To kick off this feature in Around the Word called “Pastoral Care and…,” it would probably be a good idea to lay down some definitions. The very first thing we need to get a handle on is what is meant by “Pastoral Care.” Pastoral care comes in two varieties: ordinary and extraordinary. The first is called ordinary not because it’s dull, but because it is mandated by God. Ordinary pastoral care happens week after week when Christians come into the presence of the living God in the Divine Service to receive His gifts. There, forgiveness of sins, life, and salvation are dispensed to penitent hearts through the Word proclaimed and the Sacraments administered. But on occasion Christians need individual attention. This is supplemental to the ordinary care we receive collectively in worship; hence it is commonly called “extraordinary.” Yet it’s hardly unusual. We all need personal pastoral care from time to time. So let’s focus on that: What do we mean by individual pastoral care?
Most everyone has a pretty clear picture of why caring pastors are important. A shepherd of Christ’s flock needs a caring heart, that’s for sure. He needs to be a people person; someone who is approachable, winsome, and compassionate. All the Biblical and doctrinal knowledge in the world won’t help us if it remains locked up in our pastor’s cranium. It needs to be unpacked and applied in ways that we can hear it, grasp it, and make use of it. So that’s the first quality of good pastoral care: it comes from a knowledgeable, caring pastor.
But there’s more to pastoral care than that, much more. Actually the term “pastoral care” is a modern adaptation of the ancient phrase “care of souls.” Implied in this lovely, old-fashioned expression is the conviction that Christians are chronically ill and continually in need of help. The illness is spiritual in nature; it consists of the sins we’ve committed and the sins that others have committed against us. As we say in the catechism: “…we daily sin much and deserve nothing but God’s wrath and punishment.” Only after having been forgiven are we able to “…sincerely forgive and gladly do good to those who sin against us.”
Even prior to the development of modern medical science and the medical professions, it was common to call pastors “physicians of souls.” Like medical doctors, pastors were to tend the ailments of those who were sick, providing appropriate treatment toward wellness and recovery. To this day, various departments in major hospitals are known as “care centers.” Required for informed treatment is the process of diagnosis: listening to the patient and observing the symptoms of the illness, arriving at the underlying cause(s) of the ailment, then treating the core problem rather than merely relieving the symptoms.
There is a parallel process that happens in quality pastoral care. First the pastor listens. He explores the soul’s complaint from every angle, taking into consideration preexisting conditions, unique circumstances and personal dispositions, co-morbidity/concurrent diagnoses, etc. Then working patiently and gently, he applies the cures the Lord has entrusted to His church: God’s Law in its severity and His Gospel in all its sweetness. Sin is of course a chronic condition, but we all have episodes of acute need when we’re desperately in need of God’s healing. That’s when we should seek pastoral care, fully confident that we will find in our pastor not merely a compassionate heart, but a discerning spirit and attentive cure for what ails us. He will listen, teach, admonish if needed, pray with us and for us, and bless us in the Name of the Holy Trinity. Above all our pastor will encourage and assist us with the consolation of the Holy Spirit through His life-giving Word.
Now, what about the conscience? There’s a popular view that defines conscience as the internal moral compass that everyone has: sometimes right, sometimes wrong — in fact, sometimes greatly misinformed, twisted and depraved. The common, but unfortunate term “values” comes close to the moral compass idea. In this view, each of us has our very own set of moral standards — all equally valid, no matter how diverse — by which we judge things right or wrong and chart the direction for our life.
However, the biblical evidence is that conscience involves much more than an inner compass; it actually is more of an umpire that discloses our relationship to the living God. For example, St. Paul insists that young pastor Timothy instruct the other pastors in Ephesus not to listen to false teachers but to teach only the pure Word of God. “The aim of our charge,” he writes, “is love that issues from a pure heart and a good conscience and a sincere faith” (1 Timothy 1:5).
You see, the devil is a liar and the father of lies (John 8:44). His very name, Satan, means “accuser.” He delights in getting us to sin and then accusing us of sin. His insidious goal is to drive us to despair: first to give us a bad conscience before God, then to get us to give up on God’s grace and forgiveness -- convincing us that we’ve sinned so severely that God could not possibly love us. This is where St. Paul’s instruction to Timothy comes in: all pastoral care has as its goal the delivery of a good conscience to people under constant spiritual attack from the devil, the fallen world, and their own sinful nature.
And how does faithful pastoral care deliver a good conscience? Not by the wisdom or ingenuity of the pastor, that’s for sure. Rather, the active Agent in pastoral care is Jesus Christ who has entrusted His saving gospel to the church and called servants to proclaim that gospel in His Name. The blood of Jesus Christ not only remits sin, but cleanses from sin’s defilement (1 John 1:7). It gives broken sinners new and clean hearts (Psalm 51:10). It gives new and lasting hope, bestowing a clean conscience for lively service to the living God (Hebrews 9:14).
So if you’re serious about healthy living, don’t neglect the spiritual realm. Seek out your soul’s physician for God-given care. You’ve got nothing to lose except a bad conscience!
Rev. Harold L. Senkbeil
DOXOLOGY: The Lutheran Center for Spiritual Care and Counsel
 The Fifth Petition, Luther’s Small Catechism, (CPH, 1986), p. 19.