Though the American Association of Pastoral Counselors has specific requirements for its members' certification, there is no centralized licensing board. Pastoral psychotherapists can be based at churches or religious institutions or have their own practices. Most pastoral psychotherapists say they help their patients with the same problems secular psychotherapists confront. The difference, say people in the field, is that therapists with religious training can relate to the spiritual aspects of patients' lives. Or they have anger against an authoritative regime in religion, and they transfer that anger to God.
People of faith face certain issues that nonreligious people are less concerned with.
Crises of faith and issues around sexuality often come up in sessions, counselors say. Bauman described one patient who has a wife and children but thinks he may be gay. Part of the problem, Bauman said, is that the man grew up believing that being gay is sinful. He needs to find himself on that continuum. The American Association of Pastoral Counselors has been criticized by some for being too liberal on issues such as homosexuality, and abandoning the more orthodox beliefs of its member churches.