Abstract. Sensory Processing Sensitivity (SPS) is a temperamental trait that amplifies an individual’s response to the environment, for better or worse. This article presents the trait through the DOES model and examines two configurations in which, in Highly Sensitive Persons (HSPs), the Self loses flexibility, giving rise to a dual risk of dominance: that of the patient over the relational field and that of the therapist over the patient. It argues that Gestalt intervention should not seek to correct sensitivity, but rather support patients in recognizing it as a resource.

Keywords: Sensory Processing Sensitivity; HSPs; Gestalt Therapy; power; confluence; embodied epoché; aesthetic sensitivity.

SPS within the Framework of Environmental Sensitivity

The concept of Sensory Processing Sensitivity (SPS) falls within the broader framework of Environmental Sensitivity (Pluess, 2015), which encompasses models of an organism’s capacity to register, process, and respond to stimuli. These include Differential Susceptibility (Belsky & Pluess, 2009), Biological Sensitivity to Context (Boyce & Ellis, 2005), and SPS itself (Aron et al., 2012). SPS is not a disorder but a temperamental trait: it describes a way of functioning, not a pathology.

Within the SPS framework, the trait is described by the acronym DOES, which summarizes four aspects (Aron et al., 2012). The first (D), Depth of Processing, is considered the core of the trait: HSPs compare new information with what they already know and with past experience, often before taking action. For this reason, in a new situation, they may appear hesitant when they are actually observing and evaluating. The second (O), Overstimulation, is a consequence of the first: people who process information more deeply become tired more quickly in intense, noisy, or crowded environments and need breaks to recover. The third (E), Emotional Reactivity and Empathy, concerns the intensity with which emotions, both pleasant and unpleasant, are experienced, as well as the degree to which individuals resonate with the emotions of others. In a functional magnetic resonance imaging study involving photographs of participants’ partners and strangers displaying emotional expressions, HSPs showed greater activation in areas associated with awareness and empathy, including the insula (Acevedo et al., 2014; see also Acevedo et al., 2018). The fourth (S), Sensitivity to Subtleties, refers to the ability to detect small changes, such as a tone of voice, a facial expression, or a variation within a scene (Jagiellowicz et al., 2011).

These four aspects must be considered together. Each can also be found individually in other conditions; it is their combination that characterizes the trait (Aron et al., 2012). They also have direct relational implications: those who process information deeply need time; those who become overstimulated need space; those who resonate with others risk losing themselves in them; and those who notice subtleties also perceive what others leave unsaid. In therapeutic work, timing, distance, and boundaries become matters for observation and negotiation. It is within this negotiation that the exercise of power can be examined.

At the level of measurement, the Highly Sensitive Person Scale has identified three components that do not correspond directly to the four aspects of the DOES model: Aesthetic Sensitivity (AES), referring to enjoyment and engagement with art, music, and beauty; Ease of Excitation (EOE), the tendency to feel overwhelmed by demands; and Low Sensory Threshold (LST), discomfort in response to intense stimuli such as bright lights, noise, or smells (Smolewska et al., 2006). These three components are organized around a general sensitivity factor (Greven et al., 2019). SPS has a substantial biological basis, with an estimated heritability of approximately 47% (Assary et al., 2021). In studies that have grouped individuals according to their level of sensitivity, approximately one-third fall into the highly sensitive group (Lionetti et al., 2018).

From a clinical perspective, the most important consideration is that sensitivity amplifies the effects of the environment in both directions: in a well-attuned environment, sensitivity becomes a resource and the person flourishes like an orchid; in an environment that is poorly attuned, it becomes a vulnerability (Boyce, 2019; Pluess & Belsky, 2013). Meckovsky et al. (2025) indicate that HSPs experience greater emotional loneliness, but not greater social loneliness. The issue of power emerges in the gap between what a person feels and what the other person recognizes. Here, power is understood as the capacity to determine the shape of the relational field: who sets the pace, the distance, and the meaning of what happens. Dominance is the unilateral exercise of this power, preventing the other person from contributing to the emerging figure.

The Self as a Process and the Dimensions of Awareness

In Gestalt Therapy, the Self is not an intrapsychic structure but the activity of contact itself at the organism-environment boundary, unfolding through the Id, Ego, and Personality functions (Perls et al., 1951/1997; Robine, 2006). Distress arises when this process is interrupted and becomes fixed in rigid responses that occupy the field and prevent creative adjustment.

The three dimensions of awareness — awareness (spontaneous sensory openness to the present), consciousness (reflective and narrative processing), and deliberateness (attention directed by the will) — offer a possible clinical lens through which to understand the experience of HSPs (Bellini, 2025; Perls, 2023). Their relationship with the components of the DOES model is a proposal put forward in this article, not an established correspondence. In particular, Sensitivity to Subtleties (S) may direct the therapist’s attention toward the richness of the details perceived by the patient. Whether these details support contact or lead to overload can only be determined through the person’s experience, not from the trait itself.

Depth of Processing (D) can be brought into dialogue with reflection on experience, without automatically equating this characteristic with a particular activity of the Ego and Personality functions. In clinical practice, it is possible to observe whether the time spent reflecting on an encounter helps the person find their bearings or instead becomes repetitive and limits the possibility of new responses. This distinction must emerge from the individual patient’s experience, rather than from the mere identification of SPS.

Intentional attention may help some HSPs recognize overload and regulate timing, stimuli, and boundaries. Here, too, this is a clinical possibility, not a function that can be directly inferred from the letter O in the DOES model. When one mode of awareness appears to consistently prevail over the others, the therapist can explore how this affects contact and the negotiation of the relationship.

Two Possible Configurations of Dominance

When the field fails to provide support, or when stimuli exceed the organism’s capacity for self-regulation, the functions of the Self lose flexibility. In each of the configurations described below, the risk has two sides: the patient rigidifies the field in an attempt to survive, while the therapist occupies the space that has been left vacant.

The relationship between aggression and power is central to Pizzimenti’s (2015) account. Aggression is not an individual characteristic but the way in which one moves toward the environment to satisfy a need; it is therefore co-created within the relationship. This leads to an explicit ethical implication: responsibility for what happens should be attributed in proportion to the parties’ social power, and within the therapeutic dyad, the greater share of responsibility rests with the therapist. Bellini (2015) observes that power struggles emerge when aggression lacks the support of love and sexuality, understood as the need for exchange: each person then seeks to shape the other according to their own needs.

Hyper-Cognitive Dominance: From an Hyperactivated Id to Hyper-Cognitive Withdrawal

Depth of Processing leads HSPs to continue engaging with experiences even after they have ended (Acevedo et al., 2021). When an HSP is overstimulated, the Ego function withdraws from contact, and processing may turn into rumination. The risk of dominance may take the form of a demand for control over the relational field: an egotistic defensive strategy that replaces the spontaneity of contact with a constant attempt to control both oneself and the environment, becoming increasingly rigid as uncertainty within the field becomes more intolerable (Perls et al., 1951/1997; Polster & Polster, 1973).

The patient, therefore, does not dominate in order to overpower the other but in an attempt to survive: they demand a predictable form from the other person because the unpredictability of actual contact exceeds their processing capacity at that moment. It is necessary to observe what happens within the relationship to determine whether dominance is occurring. For example, the therapist can examine whether the patient consistently dictates the pace and meaning of the encounter, and how the therapist contributes to this configuration.

There is a corresponding risk of dominance on the therapist’s side. Faced with the patient’s intellectualized rumination, the therapist may be tempted to respond with interpretations or explanations that reinforce the patient’s flight into the Personality function and deprive them of direct experience of their lived body. This form of dominance disguises itself as clinical expertise: the therapist substitutes their own well-defined narrative for the patient’s still-formless one, reproducing the same logic of imposition in a subtler form. In Pizzimenti’s (2015) terms, the clinician responds to the patient’s substitute intentionality — for example, the need to understand everything — and reinforces it.

Hyper-Empathic Dominance and Confluence: The Collapse of the Contact Boundary

In HSPs, the heightened response of the insula and empathy-related areas to the emotions of others (Acevedo et al., 2014) may, in an unsupportive field, lead to confusion between the other’s experience and one’s own. The individual loses the ability to distinguish their own legitimate needs from those of others, the contact boundary collapses, and the Self becomes caught in pathological confluence (Perls et al., 1951/1997).

Here, too, there is a less visible form of patient dominance: by relinquishing the right to decide, the confluent HSP leaves the responsibility for the outcome to the other person, receiving protection and closeness in return. This is power exercised through withdrawal, which the therapist may recognize through their own fatigue or the feeling that they must do more.

The relinquishing of decision-making must be understood in context: it may indicate a need for support, express a choice, or contribute to a rigid distribution of responsibility.

The risk of dominance in this pattern primarily concerns the therapist and appears under the guise of care. The patient’s implicit request for guidance elicits a corresponding degree of directiveness, which becomes self-reinforcing regardless of the therapist’s intentions. The therapist risks responding to the patient’s experience of helplessness by actively occupying the space the patient leaves open: deciding, advising, structuring, and directing. The relationship thus shifts from I-Thou to I-It, and the patient becomes an object to be directed and corrected (Buber, 1993), in contrast with the dialogical method, which requires inclusion, presence, and a willingness to refrain from steering the outcome (Yontef, 1993).

For the confluent HSP, the reparative experience lies in discovering that their own needs can emerge and be acknowledged without being invaded or replaced by someone else’s needs.

Clinical Implications: From Correction to Restitution

In clinical practice, the task is not to assume that every HSP already possesses a high degree of awareness, but to understand how that particular person recognizes, organizes, and communicates their experience. Embodied epoché can guide the therapist in suspending premature explanations and attending to their own bodily experience as well (Bloom, 2009; Staemmler, 2006). The therapist’s resonances may contribute to an aesthetic understanding of the field (Spagnuolo Lobb, 2018), provided they are treated as hypotheses to be tested within the relationship. When a recurring explanation emerges, the therapist can explore present-moment experience; when the patient delegates decisions, the therapist can support the emergence of the patient’s own position without taking their place.

HSPs often enter therapy feeling that something is “wrong” with them because their sensitivity has not been validated by their environment. For this reason, the paradoxical theory of change (Beisser, 2004) is more than a technical choice: change follows from accepting who one is, rather than striving to be different.

Aesthetic Sensitivity (AES), as a component of the Highly Sensitive Person Scale, concerns engagement with experiences such as art and music (Smolewska et al., 2006). Aesthetics in the Gestalt tradition, by contrast, concerns the sensory quality of experience and contact (Robine, 2001, 2006; Spagnuolo Lobb, 2018). These two uses of the term are not equivalent. This article proposes bringing them into dialogue as a clinical hypothesis: for some individuals, attention to the sensory qualities of experience may become a resource for recognizing preferences and experimenting with ways of acting within their environment.

Greven et al. (2019) describe a relationship between AES and negative affectivity that differs from the relationships observed for the other components. Activities such as cooking, painting, or modifying a space, as proposed by Robine, can be explored with the patient when they hold personal meaning. Participating in the choices that shape the relationship is one possible clinical expression of power, to be assessed within the actual therapeutic process.

The opposite is a closed system, in which a predetermined figure — for example, how one ought to experience the world or how often one should attend parties and concerts — imposes itself on the here and now. In a closed system, imposed decisions cannot be revised because they eliminate any alternative that might call their underlying principles into question or challenge them (Pintonello et al., 2022).

Conclusions

The two configurations proposed here describe clinical possibilities, not typical profiles or inevitable consequences of SPS. In some encounters, the pursuit of predictability may restrict the space for mutual initiative; in others, difficulty expressing a choice may encourage excessive directiveness on the therapist’s part. Professional responsibility requires both parties’ contributions to the relationship to be observed, while taking the asymmetry of their roles into account.

Recognizing the person’s sensitivity and exploring with them which conditions support contact offers a direction for clinical work, without assuming that the trait needs to be corrected or optimized.

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