Salus Forum December 3, 2025

Bill B

I think in small towns, it’s inevitable for physicians. Everyone in the professions has some dual relationships is these communities.  At times, they can be problematic, as we found in our study. But Jack, you’re probably right about this being a professionalism issue.

Jeremy

We’re involving psychologists in our primary care practice. So, aren’t clergy sort of behaving like primary care clinicians to some degree? They’re triaging primary care challenges? Is this a psychological issue? Is this a physical issue? Is this a financial, marital, or relationship issue for this person? I’m sure pastors are doing this every day. And they are running into personality disorders. Their entire church gets potentially split in half by those things. I think that’s a fascinating concept. Just to see the parallels between primary care and clergy care, if we were to call it “care”. And I think what I’m hearing is, in general, some folks are trying to train or provide CBT-level intervention, which to me sounds wise, because it’s hard to imagine CBT hurting anybody. Wouldn’t we categorize that as harmless, but potentially beneficial? It’s on all the recommendations and depression treatment, anxiety treatment, but rarely do primary care doctors advise people to do it, that I know of, at least.

It’s an interesting topic. And I was surprised to hear that there already is training in CBT among pastors.

Bill B

The major problem is simply disappointment. People have often gone through CBT. And nothing of significance has been accomplished by the end of the CBT sessions. There is just, at best, some temporary symptom relief.  Many times, clinicians say that the next person who comes to my office often doesn’t think psychotherapy works. They’ve been to four different therapists, and their therapists are all using CBT.

I want to get a little off and just say something strange up here, because it has to do with the issue that we were talking about earlier. Jack brought up the issue of people who had AIDS in the early eighties and were dying of AIDS. In my school in San Francisco, about a third of our students in the early eighties were gay, and about over half of them were primarily serving men who were dying. I convened a conference about this service to those dying of AIDS. I had four esteemed clinicians talking about their work with AIDS-inflicted men. They were going through the standard stuff about treating dying patients. Then the fourth panelist spoke. He said that the real issue when he was meeting with someone dying of AIDS, was that he was actually working with two people or two entities. There’s a second entity in the room. “I find I have to deal with both entities!”

I remember the room got very quiet. So I said to the other three clinicians: Does that ever occur for you? And all three of them said: “Yes, there is often another entity in the room with the man.” And what’s remarkable is that the panels and other people at the conference began to talk about the spiritual dimension. And there’s the issue. As clinicians, they’re saying: “God, we just don’t know how to handle this stuff. So, this is weird stuff. I usually don’t bring this up. But ever since that session in early 1990s, I often wonder to what extent, as physicians, you folks ever deal with a second entity in the room?

[Long quiet period.]