Background: Syncretism in South African Neo-Pentecostal pastoral counselling has emerged through the blending of biblical theology with culturally embedded healing practices. While this fusion reflects contextual engagement, it also raises serious theological and ethical concerns that require critical evaluation. Objectives: This article explores the phenomenon of religious syncretism in Neo-Pentecostal care and counselling by critically examining how traditional African religious elements such as symbolic rituals, ancestral references and spiritual diagnostics are assimilated and integrated into Christian pastoral care. The article seeks to evaluate these practices in light of doctrinal fidelity and pastoral integrity. Method: Using a qualitative document analysis approach, the study engages theological literature, ecclesial practices and academic critiques. Theological–ethical reflection guides the evaluation of syncretistic tendencies within pastoral care and counselling. Results: The findings reveal that many Neo-Pentecostal care and counselling practices are shaped by a hybrid spiritual epistemology, which blends Christian theology with African traditional religious cosmologies. This syncretism often leads to ritualised, fear-based counselling sessions that compromise the sufficiency of Christ and the authority of Scripture. Conclusion: While cultural contextualisation is vital, the uncritical incorporation of indigenous elements risks distorting the gospel message. Theological formation, rooted in the Christocentric foundations of the gospel and ethical pastoral practice, is urgently required. Contribution: This article contributes to African practical theology by proposing a theologically grounded and ethically responsible model of pastoral care and counselling. It challenges faith communities to uphold doctrinal integrity while meaningfully engaging Africa’s spiritual heritage within Pentecostal contexts.