Working with Intrusive Thoughts
How Gestalt therapy works with intrusive thought patterns and OCD
Gestalt therapy approaches intrusive thoughts a little differently from modalities that focus on thought content or cognitive restructuring. Rather than treating unwanted thoughts as problems to be eliminated or challenged, Gestalt works with the process of thinking itself—and more fundamentally, with the relationship between awareness and thought.
A central Gestalt insight is that we can distinguish between two very different modes of experience. The first encompasses our immediate, embodied present-moment reality: physical sensations, what we perceive through our senses, and directly felt emotions. The second is what is sometimes called the "fantasy zone", that is all mental activity that takes us away from present experience, including planning, remembering, interpreting, and of course, intrusive or ruminative thinking. When we become embedded in thought and "lost in thought," our awareness of actual here-and-now experience diminishes. The person suffering from intrusive thoughts is often caught in this zone, recycling mental content while disconnected from embodied sensation.
The therapeutic movement, then, is not to argue with the thoughts or suppress them, but to support the client in returning to immediate sensory and bodily experience. The therapist might invite the client to notice what is happening in their body right now, to attend to the breath, or to describe what they actually see and hear in the room. This isn't avoidance—it's a recognition that when we bring focused attention to present embodied experience, the relationship to thought itself transforms. The thought may still arise, but it loses its grip because the person is no longer exclusively identified with it.
This approach draws on Gestalt's concept figure/ground, which simply considers what is in the foreground of our awareness. Intrusive thoughts can be understood as figures that demand attention against a particular background. When the bodily and sensorial ground is permeated with unacknowledged anxiety or fear, thoughts may emerge as a kind of protective response—keeping the person occupied in the cognitive realm rather than feeling what's underneath. Francesetti (2017), writing on obsessive patterns, describes such symptoms as "creative adjustments" that serve to protect the person from more overwhelming experience. The intrusive thought, strange as it sounds, may be doing something useful—and therapy respects this function while gradually building capacity to tolerate what lies beneath.
From this perspective, the therapeutic work isn't about making the thoughts stop. It's about expanding awareness, developing tolerance for the ground experience that the thoughts may be defending against, and restoring the natural flow of figure formation and dissolution. In healthy functioning, a thought or concern arises, receives attention, moves toward some resolution, and then naturally recedes as new figures emerge. Intrusive patterns represent a disruption in this cycle—a kind of "confluence" where the person cannot complete the gestalt and withdraw, leading to continual preoccupation.
Gestalt therapy supports the client in staying with experience as it is, without trying to force change. Both mindfulness traditions and Gestalt recognise that transformation doesn't occur through coercion but through acceptance and full presence. When anything is resisted or held onto rigidly, we interfere with the natural flow of experience. The paradox is that by truly allowing the intrusive thought to be present—while simultaneously anchoring in bodily awareness—something shifts. The thought becomes less solid, more obviously just one phenomenon among many, part of the moving stream rather than an immovable obstruction.
In practice, this might look like slowing down considerably when a client reports being plagued by an intrusive thought. Rather than discussing the thought's content or meaning, the therapist might ask: "What are you aware of right now? And now?" Following this awareness continuum, moment by moment, creates conditions for something new to emerge. The client discovers experientially that they are not their thoughts—that awareness itself is larger than any particular mental content. This is not an intellectual insight but an embodied knowing that comes through repeated present-moment contact with one's actual experience.
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.
