How can pastors encourage their church members to pray beyond the sick list? The question has a simple answer, but one that may take time: members will begin to pray beyond the sick list when their pastors know how.

This process sounds simple, but it must not be. Many pastoral prayers don’t go beyond the sick list. And even these prayers are not very pointed or intelligent. Instead, they sound uncannily like a nursing report at the local hospital’s shift change:

The colon cancer in room 103 with uncertain prognosis… the lady in room 110 with a gall bladder that’s not yielding to treatment… the broken leg that’s mending well…

Such public prayers may be medically informative, but they are spiritually impoverished. They usually center on physical healing. And they typically amount to nothing more than requests for effective doctors, procedures, and medicines.

Visitors of many churches might be pardoned if they get the impression that God is chiefly interested in perking up our health, and that radiant physical fitness is our greatest need. They might also be pardoned for thinking that God can’t do what we ask, because so many chronic illnesses remain unhealed.

I have observed that pastoral prayers, prayer meetings, and prayer lists, when detached from larger spiritual considerations, too often dishearten and distract the faith of God’s people. Prayer becomes either a dreary litany of familiar words or a magical superstition verging on hysteria. It dulls our expectations of God, or it hypes up fantasy-like expectations.

It breeds cynicism. Members begin to assume the sick would have gotten better anyway as nature takes its course or as medical interventions work.

And it breeds other bizarre ideas and practices: the obsession with health and medicine that characterizes today’s secular culture; the practice of naming and claiming your healing; the superstitious belief that the quantity and fervency of prayer is decisive for getting God’s ear; the notion that prayer has some intrinsic "power"; the temptation to question the faith of a person who doesn’t get better.

Learning to pray well is hard. Somehow our words and thoughts get tangled up when we speak to God. You’ve seen, heard, and done it: the contorted syntax, the formulaic phrasing, the meaningless repetition, the "just reallys," the vague non-requests, the artificially pious tone of voice, and the air of confusion. If we talked to our friends or parents this way, they would think we had lost our minds!

But if our understanding of prayer changes,
if our practice of prayer then changes,
if the prayer requests we make and ask others to make changes,
if the model of prayer we present changes,
if our teaching on prayer changes…

There are a number of factors that can bring about good changes in how pastors and churches pray. To begin with, we should consider how the Bible approaches prayer for the sick.

James 5:13-20 certainly presents us with a warrant for praying for the sick.

Is any one of you in trouble? He should pray. Is anyone happy? Let him sing songs of praise. Is any one of you sick? He should call the elders of the church to pray over him and anoint him with oil in the name of the Lord. And the prayer offered in faith will make the sick person well; the Lord will raise him up. If he has sinned, he will be forgiven. Therefore confess your sins to each other and pray for each other so that you may be healed. The prayer of a righteous man is powerful and effective. Elijah was a man just like us. He prayed earnestly that it would not rain, and it did not rain on the land for three and a half years. Again he prayed, and the heavens gave rain, and the earth produced its crops. My brothers, if one of you should wander from the truth and someone should bring him back, remember this: Whoever turns a sinner from the error of his way will save him from death and cover over a multitude of sins. -- James 5:13-20

James does not place this type of prayer in a congregational setting, but in what we might think of as a counseling setting. The sick person asks for help. He meets with a few elders. He honestly confesses sins. And he repents and draws near to God.

Earnest prayer affects both the physical state and the spiritual state of the person.

This does not mean it’s wrong to pray for sick people from the pulpit. Of course not! Yet it’s worth observing that the classic text on praying for the sick places that prayer in a highly personal and interpersonal context.

James pointedly keeps spiritual issues in view as well. Remember that his letter as a whole is about growing in wisdom. We learn from chapter 1 that suffering presents an occasion to become wise. Indeed, suffering is a good gift from above: Count it all joy when you meet various trials, and If anyone lacks wisdom, let him ask…

James illustrates the spiritual blessings of suffering with issues of poverty, injustice, and interpersonal conflict. In chapter 5 he illustrates this with sickness. He perceives it as an opportunity to seek forgiveness for sin.

This does not mean that people get sick because they have sinned. Sometimes this is the case, as when IV drug use and sexual immorality lead to AIDS. People do reap in sickness what they sow in sin. But we should not make this into a universal rule. That leads to superstition and heartless counselors, like Job’s.

Yet we can infer from these verses at least two other spiritual dynamics in how God meets us in sickness. First, sickness, like any other weakness and trouble, should force us to stop, to face ourselves, and to look for the Lord.

It’s a chance to find sins we have been too busy to notice: neglectfulness, irritability, indifference, self-indulgence, unbelief, joylessness, anxiety, a complaining spirit, ungodly ambition, or self-reliance.

It’s a chance to find a quickened need for Jesus’ mercies and a deepened delight in God. Fruit of the Spirit may develop that would develop in no other way than by suffering well: the endurance of faith, a hope and joy that transcend circumstances, a mature character, a richer knowledge of the love of God, an increased desire to live for God and not for self-absorbed pleasures, the humility of weakness, the ability to help other people who suffer (cf. Jam. 1:3; Rom. 5:3-5; 1 Pet. 1:6-8, 4:1-3; 2 Cor. 12:9f, 1:4; etc.).

A second spiritual dynamic we can infer from James 5 is that sickness, like any weakness or trouble, can present us with a host of temptations. Whether a life-threatening disease or a couple days of feeling lousy, it is amazing what will emerge from our hearts.

• Some people complain and grumble, getting grouchiest with the people who most try to care.
• Others get angry at God, at themselves, at others, or simply at the inconvenience.
• Others deny reality and pretend nothing’s wrong.
• Others pretend they are sicker than they are, seeking an excuse to avoid responsibilities at work, school, or home.
• Others invest vast hopes, time, and money into pursuing doctor after doctor, book after book, drug after drug, diet after diet.
• Others try to find someone or something to blame, even getting litigious. 
• Others just press on with life by doing, doing, doing. 
• Others milk the occasion for all the extra attention and pity they can get. 
• Others plunge into the gluttony of utter self-indulgence. 
• Others get depressed and use the occasion to question the meaning and value of their entire existence. 
• Others are too proud or embarrassed to ask for help. 
• Others brood that God must be out to get them and become morbidly introspective about every real or imaginary failing.

You get the picture. With so many temptations potentially knocking on our door, sickness provides one of the richest opportunities imaginable for spiritual growth and pastoral counseling, as James 5 makes clear.

Is God interested in healing illnesses? Sometimes yes, sometimes no. Yet he is always interested in making his children wise, holy, trusting, and loving, even in the context of pain, disability, and death.

When we move beyond James 5 and consider the vast biblical teaching on prayer, we find that only a few passages focus on prayer for sickness. But they are a significant few and give us good warrant to plead passionately with God for healing.

In Isaiah 38, Hezekiah pleads for his health to be restored, and it is.

In 2 Corinthians 12, Paul prays earnestly three times to be delivered from a painful affliction; but this time God says no.

Psalm 35:12-14 mentions a heartfelt prayer for the sick to be restored.

Both Elijah and Elisha passionately approach God concerning only sons whose sicknesses ended in death, devastating their mothers (1 Kings 17; 2 Kings 4). In both cases God mercifully restores the sons.

On the other hand, the Bible speaks harshly of Asa because "his disease was severe, yet even in his disease he did not seek the LORD, but the physicians" (2 Chron 16:12). He is chided for failing to pray through sickness.

Prayer can occur in many different degrees of intensity, with supplication and outcry being the strongest. It is striking how passionate and blunt the prayers for healing in Scripture are. These passages vividly challenge the perfunctory and medicine-centric prayers spoken in the very churches preoccupied with praying for the sick!

When pastors and churches pray for the sick (which will teach the sick how to seek God for themselves), they ought to do so in a fiercely thoughtful firestorm.

As significant as the prayers for healing in Scripture are, the vast majority of prayers in the Bible focus on other matters. Let me broadly categorize three kinds of biblical prayer: circumstantial prayers, wisdom prayers, and kingdom prayers. Prayers for the sick are one form of a circumstantial prayer.

With a circumstantial prayer, we ask God to change our circumstances: heal the sick; give us daily bread; protect me from suffering and evildoers; make our political leaders just; convert my friends and family; make our work and ministries prosper; provide me with a spouse; quiet this dangerous storm; send us rain; give us a child.

With a wisdom prayer, we ask God to change us: deepen my faith; teach us to love each other; forgive our sins; make me wise where I tend to be foolish; make us know you better; enable me to sanctify you in my heart; don’t let me dishonor you; give us understanding of Scripture; teach me how to encourage others.

With a kingdom prayer, we ask God to change everything by revealing himself more fully, magnifying the degree to which his glory and rule are obvious: your kingdom come, your will be done on earth as it is in heaven; be exalted above the heavens; let your glory be over all of the earth; let your glory fill the earth as the waters cover the sea; come, Lord Jesus.

The Lord’s Prayer presents examples of all three categories; and all three are tightly interwoven whenever we pray rightly. After all, the coming of the Lord’s kingdom involves the destruction of our sin and suffering. His reign causes a flourishing of love’s perfect wisdom and a wealth of situational blessing. And when we ask God to change our circumstances or to change us, ultimately, we are asking him to reveal his glory and mercy on the stage of this world. That’s the inner logic of such requests.

When any of these three categories is detached from the other two, prayer quickly sours. If we only pray for better circumstances, then God becomes an errand boy (usually a somewhat disappointing errand boy). He exists to provide our shopping lists of desires and pleasures, while his sanctifying purposes and higher glory are left behind. Such prayer pursues self-centered "gimme’s."

If we only pray for personal change, then we may be revealing an obsession with moral self-improvement. We think we are spiritual, but really we are self-absorbed and detached from other people and the tasks of life that need doing. Where is the longing for Christ’s kingdom to right all wrongs, not just to alleviate my sins so I don’t feel bad about myself? Such prayer pursues self-centered, morally-strenuous asceticism, and there is little evidence of real love, trust, or joy.

If we only pray for the sweeping invasion of the kingdom, then our prayers will tend toward irrelevance and overgeneralization. We pray this way when we don’t want to bother with working out how the actual kingdom rights real wrongs, wipes away real tears, and removes real sins. Such prayer pursues a God who won’t touch ground until the last day.

Scripture contains countless examples of these three categories of prayer done well.

Let me note a few, beginning with the Psalms, the book of talking with God.

About ninety psalms are in a "minor key," where the intercessions focus on the removal of sin and suffering. Yet these requests are always spoken in light of God revealing his mercies, power, and kingdom.

For example, about one-third of these minor key psalms present the battle with personal sin and guilt. Yet the psalmist often asks for wisdom as well: Teach me. Give me understanding. Revive me.

Even more of these minor key psalms ask God to change circumstances: Deliver me from evildoers. Be my refuge and fortress amid suffering. Destroy your enemies. These prayers are always tied to the request that God would arrive with kingdom glory and power.

God reveals himself by making bad things and bad people go away!

Then there are sixty or so "major key" psalms. These emphasize the joy and praise that mark God’s kingdom reign.

We should also briefly consider several of Paul’s prayers. In Philippians 1:9-11 and Colossians 1:9-14, Paul makes no mention of circumstances. There is no request for healing, food, or protection.

Instead, Paul asks God to grant the churches wisdom—in the light of the coming glory of God’s kingdom. And he asks for wisdom that would be expressed in two ways: a vertical love for God and a horizontal love for neighbor. Paul pleads on behalf of other people for both kinds of love to deepen: May God make you know him better. May God make your love for people more intelligent.

In Ephesians 1:15-23 and 3:14-21, Paul’s intercessions again focus on wisdom in the light of Christ’s glory. He makes no circumstantial requests. In fact, he does not even ask for the growth of intelligent love for others.

Instead, he zeroes in on what we most need: I ask that God would make you know him better.

Why don’t church members pray beyond the sick list? Because their pastors have not taught or modeled otherwise.

We all tend to pray for circumstances to improve so that we might feel better. Such requests are honest and good—unless these requests go no further. Detached from God’s purposes for sanctification and hearts that groan for his kingdom to come, such prayers become self-centered.

Teach church members to pray with the three-stranded braid of our real need. They will begin to pray far beyond the sick list. And they will pray in a noticeably different way for the sick as well.

David Powlison edits The Journal of Biblical Counseling. He also teaches and counsels at the Christian Counseling & Education Foundation’s School of Biblical Counseling and at Westminster Theological Seminary. He is the author of numerous articles and books.

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