While pastoral counselling is a function of pastoral ministry in religious communities, it is also a specialised ministry requiring professional training that extends well beyond a pastorall theological education for ministry, as well as beyond the confines of religious communities. This article is an American perspective on Certified Pastoral Counsellors as mental health care providers for individuals, couples, and families, generally on a fee-for-service basis, with many qualifying for reimbursement by private and federal third party payers. It demonstrates that pastoral counselling as practised in the USA is spiritually integrated counselling and psychotherapy, requiring graduate academic and clinical work in these disciplines as well as graduate education in religious studies. It offers an American perspective on this specialised ministry of mental and relational health and discusses its identity and function, methodology, supervision requirements, and the clinical use of religious resources, including a case illustration.