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From Pain as Symptom to Pain as Process: A Gestalt Perspective in
the Age of Medicalization
Anna Maria Acocella, Oliviero Rossi
Istituto di Psicoterapia della Gestalt Espressiva, Roma, Italia, Italy
DOI: https://dx.doi.org/10.47772/IJRISS.2025.910000157
Received: 28 September 2025; Accepted: 04 October 2025; Published: 06 November 2025
ABSTRACT
Contemporary pain management in clinical settings faces a fundamental epistemological dilemma between the
traditional biomedical approach, focused on sedation and symptom control, and phenomenological approaches
that recognize pain as a meaningful existential experience. Gestalt psychotherapy offers a unique perspective in
this debate, proposing the traversal of pain as a therapeutic alternative to systematic avoidance. This article
examines the theoretical foundations and clinical implications of the Gestalt approach to pain, analyzing the
tension between sedation and traversal as alternative therapeutic paradigms, and evaluating the conditions that
make each strategy clinically appropriate. This narrative review of the Gestalt literature on pain, supplemented
with contributions from phenomenology, affective neuroscience, and narrative medicine, proposes atheoretical-
clinical synthesis that links the principles of contact theory with the clinical experience of traversing pain. The
Gestalt approach conceptualizes pain not as an error to be corrected, but as a meaningful interruption in the cycle
of organism-environment contact. The process of moving through pain, based on the principles of allowing,
giving time, and trusting the process, emerges as a therapeutic strategy that preserves the vitality of contact with
oneself, offering an alternative to systematic sedation when clinically appropriate. The processual management
of pain in Gestalt psychotherapy contributes to a more holistic therapeutic paradigm that integrates technical
skills with existential accompaniment abilities. The article proposes clinical criteria to guide the choice between
sedation and traversing and emphasizes the importance of specific training for mental health professionals. This
work aims to offer an innovative conceptual framework and stimulate scientific debate, laying the foundations
for future empirical and applied investigations.
Keywords: Gestalt psychotherapy, pain management, phenomenology, contact cycle, traversing,sedation,
integrative medicine
INTRODUCTION
Contemporary medicine has developed sophisticated therapeutic arsenals for pain control [1; 2] based on
standardized pharmacological protocols and progressively refined sedation techniques. This paradigm,
undoubtedly effective in acute contexts, is rooted in a conception of pain as an essentially pathological
phenomenon to be eliminated [3] in order to restore a state of functional normality. However, this perspective
raises epistemological questions about the nature of pain inhuman experience, in the face of which rigid
interpretative frameworks prove inadequate. The phenomenological tradition, from Husserl to Merleau-Ponty,
has recognized in the lived body (Leib) a dimension of meaning that transcends biological materiality,
configuring pain as an existentially meaningful experience that requires understanding. Gestalt psychotherapy,
rooted in the phenomenological tradition and field theory, proposes an interpretation of pain as a significant
interruption in the process of organism-environment contact, a potential expression of creative adaptation that
requires therapeutic approaches respectful of the implicit wisdom of the process.
This perspective is particularly relevant in the contemporary clinical context, characterized by the epidemic of
chronic pain in Western societies, the limitations of a purely pharmacological approach, evidence of the
effectiveness of integrative approaches, and recognition of the existential dimension in healing processes.
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Aims
This paper aims to critically examine the Gestalt approach to pain through four main lines of inquiry:
1. Theoretical foundations: analysis of the concepts of contact, boundary, and interruption in Gestalt theory
2. Phenomenological reinterpretation: pain as a meaningful process rather than a symptom to be eliminated
3. Methodology of traversal: principles and techniques for therapeutic accompaniment
4. Clinical implications: criteria for choosing between sedation and traversing
THEORETICAL FOUNDATIONS OF GESTALT PSYCHOTHERAPY
Gestalt therapy and field theory
The theoretical model of Gestalt Therapy (GT) was first presented in the seminal work by Perls, Hefferline, and
Goodman [4] and has its roots in Lewin's field theory [5], Wertheimer's Gestalt psychology [6], and
Goldstein's organismic concept [7]. Among the fundamental principles of the model is field theory,
according to which the individual and the environment represent a single ecosystem that, through interaction,
self-regulates and develops according to each of its constituent elements. Consequently, in this approach,
psychological distress constitutes a creative adaptation in response to the field in which the individual is
immersed. [8; 9]. This response, which was somewhat functional in the past when it developed, may not be as
useful in the present. GT takes a holistic approach to caring for the person, paying attention to the
individual's entire experience (physical, psychological, intellectual, emotional, relational, and spiritual) at
a given moment.
Through direct experience with the therapist in the here and now, the therapeutic relationship is the ideal place
in which the patient is guided on a journey of awareness of their thought processes, emotions, and actions. In
this way, the phenomenological experience becomes meaningful and attention is focused on the “what” and
‘how’ of a particular action or behavior, rather than on the “why.” As a result, awareness of how something
happens allows the patient to more easily make authentic and responsible changes.
The contact cycle
According to Gestalt theory, the human organism is naturally inclined to grow and achieve self-actualization. At
any given moment, needs emerge in each individual, which represent the organizers of their behavior, or rather,
what drives them to movement and action. Perls, in his seminal book on Gestalt psychology, writes: “Experience
occurs at the boundary between the organism and the environment,” often referring to the self-coming into
contact with the environment “... but the simple and immediate reality is the contact (between organism and
environment) itself”[10] (p. 47). " Contact, or that process that gives rise to assimilation and therefore
growth, consists in the slow establishment of a figure that prevails over a background or context, determined by
the organism/environment field.
In self-regulatory processes, the figure (gestalt) can be a perception, an image, or a vivid and clear intuition; in
the realm of motor behavior, the gestalt can be an energetic and harmonious movement that is performed. In both
of these realms, both the needs of the organism and the possibilities of the environment are incorporated and
unified in the figure & quot; [10] (p. 41). In this sense, the organism and the environment are in constant
interdependence, and the process of self-regulation is never static but always inhabited by new emerging needs.
The pathology emerges when the natural circular movement (attraction/repulsion-contact/retraction) goes out of
rhythm. In the complex interaction between the organism and the environment, the Self, defined by Gestalt as
an agent of contact with the environment, allows for exchange and creative adaptation between the individual
and the environment, ensuring development and growth. The place where the Self emerges is the contact
boundary, since that is where it expresses its activity, i.e., the “between” the individual and the world. According
to Gestalt psychotherapists, contact between the individual and the environment is expressed through a cycle
called the contact cycle, which is divided into four different moments.
Pre-contact, which is the phase in which the individual perceives an activation, the presence of needs. It is a
phase of sensations, at first undifferentiated and then increasingly clear. The excitement that arises from the body
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becomes the Gestalt (figure) that stimulates the subject' sinterest, while the rest remains in the background.
In this phase, the style that the person has built up over the course of their life cycle to relate to the world is
activated. It highlights the way in which the person has learned to satisfy their needs and support themselves.
This phase is characterized by the Es function. Contact, an active and processual phase, in which contact is not
yet present, but the individual is activated to go out into the environment and seek opportunities to satisfy their
needs.
The movements in this phase involve the organism moving toward the boundaries of contact and the environment
approaching and entering the field of perception. In the first movement of orientation, the need is focused on; in
the second, the organism allows the excitement necessary to sustain the action to emerge. In this phase, bodily
tension and fear of failure increase, while the direction of action that will lead to the gratification of the need
becomes increasingly clear. The phase following orientation is that of manipulation, in which the organism is
now ready for the experience of contact. In this phase, there are one or more emotions that drive the
individual' sactions; the Self acts mainly through the function of the Ego, which chooses or rejects what it
finds in the environment.
Full contact, which is when the Ego merges in a “healthy confluence” with the desired object; in this phase, there
is strong contact between the organism and the environment. The boundary is completely permeable, the Ego
and the You lose their boundaries and merge into a We. At the end of this phase of full contact, the field
differentiates again, the energy is reduced, and the two subjects detach, separate, and enter a dimension of
withdrawal.
Post-contact (withdrawal), in which boundaries are reestablished and one can begin to perceive theaftermath,
the rest. This is a process of assimilating the experience. Here, the personality function intervenes, integrating
the experience by metabolizing it. At this point, the cycle closes and the individual is ready for the next cycle.
Before the organism is ready for a new cycle, there will be a moment that Gestaltists call “Fertile Void” or
“Creative Indifference”: this is a state in which the organism, even if only for a few seconds, is in perfect balance.
In order to withdraw, it must have achieved its purpose.
Contact Interruptions: Creative Adaptations or Pathological Mechanisms?
Gestalt theory revolutionized the understanding of so-called “resistance” or “defenses,” reconceptualizing them
as “interruptions of contact” or “creative adaptations.” These reinterpretations particularly significant for
understanding pain and the strategies that the organism develops to manage it. The contact process begins with
the disruption of the organism's homeostasis and the identification of the resulting need, with subsequent
operations leading to the satisfaction of that need and the restoration of homeostasis. " Therapist and patient
start from the fog of the ES of the situation, co-creating the contact process in an upward spiral of excitement
and mutual involvement until the formation of the figure that will give space to the satisfaction of the need in
the here and now and subsequently to growth [11; 12]. Psychopathology is generated by the interruption of the
contact process, both in the formation phase of the ES of the situation where psychoses are generated, and in the
genesis of figure/background configurations where neuroses and personality disorders arise [8].
The founding text of Gestalt therapy describes five types of interruption in the contact process:
“The difference between the types depends on when the interruption occurs: before the new primary excitation—
confluence; during excitation—introjection; while facing the environment—projection; during conflict and
destruction—retroflection; at the moment of final contact—egotism” [13].
The Metaphor of the Tightrope Walker: Dynamic Balance in Uncertainty
The Gestalt approach to pain can be understood in light of the metaphor of the tightrope walker:
like a tightrope walker, humans are constantly engaged in a dynamic process characterized by opposing forces
[14]. In this process, balance is achieved not through rigidity, but through continuous micro-adjustments that
respond dynamically to changes in the wind, the rope, and one' sown body [15]. Similarly, overcoming
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pain requires accepting instability as an inevitable condition of existence. At the same time, the possibility of
fully experiencing pain also implies trust in the process and a consequent abandonment of the need to control
and quickly achieve results [16; 17].
By cultivating presence as a resource for navigating uncertainty, humans can traverse pain and existential
instability by finding a dynamic balance that requires constant readjustment.
Just as a tightrope walker uses awareness of the precariousness of his balance as a resource, similarly, recognizing
the possibility of pain and suffering, rather than systematically denying or avoiding it, can develop a more
authentic and sustainable form of resilience.
PAIN AS A PROCESS: A PHENOMENOLOGICAL INTERPRETATION
One of the fundamental premises of the Gestalt approach is the overcoming of the traditional Cartesian
distinction between mind and body, replaced by a unified view of the organism as a psychosomatic whole. This
perspective is particularly relevant for understanding pain, which is too often artificially categorized as
“physical” or “psychological.” A phenomenological reading of pain reveals the inadequacy of this distinction:
while physical pain always has emotional, cognitive, and relational components that influence subjective
experience, psychic pain manifests itself through bodily tensions, postural alterations, and neurovegetative
changes [18].
The Gestalt perspective, considering pain as an interruption of the contact cycle, radically shifts the therapeutic
focus from eliminating the symptom to understanding the underlying process. From this point of view, the Gestalt
approach recognizes the adaptive function of pain and highlights an implicit wisdom of the organism: pain
represents an emergency adaptation or a choice of survival [19].
Although this work is grounded in phenomenology and Gestalt theory, the conceptual framework can be
translated into clinical terms for medical and healthcare professionals to improve accessibility and
interdisciplinary dialogue. Table 1 summarizes the main conceptual equivalences between key Gestalt terms and
their possible clinical interpretations, facilitating dialogue with medical professionals by mapping
phenomenological constructs onto familiar clinical language. The term contact represents the dynamic
interaction between physiological, emotional and cognitive processes that characterize adaptation to pain.
When this process is interrupted, however, biological, psychological and social factors are unable to integrateand
generate functional dysregulation.
Tab. 1 – Conceptual Equivalences Between Gestalt and Clinical Terminology Gestalt Term Clinical Equivalent
/Interpretation
Description References
Contact Integration process Dynamic interaction among physiological, emotional, and cognitive systems
supporting adaptation and homeostasis. [20; 21]
Interruption of contact Functional dysregulation Breakdown in the integrative process leading to imbalance
among biological, psychological, and social components. [20; 22]
Cycle of contact Adaptive regulation cycle Sequential process of activation, engagement, assimilation, and
withdrawal, comparable to physiological regulation cycles. [20; 23]
Creative adjustment Compensatory mechanism Adaptive response of the organism to maintain stability under
conditions of stress or pain.[21; 24]
Fertile void Restorative homeostatic state Transitional equilibrium that precedes the emergence of new adaptive
configurations. [20; 25]
Note. References correspond to the numbering in the main reference list.
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The non-pathologizing reinterpretation of the pain allows us to reconceptualize it as a fundamental evolutionary
resource that performs multiple functions. First, it has a communicative function, signaling unmet needs,
limitations, and requests for care. Second, it has a protective function, as pain acts as a warning signal and
triggers protective behaviors. Finally, it has a relational function, as it promotes the ability to ask for and receive
help, highlighting the vulnerability and interdependence of human beings [26; 27].
Many spiritual and therapeutic traditions also conceive of pain as a catalyst for growth and change, emphasizing
how it can promote the attainment of greater awareness and maturity [28].
One of the most significant paradoxes of the Gestalt approach is that of accepting pain, according to which
ceasing to fight against it allows it to change form. This paradox has deep roots in the Gestalt theory of change,
formulated by Arnold Beisser (1970) [29], according to which change occurswhen an individual becomes what
they are, rather than trying to become what they are not.
Re-examining painful experiences in light of this principle, resistance to suffering amplifies pain through muscle
tension and hyperarousal, [24] while acceptance of the experience allows for change. When the body no longer
has to expend energy denying or fighting the present experience, pain becomes a starting point for authentic
transformation [26].
This does not imply that pain must always be accepted uncritically, but that acceptance is a prerequisite for
conscious and effective choices regarding its management.
METHODOLOGY OF PAIN CROSSING: PRINCIPLES AND THERAPEUTIC
TECHNIQUES
The Fundamentals of Process Accompaniment
In Gestalt psychotherapy, the experience of pain is not considered an obstacle to be quickly removed, but rather
a privileged path to personal growth. Therapeutic support is based on an attitude that integrates presence, trust,
and willingness to inhabit the painful experience together with the patient [30].
A first methodological principle is that of allowing. Allowing is not a passive attitude, but involves creating a
safe space in which suffering can emerge without the therapist rushing to reduce it. This attitude translates into
the clinician's ability to tolerate their own frustration in the face of another'spain, avoiding the
temptation to provide immediate relief [30].
A second principle is that of giving time to the process. The processing of pain follows its own temporality,
which is different for each individual and very often incompatible with the frenetic pace of society. Research on
Gestalt applications to trauma treatment shows that transformative moments emerge spontaneously only when
the patient-therapist field is ready to welcome them[31].
Trust in the process is the third pillar of accompaniment. This is not an idealistic attitude, but a trust rooted in
the organismic capacity for self-regulation [32] and transformation, even though suffering. Recent work on
control and trust polarities has emphasized how therapists, in maintaining this trust, also facilitate greater
tolerance of uncertainty in patients [33].
Specific Crossing Techniques
The process of working through pain takes the form of experiential practices that maintain the flexibility
characteristic of the Gestalt approach, but which are supported by a consolidated methodological framework.
Body awareness work is the first tool used by the Gestalt therapist: locating pain and exploring its qualities and
boundaries opens the way to deep emotional meanings. The body thus becomes a privileged medium for
connecting the symptom to personal and relational experiences [30].
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Dialogue with the symptom is a second fundamental intervention. Rather than treating suffering asan enemy to
be fought, the patient is invited to question it as an interlocutor with intentionality.
Experimental studies on the use of empty chair dialogue have demonstrated the effectiveness of this approach in
resolving unresolved emotional conflicts and activating transformative processes [34;35].
Working with polarities is another key technique. Every painful experience carries within it its latent opposite,
and the integration of these polarities reduces the patient's internal fragmentation.
Thorne (1974) [36] had already emphasized how the Gestalt technique promotes a movement of “centering”
between opposite poles, while Perls (1977) [37] had placed integration at the heart of the therapeutic process.
More recently, Furtado and Gaspar (2022) [33] showed how the dialectic between control and trust remains
central even in contemporary challenges.
The Crossing Process: Stages and Transformations
Table 2 describes the process of overcoming suffering as one that occurs through recurring cycles of contact and
detachment, followed by subsequent re-elaboration.
The initial phase is often characterized by ambivalence between the desire for relief and the fear of direct contact
with suffering. Here, the therapist's task is to build a solid alliance and validate resistance as a natural part
of the process [31]. In the immersion phase, pain is encountered more fully: suffering may temporarily intensify,
but this increase is often a sign of its emergence into consciousness. The therapist supports and normalizes this
intensification [30]. The processing phases marked by the emergence of meaningful connections between present
pain and past experiences, between body and emotions, between the individual and the relational context.
Experiential techniques such as empty-chair dialogue have shown particular effectiveness at this stage [34; 35].
The final phase of this process involves a qualitative transformation of the relationship with pain. The symptoms
do not necessarily disappear, but the meaning attributed to the painful experience changes: suffering is no longer
perceived as a catastrophe, but as a signal to be listened to and integrated into a more mature process of self-
regulation [33; 36].
Tab. 2 - Pain Traversal Process Phases
Phase Main Characteristics Therapist' s Role Specific Techniques Progress Indicators Initial Ambivalence
Conflict betweendesire for relief and fear of direct contact with suffering
Build solid alliance and validate resistance as natural part of process Psychoeducation, trust building, resistance
normalization Increased willingness to explore; reduced defensive rigidity Immersion More complete encounter
with pain;
Temporary intensification of suffering Support and normalize intensification assign of emergence to
consciousness Body awareness work, symptom dialogue, containing presence Ability to stay present with pain;
emergence of emotions/memories Elaboration Emergence of significant connections between present pain and
past experiences Facilitate connections through experiential techniques Empty-chair dialogue, polarity work,
phenomenological exploration Development of insights; integration of fragmentedaspectsTransformation
Qualitative change inrelationship with pain; different meaning attribution Support in titration and new self-
regulation modalities
Integration work, meaning consolidation, autonomy support Reduced catastrophic perception; pain as signal to
listen to; increased self-regulation capacity
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CLINICAL, SOCIAL, AND CULTURAL IMPLICATIONS
Criteria for choosing between sedation and crossing
The clinical decision between resorting to pharmacological sedation or accompanying the patient through the
pain is one of the most complex challenges for the contemporary therapist. As shown in Table 3, this choice
involves a multi-level assessment that considers psychological, medical, and relational aspects: the nature of the
pain and the characteristics of the patient must be considered, Aswell as the therapeutic context, the available
resources, and the dynamic evolution of the clinical situation.
Tab. 3 - Criteria for Therapeutic Choice
Criteria Pharmacological Sedation Pain Traversal Individual Tolerance Recommended when pain intensity
exceeds patient's regulatory capacities; risk of dissociation or psychic collapse Appropriate when pain is
integrable in consciousness and patient's experience
Diagnostic Context Necessary in acute cases or severe medical conditions for immediate suffering management
Beneficial for chronic pain to reduce pharmacological dependence and improve quality of life Clinical Phase
Priority in acute emergencies requiring rapid symptom control Preferred in chronic/stable phases allowing for
deeper elaboration AvailableTherapeuticResourcesSuitable when limited time or specialized skills for
accompaniment Requires specific training in Gestalt therapy and crisis management Patient's Integrative
Capacities Indicated when integration capacities are compromised or insufficient Feasible when patient
maintains contact capacity and self-regulation
Therapeutic Relationship
May be necessary when therapist cannot sustain anxiety generated by patient's pain Requires solid
therapeutic alliance and therapist's ability to contain process Individual tolerance to pain and emotional
suffering is the first aspect to be assessed: in some cases, the intensity of pain can exceed the patient's
regulatory capacities, leading to a risk of dissociation or mental collapse. Sedation can thus represent a temporary
measure to restore minimum safety conditions [38]. When pain can be integrated into the patient's
consciousness and experience, the Gestalt approach suggests supporting the process by promoting elaboration
and transformation [30].
The clinical and diagnostic context is a second criterion for evaluation: the exclusive use of sedation risks
reinforcing avoidance and medicalization of suffering in patients with chronic pain [39]. Inthese cases,
psychotherapeutic interventions based on body awareness and dialogue with the symptom can help reduce drug
dependence and improve quality of life [40].
However, in acute cases or severe medical conditions, sedation may be necessary to support the immediate
management of suffering [41].
A third criterion is the therapeutic relationship, as the therapist's ability to support the anxiety generated
by the patient's pain without resorting to premature interventions must also be assessed.
The literature emphasizes the importance of a dynamic balance: on the one hand, ensuring containment through
pharmacological interventions when pain is intolerable; on the other hand, preserving spaces of transition in
which pain can become a transformative resource [31; 33].
This choice is far from definitive: it requires continuous reassessment based on the evolution of the clinical
picture and the patient's response. Monitoring the patient's ability to traverse pain therefore becomes
a central element of clinical practice. The therapist assesses the patient's indicators of good or poor
tolerance to suffering on a case-by-case basis.
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Positive indicators of good tolerance include: maintaining contact with the therapist during moments of
emotional intensity, ability to self-regulate between sessions, development of meaningful insights into
one's own experience, improvement in overall relationship quality.
Conversely, signs of poor tolerance may include: dissociative episodes, hetero- or auto-aggressive acting out,
deterioration of social or work functioning, and development of severe anxiety-depressive symptoms.
Many patients benefit from integrated approaches that combine sedative elements for acute crisis management
with exploratory elements for in-depth work. For example, a patient with panic attacks can use relaxation
techniques to manage acute anxiety, while simultaneously exploring the existential and relational meanings of
their symptoms in therapy.
Although the dialectic between sedation and crossing is conceptually useful, clinical practice often requires
integrative solutions. Partial pharmacological support can create stability that allows the patient to enter deeper
into psychotherapeutic work. This is especially useful for managing chronic pain. Rather than opposing
biomedical and phenomenological paradigms, Gestalt therapy constitutes an integrative approach that is not
opposed to other paradigms, such as the biomedical or phenological one, but recognizes the importance of using
all the resources that can bring benefits to the therapeutic process. This integrative position reflects a true
biopsychosocial model, in which pharmacological containment, promoting awareness and the patient's
emotional regulation, coexists dynamically with experiential processing along the therapeutic process.
Training and Skills of the Therapist
The safe and effective implementation of pain traversal requires specific skills that go well beyond standard
psychotherapeutic training [42; 43]. The therapist must have developed a deep familiarity with their own
experience of pain and suffering, having personally undergone significant processing processes. The personal
experience of processing one's own suffering allows the therapist to authentically support the patient in
times of greatest difficulty.
Specific training in Gestalt psychotherapy must include in-depth training in recognizing the transference and
countertransference dynamics that emerge when working with pain. The therapist must be able to distinguish
between their own pain and that of the patient, avoiding both excessive identification and defensive detachment.
Continuous supervision is an indispensable tool for maintaining this discrimination and for processing the
inevitable emotional resonances aroused by this type of work [44].
Equally fundamental are crisis management skills, which the therapist can develop by integrating psychiatric
and emergency medicine knowledge into their training. Therapists who propose working through pain must be
able to recognize when the process is exceeding the patient's integrative capacities and intervene promptly
with appropriate containment measures.
Dealing with pain may require the involvement of doctors, physical therapists, nurses, and other health
professionals, making multidisciplinary teamwork a necessity. The ability to integrate multiple perspectives in
the patient's best interest is a fundamental clinical skill for contemporary pain management. The Gestalt
therapist must be able to communicate effectively with these colleagues, explaining the principles of their
approach without adopting a sectarian or oppositional attitude towards different approaches.
Finally, therapists must develop solid ethical competence in managing informed consent. Patients have the right
to clearly understand the differences between sedative and traversal approaches, the potential benefits and risks
of each, and the available alternatives. This information process must be continuous and adapted to the evolution
of the clinical situation, allowing patients to maintain an active role in decisions regarding their own care.
From a training viewpoint, clinical competence in pain traversal should be developed through structured modules
including:
1. Theoretical seminars on phenomenology, affective neuroscience, and pain physiology
2. Supervised experiential practice focusing on embodied awareness and relational presence;
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3. Interdisciplinary workshops with physicians, physiotherapists, and palliative care specialists;
4. Systematic supervision processes that monitor the therapist’s countertransference reactions and use
reflective tools such as self-supervision diaries.
The integration of these components ensures that clinicians acquire both technical precision and existential
attunement in accompanying patients through pain.
Practical, social, and cultural implications
The Gestalt approach to pain has implications that transcend the clinical dimension; in fact, it constitutes a
genuine proposal for social innovation in the field of health. The paradigm of traversal challenges the dominant
cultural model of systematic avoidance of suffering [45], promoting greater social acceptance of human
vulnerability and community interdependence. In a society characterized by the imperative of efficiency and
constant well-being, this approach favors the recovery of deeper existential meanings, counteracting the
tendency to commodify the experience of pain through pharmacological consumption.
The phenomenological perspective restores epistemological dignity to experiential knowledge, while the partial
de-medicalization of pain can contribute to the sustainability of healthcare systems through the reduction of drug
dependence and the active involvement of the patient. These implications require a rethinking of professional
training in the social and healthcare fields, promoting multidisciplinary skills that integrate biomedical,
psychological, and socio-anthropological knowledge in the management of pain as a complex social
phenomenon.
Integrative and Hybrid Models of Pain Management
Recent developments in integrative medicine have highlighted the usefulness of combining pharmacological and
psychotherapeutic approaches for the management of chronic pain. Gestalt-based interventions can be
effectively combined with pharmacological stabilization, mindfulness or physiotherapy programmes. Such
hybrid models make it possible to gradually reduce the patient's dependence on drugs. By allowing the
containment of symptoms, the patient can invest more energy in the psychotherapeutic work of self-awareness.
This integration of Gestalt techniques (body awareness, dialogue with the symptom and work on polarity) with
biomedical interventions favor both the biological regulation and the existential processing of pain.
CONCLUSION
The procedural management of pain in Gestalt psychotherapy contributes to defining a moreholistic therapeutic
paradigm, which integrates technical skills with existential accompany meltabilities. The article highlighted that
the choice between sedation and traversal requires careful consideration of the context, the relationship, and the
patient's internal resources.
Specific training for mental health professionals is crucial: not only in the pharmacological management of pain,
but above all in developing the ability to tolerate the intensity of others' experiences [46] and to accompany
them on a path of transformation. Only in this way can the therapist help restore pain's function as a guide
toward greater awareness and personal integration.
LIMITS AND FUTURE DEVELOPMENTS
This work has some limitations that must be considered. First, the narrative and theoretical nature of the review
does not allow for empirically validated conclusions to be drawn about the clinical effectiveness of pain traversal
techniques. Second, the selection of sources was based on conceptual and theoretical criteria rather than
systematic research, with the risk of not including all the available literature on the subject. Finally, the highly
theoretical and phenomenological nature of the article may make it less accessible to readers from strictly
biomedical backgrounds.
Despite these limitations, the article opens up interesting perspectives for future research. In particular, it would
be useful to develop clinical and qualitative studies that evaluate the concrete application of Gestalt principles
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in the management of chronic pain. In addition, comparative research between sedation-based approaches and
traversal-oriented approaches could offer more solid evidence on therapeutic choice criteria. Finally, exploring
the social and cultural implications of the Gestalt approach to pain through interdisciplinary studies would allow
us to verify its actual ability to influence healthcare practices and policies. The article aims to offer an innovative
conceptual framework and stimulate scientific debate, laying the foundations for future empirical and applied
research.
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