If brief situational counseling is like taking a car in for lubrication, oil change, and tire rotation, then longer term pastoral psychotherapy is like rebuilding the car’s engine. This requires the thorough integration of a Christian personality theory with a well-established counseling theory, and supervision of your initial counseling experience.
You want enough knowledge about personality disorders to treat counselees with narcissistic, compulsive, paranoid, antisocial, histrionic, dependent, avoidant, schizoid, and borderline personality patterns. You want enough knowledge of biochemical disorders such as chronic depression, bipolar disorder, and attention-deficit disorder to discern when a referral for medical evaluation is indicated.
You want an understanding of the role of the unconscious in the generation of psychopathology and the therapeutic transformation of personality. And you need to undergo a course of psychotherapeutic treatment yourself, a standard requirement for advanced degrees in counseling, so that your own personality patterns do not negatively impact the counseling process.
The reason for this extensive psychological preparation is simply that you don’t want the counselee to become worse off for seeing you! And this is what can happen when a counselee’s repressed emotions, irrational thoughts, conflicted values, and pent-up pain enter the counseling arena. You can take them too far too fast, or make a seemingly innocuous remark that sets in motion rash decisions, suicidal urges, destructive aggression, or the collapse of a fragile sense of self.
Nor do you want to become emotionally enmeshed with your counselee, so that you both topple off the nearest cliff. Think of it like this: if your counselee needs you as a guide to ascend Mount Everest, you want to have safely guided many people up that mountain so that you know the territory.
Contemporary theoretical and practical tools for the empowerment of pastoral psychotherapy are found in the following books: Pastoral Counseling and Personality Disorders, by Richard Vaughan (1994); Clinical Handbook of Pastoral Counseling, edited by Robert Wicks, Richard Parsons, and Donald Capps (2003); and Christian Counseling That Really Works: Compass Therapy in Action, by Dan Montgomery (2008).