Claims that a strong professional identity is key to offering a healing presence and that pastoral counselors can use their dis-ease with conflicting paradigms and wave-trends in mental health care and the wider culture to maintain a professional identity rooted in the history of pastoral care and their respective theological and psychological world-views. Identifies these wave-trends as the defensive use of language, the medicalization of normal human experience, the lack of interest in developmental perspectives on human life, and the overlooking and denial or internal mental processes of persons. Introduces the concept of pastoral counseling as cultural critique and points out implications of this for the direction of the profession of pastoral counseling.