From Pain as Symptom to Pain as Process: A Gestalt Perspective in the Age of Medicalization

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.