Metapsychiatric Group Experiences

This paper will present the spiritually-oriented psychotherapy (Spiritually-oriented psychotherapy differs from conventional, psychoanalytically-oriented therapy in that it focuses as much on the redemptive value of spiritual truth as it does on the etiology of patients’ problems in living.) called Metapsychiatry that was developed by the late Thomas Hora M.D. during the latter half of the last century. It will describe how group therapy evolved over the years and how it was conducted under his leadership. It will contrast those sessions with how a leaderless group of students of Metapsychiatry currently operates. The conclusion will suggest the implications of these experiences. The authors were participants in each of these groups.

Historical Background
In 1958, the Karen Horney Award for the Advancement of Psychoanalysis was conferred on Dr. Thomas Hora. At that time, Hora, who had emigrated from Europe after World War II, was delivering and publishing papers in the United States and Europe on theistic existential psychotherapy. His ideas were influenced by the varieties of phenomenological and existential analysis that were in vogue. Yet despite the recognition provided by some of his peers, the emphasis that his approach placed on the primacy of understanding man in the context of his creator tended to associate Hora with a spiritual realm for which the majority of psychotherapists were unprepared. The quest for acceptance of the scientific legitimacy of psychotherapy dominated the thinking of that era and resulted in mostly a dismissal of Hora's ideas.

Nevertheless, the compelling clarity of his therapeutic teaching attracted a large and growing following of patients, spiritually-oriented therapists (he was a training analyst at Blanton-Peale after receiving his psychoanalytic training at the Postgraduate Center for Mental Health) and students, notably in New York, Connecticut, and California. Beginning in the mid-1960s until his passing in 1995, he confined himself to working with patients, publishing books that were substantially edited transcriptions of ideas presented in group sessions in response to participant questions, and allowing the creation of a non-profit organization, The PAGL (for Peace, Assurance, Gratitude, and Love; The presence of these values in consciousness indicates a soul in harmony with existence; they are considered worthy of our great esteem.) Foundation (see to perpetuate the distribution of his legacy of writings and tape-recorded groups.

Principal therapeutic Ideas
Metapsychiatry is a cognitively focused form of theistic existentialism. It asserts that "the meaning and purpose of life is to come to know reality." (All quotations that are not specifically annotated are from Dr. Hora's writings and group sessions.) Lesser pursuits invariably restrict us to an unfulfilling existence. By reality, it means the spiritual force characterized mainly by love and intelligence that governs the universe. Reality is contrasted with experience, which is always limited because it focuses on those aspects of man that ignore his spiritual essence. It bases this conclusion on the biblical definition that man is an "image and likeness of God," and hence a spiritual being, i.e. one capable of discerning and being aware of spiritual qualities, values and ideas.

It defines spirit as "non-dimensional substance," consisting of such qualities of consciousness as love, gratitude, assurance, peace, intelligence, harmony, joy, generosity, beauty, vitality, goodness, humility, etc., each of which is non-quantifiable, intangible, and yet real, life-enhancing, and knowable.

The method developed by Hora for helping patients discover these truths was called “the two intelligent questions.” (They were often contrasted with the six “futile questions:” ‘what’s wrong?’ ‘how do you feel?’ ‘why did this happen?’ ‘who is to blame?’ ‘what should I do?’ ‘how should I do it?’ which were invariably unproductive of meaningful answers.) They are:What is the meaning of what seems to be?” and “What is what really is?” (In philosophy, these are known, respectively, as the phenomenological and ontological questions.) They are dubbed “intelligent” because when applied conscientiously they lead to helpful answers that identify erroneous notions and clarify the truth. He also called them “epistemological” in the sense that they lead to knowing as opposed to merely believing, for the latter has little therapeutic efficacy.

The first question derives from the observation that we inhabit a mental universe or "idios cosmos" (Heraclitus), in which our intentionality, as defined by our interests, determines our perceptions and consequent experiences. We suffer from what we want (producing, when frustrated, anger) and what we don’t want (promoting fear of what shouldn’t be). Consequently, what happens to us in life corresponds to our individual world-views derived from the values that together constitute, and manifest as, a "mode of being-in-the-world" (Binswanger). Most often, it is our highly prized involvements, what we "cherish, hate, or fear," that are responsible for our daily dilemmas.

Asking this question of ourselves represents a turning inward in order to understand, a recognition that "nothing comes into experience uninvited," and a willingness to be embarrassed at the revelation of our attachment to some existentially invalid idea. This last characteristic is essential to engender regret and reorientation, which are seen to be the path to healing.

The second question directs our attention toward God, which Metapsychiatry calls infinite, omni-active Love-Intelligence, as the only source of creative, valid ideas. The two questions juxtapose appearance and reality, and the cognitive dialectic that ensues within consciousness when they are sincerely considered can lead the receptive individual to a liberating truth.

The process rests on the notion that reality is perfect and that our inharmonious experiences indicate our conscious and unconscious association with existentially invalid ideas, i.e. those that invariably prove themselves to be troublesome, as well as our lack of appreciation and acknowledgment of the nature and presence of the governing principle of life. Aligning our awareness with God frees us from a preoccupation with a problematic perspective (since we can only pay attention to one idea at any time), and turns us toward an expectancy of healing revelation.

This combination, of the explanatory and the inspiring, which is achieved by undertaking this inquiry, offers to clarify experience and to lift the spirit of the engaged seeker because it dissolves the mystery and hence the discomfort of the moment and replaces them with a grateful acquiescence of the good (i.e. God) which, as the second principle of Metapsychiatry proclaims, "already is."

Metapsychiatry's therapeutic method, then, consists of using the two intelligent questions to illuminate and clarify the patient's mode of being in the world and the alternative, spiritually enlightened mode of being in the world so that the patient might have a broader understanding with which to make a choice. It seeks not to influence, but to allow its revelations to be influential in the consciousness of the patient.

The Metapsychiatric Group led by Dr. Hora
The primary distinguishing difference between Metapsychiatric and traditional groups is that the former has no interest in personal interactions between members of the group (It was pointed out by an early participant that Hora's group did originate as an interpersonal meeting that eventually evolved into a non-personal dialogue.. As a consequence, dialogue focuses strictly on issues presented by the participants in an effort to find a beneficial resolution. It sees all problems as psychological (i.e. interactional) in nature, while it finds all solutions to be spiritual (i.e. based on understanding man's real identity). The tone is educational rather than pathology ameliorative.

Dr. Hora, true to his European heritage, and despite the fact that he was invariably good-humored, functioned somewhat like a professor in teaching his students who were suffering from mis-education and ignorance. Early in our attendance the group session (always one hour in length) featured a kindly, understanding Dr. Hora patiently explaining to his uninformed students the nature of appearance and spiritual reality.

Typically, he would enter the room where group was conducted after all were seated. He would then make smiling eye contact with each individual willing to do so. During this period of silence, he would wait, alert and peaceful, for an individual with the highest level of anxiety to formulate and state a question. If an inquiry were not forthcoming, Dr. Hora would discern the dominant mood troubling the group and initiate a query himself.

Occasionally this took the form of a Zen or Zen-like conundrum. Examples were "Who has the better life, the first violinist or the second violinist?"; "There is a goose in a bottle; how does the goose get out of the bottle?"; "What is meant by the expression 'idle hands do the devil's work?'" Such provocative questions generally evoked guesses that were mostly off target. It was a Socratic approach, but it tended to yield very slow understanding.

More commonly, when Dr. Hora began the session with his own question, it was uncanny how often he was able to become aware of and articulate an existentially exigent issue for his patients. We were frequently awestruck by his seeming prescience.

Most often, however, a question quickly emerged from one of the members of the group. Usually, the same individuals were the ones to ask questions. Sometimes Dr. Hora would turn the question back to the group for a response. Only if the group itself was unable to identify the invalid idea underlying the question would Dr. Hora provide the explanation.

Over the years, as the various groups became more knowledgeable about Metapsychiatry, standards rose, expectations were higher, and sometimes we were greeted with a verbal "bamboo pole" (The bamboo pole is used in some Zen Buddhist practices to strike distracted meditators so that they might become aware that they need to improve the focus of their attention.) correcting our misstated remarks. Metapsychiatry is very precise about language and definitions because they preserve the clarity and accuracy of its ideas. Nevertheless, individuals so corrected generally suffered in silence. It is questionable how helpful this approach was.

The principal, undeniable benefit of this group for participants was the opportunity to partake of the wisdom of its leader. His understanding of numberless issues in life was so profound and inspiring that he retained the abiding interest and loyalty of hundreds of students over many decades of practice. In addition to having our spirits uplifted, we learned many useful life lessons. Perhaps the single most distinguishing characteristic of this education was its emphasis on being issue-oriented as opposed to interpersonally-involved. We may not have attained an exalted state of permanent enlightenment, but we did learn how to be more effective and less troubled.

Appearing below, as an illustration, is a short sequence of group dialogue excerpted from a 1992 session:

Participant: Dr. Hora, one thing that's troublesome to me is, when you're with another and you want to show consideration, and it seems appropriate, and then in a short time I'm finding that it's interpreted as the other person can lead the way or just do anything they want and then I'm resentful. Now this is very human level and I know it. Is there a way when you're with another to be with God and to be considerate? I see what's happening and it's no good.
Dr. Hora: First, you have to learn to speak. For instance, you say you want to show consideration. Now what kind of a sentence is that? What does it say? You want to show consideration.
Participant: It's operational.
Dr. Hora: Operational. It is phony. It is nice. It's manipulative, and you're out of it. You're not being considerate. Being considerate is a form of love, and it's a godly way to be. But to show consideration, this is manipulation and it has nothing to do with God. We don't do that. It's not nice to do these things. We have to be authentically spiritual for God. God is love. God is truth. God is authenticity. God is genuineness. God is forthrightness. We don't just show it. We are it. There is so much insincerity in the world. And people think they have to show. To show is to make impressions. We are on Broadway or Hollywood (laughs). We have to be careful of our words, of our syntax, of our sentences because there is a lot hidden in them. You want to show consideration. If you show consideration, somebody else will show you a fist in your nose.
Other Participant: You're saying be careful with your words. Isn't our motivation being revealed by our words?
Dr. Hora: Well, it is ignorance. With the best of intention, we don't understand the difference between being considerate and showing consideration. There are many such phrases that betray our ignorance. When we are here for God, when we live and move and have our being in God, our language changes. Phrases which previously we may have used without much examination become changed. Perhaps from now on you will never say "I want to show consideration."
Participant: Yes.

The Leaderless PAGL Group
Subsequent to Dr. Hora's passing, (There are, and have been prior to his demise, several PAGL groups around the country run by therapists trained by Dr. Hora) the authors assembled a group, consisting of former students of Metapsychiatry, which has continued to meet in their home for two sessions of ninety minutes each month. The purpose of the group is to examine individual problems in living from a Metapsychiatric perspective. No fees are charged. Attendance ranges from three to nine group members. Unlike its predecessor in which there was little or no interaction between group members outside the group, there is some socializing over refreshments at the conclusion of each session.

It is called a leaderless group because no one presumes to have attained the level of understanding manifested by Dr. Hora. Nevertheless, each participant is able to contribute from past experience, either with Dr. Hora or from his or her own realization, helpful ideas that benefit all. As with Dr. Hora's group, the willingness to expose one's problems before a like-minded group of individuals is essential to eliciting the kind of dialogue that is most beneficial, one that is not merely theoretical, but practical in its significance for everyday living.

The format followed allows either for an individual to present his or her problem for consideration, or to begin with a reading from one of Dr. Hora's books. When the former occurs, after dialogue among group members, we often turn, seemingly randomly, to one of Hora's books to see if there are ideas pertinent to the issue just discussed. It is surprising how relevant nearly every reading turns out to be.

The group differs from Hora's group in other ways. Non-metapsychiatric ideas can be introduced, and the discussion is not restricted to metapsychiatric doctrine. Still, whenever we stray or flounder, we find that we are guided back toward some clarifying idea either by a group member or by our reading.

In the spiritual, psychotherapeutic realm, much attention and credit is given to the teacher, the seer who has been transformed by a realization that has elevated his or her consciousness to an understanding not immediately available to the rest of us. In general, we seek to obtain wisdom from such a leader to help us with our problems, and the more we tend to rely on the teacher, the less capable we seem to be in confronting and resolving them on our own.

When an appreciated, healing presence like that disappears, whether through death, or through the revelation of personal shortcomings that call into question the teacher's credibility, the students/patients who remain behind may feel lost. But in fact, it is their ability to apply the ideas on their own that they have been taught that is a real measure of the efficacy of the teacher. This accords with the idea that the most pertinent criterion for assessing the extent of a spiritually-oriented psychotherapist's understanding and effectiveness is not by judging the therapist directly, but by observing the relative health, happiness, sense of well-being, and loving presence manifested by his or her patients/students/disciples.

It also conforms to the evidence provided by personal observation and biographies of spiritual guides, that there are no permanently enlightened individuals. Rather, there are only enlightened ideas, which, nevertheless, themselves merit our profound gratitude. This realization can help us to further appreciate the oft-mentioned assertion that “the thinker and the thought are one,” which means that there is no enlightened consciousness, and hence no enlightened individual, without an enlightened thought filling it.

The Metapsychiatric group, whether led by a brilliant teacher or run as a leaderless meeting, always encourages its members to direct their attention toward valid ideas and not concern themselves with individual personalities or superior insightfulness. It is also intended to be relevant rather than theoretical by attending to real and pressing issues emerging from participants' life experiences.