change?)

Cosmology (How should I understand the world? Safe?
Scary?)

Epistemology (How can I know what is true or what matters?)

38. Pastoral/Spiritual Assessment
Using the Beatitudes
For diagnosis, the 8 characteristics are looked at in
terms of characteristics of healthy people:
--Poor in Spirit Identity (shame)
--Mourn Vulnerability
--Meek Discipline
--Hunger... Righteousness Motivation
--Pure in Heart Integrity (guilt)
--Merciful Empathy
--Peacemakers Community
--Persecuted... Courage

39. You may have noticed:
There is NO ONE WAY to diagnose or treat in
pastoral counseling.
There is also no single set of clearly defined
diagnoses.
Rather, there are basic principles drawn, primarily
from theology, centuries of pastoral care
experience, and, to a lesser extent, the social
sciences.

40. References
Pruyser, Paul W. The Minister as Diagnostician: Personal Problems in Pastoral
Perspective.” Westminster Press, 1963.
Additionally
Pargament, Kenneth, et al. “The Many Methods of Religious Coping: Development and Initial
Validation of the RCOPE” Journal of Clinical Psychology, April 2000
Townsend, Loren L. “Best Practices: Rethinking Pastoral Diagnosis”
Dickens, Doug. Notes from class “Pastoral Theology,” ABGTS, 2015/2017.
Larocca-Pitts, Mark. “FACT, A Chaplain's Tool for Assessing Spiritual Needs in an Acute Care
Setting.” Chaplaincy Today. Vol. 28 No. 1, Spring/Summer 2012, 25-32.
Malony, H. Newton. “The Demise and Rebirth of the Chaplaincy” Journal of Pastoral Care, Vol. 29
(1975).