A group of women engages in a bible study in a welcoming interior space.

Church & Ministry Boundary Policy

Dr Justine Dreyer | Psychiatrist (HPCSA Registered)

1. Purpose of This Policy

As a registered psychiatrist in South Africa and an active member of a local church community, I serve in various ministry roles including worship, prayer, discipleship, outreach, group facilitation, and teaching.

Because Christian communities – online and in-person – may involve overlapping relational networks, this policy clarifies the distinction between my clinical, ministry, and educational roles.

This policy reflects my commitment to:

  • HPCSA Ethical Rules of Conduct
  • Protection of confidentiality
  • Prevention of dual relationship risks
  • Preservation of patient autonomy
  • Responsible stewardship of both clinical and spiritual authority

A group of women engages in a bible study in a welcoming interior space.

2. Distinction of Roles

2.1 Clinical Practice (Psychiatry)

In formal psychiatric care:

  • A doctor–patient relationship exists only after formal intake and consent procedures.
  • Care is confidential and regulated by the Health Professions Council of South Africa (HPCSA).
  • Treatment decisions follow evidence-based practice.
  • Spiritual themes may be explored, as part of standard psychiatric cultural and spiritual assessment
  • Spiritual themes may be further explored in psychotherapy if requested and consented to by the patient
  • Therapy is not intended to be used for theological persuasion or discipleship.

2.2 Church & Ministry Contexts

In church settings:

  • I serve as a fellow believer and in ministry roles.
  • Conversations in church or ministry contexts do not constitute medical assessment or psychiatric treatment.
  • Ministry support does not create a doctor–patient relationship.
  • I do not provide diagnosis, prescribe medication, or conduct clinical assessments in ministry environments.

2.3 Online & Educational Platforms

(Including social media and all publicly-available content or teachings)

  • Content is educational and reflective in nature.
  • It is not individual medical advice.
  • Engagement via social media does not establish a therapeutic relationship.
  • I do not offer psychiatric consultations via direct messages or online comments.

3. Managing Overlapping Communities

In Christian communities, complete separation between clinical and ministry spheres may not be possible.

Where reasonably feasible:

  • I avoid providing psychiatric care to individuals under my direct ministry oversight.
  • I avoid assuming one-on-one spiritual mentoring, discipleship or doctrinally directive roles with individuals I currently treat.
  • I will avoid intensifying relational or one-on-one spiritual authority dynamics with individuals I currently treat.
  • I may adjust leadership involvement over particular persons, if it is possible to do so without disclosing confidential information.
  • I may terminate a clinical relationship or refer a patient to another practitioner for continued clinical care, when appropriate.

Confidentiality remains paramount.

4. Protection of Patient Autonomy

If a patient and I share a church or theological context, my aim as far as is reasonably feasible, is that:

  • Therapy remains patient-centred.
  • Patients are not expected to share my theological views.
  • Clinical decisions are not contingent on doctrinal alignment.
  • Spiritual material is explored within the patient’s own framework and consent.

5. Teaching & Recorded Content

When teaching or preaching:

  • I speak in a ministry capacity, not as a treating psychiatrist.
  • I avoid diagnostic labelling of identifiable individuals or groups.
  • I aim to uphold confidentiality and not reference clinical cases where identification risk may exist.
  • Public teaching is not psychotherapy and does not constitute medical advice.

6. Crisis Disclosures in Ministry Settings

If an individual discloses acute psychiatric risk in a ministry context:

  • Immediate safety is prioritised, and this may include breaching confidentiality.
  • Appropriate emergency or referral pathways may be activated.
  • Ministry response does not automatically create a formal therapeutic relationship.

Formal psychiatric care requires proper intake, consent, and clinical structure.

7. Ethical Foundation

Across all roles, I aim to:

  • Avoid exploitation of authority
  • Prevent role fusion
  • Protect confidentiality
  • Uphold HPCSA standards
  • Practice transparency regarding scope of care

8. Questions or Concerns

If you are part of my Christian community and are considering psychiatric care, or if you are uncertain about role boundaries, you are welcome to raise concerns directly.

Dr Justine Dreyer
HPCSA-registered psychiatrist