Understanding Attention Through Awareness
Gestalt and Attention Deficit Hyperactivity Disorder (ADHD)
Characterised by difficulties with sustained attention, hyperactivity and impulsivity, Attention Deficit Hyperactivity Disorder (ADHD) is often understood through cognitive-behavioural and neurobiological frameworks that emphasise symptom management and behavioural control. ADHD in the context of Gestalt therapy may be thought of as pattern of organismic (personal) functioning that can be understood and worked with through enhanced awareness and contact.
The word "gestalt" is German for "whole" or "form", and it refers to the fundamental idea that we experience the world as meaningful wholes rather than isolated bits of information. In Gestalt therapy, the term describes how our needs, feelings and interests emerge as complete patterns of meaning from the background of our total life experience. Central to this approach is the concept of "figure and ground". Imagine looking out of a window: you might notice a car driving past (this becomes the "figure"—what stands out for you), whilst everything else—the pavement, other cars, buildings—fades into the "ground" or background. Now a bird suddenly flies across your view, and instantly the bird becomes the new figure whilst the car recedes into ground. This constant dance between figure and ground is how we organise our experience moment by moment. What becomes figural for us depends on our needs, interests and the situation we're in. If you're hungry, food-related things naturally pop into the foreground of your attention.
For someone with ADHD, this figure-ground relationship often functions quite differently. Multiple things compete to become figure simultaneously, making it difficult to let any single ‘gestalt’ form clearly and completely. It's as though dozens of figures are all shouting for attention at once, none able to settle long enough to become truly satisfying.
Gestalt therapy's approach to ADHD would attend to the present-moment awareness and the holistic understanding of the person within their environment. Rather than focusing solely on observable behaviours like inattention or restlessness, Gestalt therapy would consider how individuals with ADHD experience themselves and make contact with their world. From this perspective, what appears as scattered attention may actually represent an overwhelming flood of competing figures emerging from ground, making it difficult to sustain focus on any single ‘gestalt’ long enough for completion and satisfaction.
The Cycle of Experience, a central concept in Gestalt therapy, provides a particularly useful framework for understanding ADHD. This cycle maps the natural flow from sensation and awareness through mobilisation, action and contact, culminating in satisfaction and withdrawal, for example it might show how a need emerges, how we mobilise to meet it, and how we complete the experience. An example of a gestalt cycle of experience would be - i notice I am hungry, i go to the fridge, i get a snack, eat it and my hunger is satisfied making space for awareness of new needs.. Research suggests that individuals with ADHD show characteristic interruptions at various points in this cycle. The constant shifting of activities and interrupted tasks leave the ‘gestalt’ continually open, creating what might be described as a disorganised internal world where meaningful completion rarely occurs. This perpetual incompletion generates chronic dissatisfaction, as the person searches for themselves through impulsive feeling and action without achieving the resolution that comes from full contact.
Gestalt therapy conceptualises these patterns not as pathological deficits but as ‘creative adjustments’—basically ways the we have learned to function. Someone diagnosed with ADHD may have developed patterns of quickly shifting attention (deflection), going along with (confluence) or hypervigilance as responses to environmental demands that feel overwhelming or incomprehensible. The therapeutic task becomes one of increasing awareness of these patterns and exploring whether they still serve the person's needs in their current life circumstances. Often, what was once an adaptive response has become rigidified, introducing difficulties rather than resolving them.
Research into Gestalt group work with adolescents diagnosed with ADHD has shown promising results. Programmes focusing on developing sensory awareness, emotional recognition and self-regulation demonstrated measurable improvements in both inattention and hyperactivity-impulsivity symptoms. The group format proved particularly valuable, creating a space where adolescents could explore acceptable and unacceptable social behaviours with peers whilst receiving immediate feedback about their impact on others. This interpersonal context mirrors Gestalt therapy's fundamental understanding that self-awareness develops through contact with others.
The therapeutic approach emphasises building what Gestalt therapy calls 'self-support'—the capacity to identify one's own needs, mobilise energy towards meeting them, and experience satisfaction from completed action. For someone with ADHD, this might involve learning to notice bodily sensations that signal restlessness before it becomes overwhelming, or recognising the difference between genuine interest (which supports sustained attention) and anxiety-driven hypervigilance (which scatters it). Progressive muscle relaxation, breathing exercises and mindfulness practices help cultivate this embodied self-awareness, grounding attention in present-moment sensation rather than allowing it to fragment across multiple competing stimuli.
Gestalt therapy's approach challenges the common focus on external behaviour management alone. Whilst acknowledging that observable behaviours matter—particularly in school and work settings—lasting change requires addressing the person's internal experience. Helping someone with ADHD understand why they lose focus, what happens in their body and emotions when they feel restless, and what unmet needs might be driving impulsive behaviour creates the possibility for genuine self-regulation rather than mere compliance with external demands.
The dialogic, present-centred nature of Gestalt therapy also offers particular advantages for working with ADHD. Rather than lengthy analysis of past patterns or abstract discussion of coping strategies, the therapy emphasises experiments and exercises conducted in the here-and-now. Empty chair work might help someone explore the conflict between their desire for focused achievement and their restless energy. Creative activities engage multiple modalities of experience, matching the varied and intense way many people with ADHD engage with their world.
Ultimately, Gestalt therapy's contribution to supporting those with ADHD might lie in its insistence on seeing the whole person, not merely a collection of symptoms. The adolescent who cannot sit still in lessons, the adult who struggles to complete projects—these are living, sensing, feeling beings trying to make contact with an environment that often feels confusing, overstimulating or insufficiently engaging. By cultivating awareness, supporting present-moment contact, and helping individuals develop their own rhythms of engagement and withdrawal, Gestalt therapy offers a path towards living more fully with ADHD rather than simply managing against it.
References
Antony, Sheila & Ribeiro, Jorge. (2005). Hiperactivity: nature or disease? understanding ADHD in a Gestalt perspective. Psicologia: Ciência e Profissão. 25. 186-197. 10.1590/
Serfontein, Mariana. "The effect of Gestalt group work on behavioural aspects of ADHD among adolescents in a school setting." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/62656.
