Q. My 19-year-old niece appears to be struggling with deep anxiety. She's decided not to return to college and only appears comfortable in her parents' home. Although she works and has friends, she needs to feel that her parents are always close by. This was a minor problem in her younger years, which has worsened with age. I feel she needs to consult with her medical doctor and/or a mental health counselor, but my brother seems convinced that the counsel of their minister is sufficient. Clearly it isn't, evidenced by her quitting college at a school less than an hour away. When do you feel counsel by clergy is sufficient and when should a person move on to other professionals? I worry that my brother is doing a grave injustice to his daughter, as is the minister.

-- B., via email

A. All the clergy I know face this difficult question often in their counseling. Many people feel there's a stigma attached to consulting a psychologist or psychiatrist that doesn't exist when seeking advice from clergy.

Pastoral counseling enables troubled people to at least receive some help rather than suffering alone. Some also feel that many mental health professionals harbor a negative view of religion, and therefore won't respect the religious commitments of their patients.

My view is that for spiritual questions, clergy are just the right people to consult. However, when the problem is more than a spiritual crisis, and when medication or long-term therapy is required, the troubled person and his or her family should seek out trained medical help.

Most sensitive clergy are aware of their limitations in this regard and will, on their own, suggest a referral to a therapist sensitive toward religious patients. Your niece does seem to have a problem a clergy person is unlikely to be able to address.

I encourage you to speak to your brother and strongly suggest at least a preliminary visit to a trained professional therapist, perhaps using a therapist's ability to prescribe medications as your main argument. If he won't hear you, sadly, there's nothing more you can do.

When I was struggling with health issues and with despair over my dear friend Father Tom Hartman's illness, another friend made and paid for an appointment for me with an excellent psychiatrist. I didn't want to insult my friend or waste his money, so I went to see the doctor and he helped me greatly to begin my crawl out of the pit. Perhaps such an intervention might be received in the same way by your niece and her parents. I pray for her and them and thank God that she is blessed with a family member who cares for her so deeply.

Q. I want to cry, but the tears won't come. Our family recently left our Lutheran church after eight years because our 11-year-old son couldn't handle the noise or the crowd. Our children have autism. One son became very violent during services, creating a public spectacle. My husband, my other son and I took quite a beating from him every Sunday for about a year. We went home sore, exhausted and frustrated. Medication didn't help; neither did discipline nor bribes. The only thing that helped was moving to a smaller, quieter, less crowded (United Church of Christ) church. Our son's doctor said we were wise to leave the larger, overstimulating environment.

While we like the pastor of this new church and the members seem nice, I'm reluctant to join because this is not the first time we've had to switch churches. I don't want to attend another church where things go well for a few years, then turn sour and we have to leave again. I'd be relieved to find a church with a quiet atmosphere where we don't have to explain and apologize, where people understand how difficult it is to raise children with special needs, where they'd refrain from giving us unsolicited parental advice and accept us for who we are. Does such a place exist?

-- K., via email

A. You are wonderful parents, but you are not only parents. You are also individuals with your own spiritual needs, and your other son also has these needs. I would advise you to get a sitter for your more troubled son so you can attend church in peace.

Then contact the pastor and ask him or her if it would be possible to arrange a regular but brief private prayer session with your special-needs son sometime during the week. This would give you an opportunity to pray together while still preserving your time for spiritual regeneration on the Sabbath without distractions or guilt.