Working with Intrusive Thoughts

How Gestalt therapy works with intrusive thought patterns and OCD

If you live with intrusive thoughts, you have probably already tried arguing with them. Telling yourself they are not true, or not you, or not worth the attention. Sometimes that helps for a minute. Mostly it doesn't, and the thought comes back louder, as if the arguing fed it.

Most approaches to intrusive thoughts go to work on the content of the thought, or on changing how you think about it. Gestalt therapy starts somewhere earlier. It is less interested in the thoughts themselves than in the act of thinking, and in what happens to your awareness when a thought takes hold.

There is a distinction at the centre of this work, between two kinds of experience. One is what is actually happening in your body and senses right now: the chair under you, the tightness somewhere in your chest. The other is everything that pulls you into your head, planning, remembering, going over things, and the intrusive or looping thoughts themselves. When you are lost in that second mode, your contact with the here and now shrinks almost to nothing. If you suffer from intrusive thoughts, you probably spend a lot of time there, turning the same material over while you lose contact with your body.

So the work doesn't go after the thought, not arguing with it nor forcing it away. Instead it helps you come back to what your body and senses are actually doing. In a session I might ask you to notice your breath, or to tell me what you can see and hear in the room, or where exactly in your body you feel the pull of the thought. This is not a distraction technique, and it is not avoidance. When your attention settles back into present experience, your relationship to the thought starts to change on its own. The thought may still come. But it loses some of its grip, because you are no longer entirely fused with it.

This rests on a Gestalt idea called figure and ground, which is really just a way of talking about what sits in the foreground of your attention and what sits behind it. An intrusive thought is a figure: something insistent in the foreground that wants dealing with. But it stands against a background. And when that background, your bodily and felt experience, is soaked in anxiety or fear you have not let yourself feel, thoughts can rush in as a kind of cover. They keep you busy up in your head so you do not have to feel what is underneath. Gianni Francesetti, who has written closely about obsessive patterns, describes these symptoms as creative adjustments. The strange-sounding implication is that your intrusive thought may be doing something for you. It may be protecting you from something that feels, at some level, much worse. The therapy takes that function seriously rather than trying to strip it away, and slowly builds your capacity to bear what the thought has been hiding.

In this view, making the thoughts stop is not the aim at all. What we are trying for is wider awareness and more tolerance for the feeling underneath, so the natural movement of attention can start working again. When things are going well, a worry surfaces, gets its due, moves towards some kind of resolution, and falls back as something else takes its place. Intrusive patterns are a jam in that cycle. You cannot finish with the thing and let it recede, so you stay stuck with it, going round and round.

Gestalt therapy asks you to stay with your experience as it is, without forcing it to be different. This is something it shares with mindfulness: the idea that change does not come by pushing, it comes through allowing and being fully present. Whenever you resist something or grip it too tightly, you interfere with that flow. The paradox, and it really is one, is that when you let the intrusive thought be there while keeping connected to your bodily awareness, something gives. The thought becomes less solid and it starts to look like one passing event among many rather than a wall you have run into.

I want to be honest, it works well for rumination, anxious preoccupation, and the everyday intrusive thoughts most of us get under stress. If your intrusive thoughts meet the threshold of obsessive-compulsive disorder, this work on its own might not be enough. OCD can have its own treatment needs, including exposure-based work and sometimes medication, and a Gestalt approach is best thought of as something that sits alongside those, not as a substitute for them. If you are not sure which side of that line you are on, that is worth working out, and I am happy to think it through with you or point you towards the right help.

In practice this often means slowing right down. You tell me you are being plagued by a thought, and instead of getting into what it means or whether it is true, I might just ask: what are you aware of right now? And now? And now? We follow that, moment by moment. Somewhere in the following, you start to notice for yourself that you are not the thought, that the awareness doing the noticing is bigger than anything it notices. And you cannot get there by being told it, instead it arrives through doing, again and again, until one day it is simply true.

Reference
Gianni Francesetti (2017). "'Suspended from shaky scaffolding, we secure ourselves with our fixations.' A phenomenological and Gestalt exploration of obsessive–compulsive disorder." British Gestalt Journal, Vol. 26, No. 2, pp. 5–20.