ABSTRACT

This paper proposes a reinterpretation of sexual dysfunctions through the lens of Gestalt Therapy. Symptoms are considered bodily expressions of unresolved relational conflicts. Drawing on the concepts of aggression, sexuality, and the contact boundary, we explore difficulties such as vaginismus, erectile dysfunction, and low sexual desire as creative adjustments that shift conflict from the relational level to the bodily level. The article distinguishes dominant aggression, grounded in control and power struggles, from sexual aggression, understood as the capacity to sustain differentiation and intimacy simultaneously. Through the concepts of responsibility, vulnerability, and the transition from the “one-power” model to the “two-power” model, a clinical framework is proposed in which symptom transformation is understood as the outcome of a shift from domination to creative participation in the relational field.

Keywords: Gestalt Therapy, sexual dysfunctions, sexual aggression, couple conflict, responsibility, vulnerability, contact boundary, erectile dysfunction.

INTRODUCTION

In this paper, we aim to reinterpret sexual dysfunctions from the perspective of Gestalt Therapy, describing how aggression and sexuality influence relationships and what happens when sexual aggression is disrupted (Pizzimenti, 2015).

In Gestalt Sexology, we have observed how sexual difficulties arise from the challenge of integrating the need for intimacy, pleasure, and fusion with the need to remain individuals, reject what causes pain, and engage with the other person’s differences.

Working with sexual difficulties requires new lenses through which to understand and navigate conflicts. Within patriarchal society, these conflicts tend to be characterized by violence, abuse, or power struggles, and the genitals frequently become the bodily site to which conflict is displaced (Bellini, 2022).

This interpretation of sexual dysfunctions takes full account of the background from which the relational figures expressed by couples emerge and is consistent with the field approach that characterizes Gestalt Therapy (Robine, 2008; Francesetti & Roubal, 2020).

SEXUAL DISORDERS: THE BODY OF CONFLICT

Gestalt Therapy places the contact boundary at the center of its approach: the experiential boundary at which the exchange between the individual and the environment takes place. For this exchange to be possible, the boundary must remain flexible, able to expand and contract in response to what happens. This requires both the capacity to open up and become vulnerable enough to let the other person in, and the capacity to withdraw in order to protect oneself or reject what cannot be assimilated.

Boundaries serve protective, cognitive, exploratory, transformative, and expulsive functions: they enable us to welcome, modify, or reject the other person.

Through these boundary processes, people navigate a battleground of disagreements, fears, conflicting wishes and needs, misunderstandings, and more. At best, these experiences allow partners to come to know one another anew. Italian singer-songwriter Ivano Fossati offers an evocative image: “The building of a love breaks the veins in your hands, mixes blood with sweat, if any is left” (1981).

Conflict is intrinsic to intimacy.

From a philosophical perspective, Sartre articulates this view by arguing that the other person threatens my absolute sovereignty because, through their gaze, they turn me into an object and force me to confront a perspective I cannot control. A relationship cannot be a peaceful fusion, but rather a field of tension between freedoms that seek to limit one another while simultaneously seeking mutual recognition.

The presence of the other person is therefore unsettling yet necessary, because it challenges the illusion that I can be self-sufficient.

In couples, arguing and subsequently finding ways to make peace are two relational skills through which contact and growth take place (Resnick, 2016).

We can offer an initial definition of sexual disorders: they result from the internalization of conflict with the environment, which is thereby manipulated and, at least partially, displaced. This understanding of conflict draws on Perls’s thought. In the 1940s, Fritz Perls moved beyond the Freudian interpretation by arguing that Eros and Thanatos were not original instincts but rather the result of internalized conflictual relationships (Perls, 1949; Perls, Hefferline, & Goodman, 1951).

When aggression becomes destructive and communication between people breaks down, power struggles and more or less violent dynamics emerge, producing mutual suffering. From a field perspective, these configurations cannot be understood without considering the cultural context in which they develop. Patriarchal culture often implicitly teaches people to manage conflict through dominance, according to the logic of “winning” and proving oneself right at the expense of the other. Yet in intimate relationships, when one partner wins and the other loses, the relationship itself suffers a mutual loss (Pizzimenti, Bellini, & Montella, 2025).

Following Perls’s thinking, unresolved conflict is “creatively” displaced from the relational level (“between”) to the intrapsychic level in order to reduce the sense of helplessness it produces. Conflict is thus internalized and transformed into an internal split, giving rise to symptomatic configurations. This is a creative adjustment because it allows us to shift our attention away from a divisive war toward more manageable territory, even though the costs of this adjustment will eventually emerge.

Sexual dysfunctions can be understood as bodily manifestations of these internal divisions. Lack of desire, erectile or lubrication difficulties, vaginismus, and orgasmic difficulties often express a split between parts of the self that carry divergent needs: one part desires contact, while another rejects it, fears it, or attempts to control it. The bodily symptom then becomes the form through which this conflict is organized and made visible.

In this sense, the symptom is not merely a deficit to be eliminated, but a form of communication. Through the body and the genitals, the person acts upon the environment in ways that they cannot express at the relational level. Sexual dysfunctions can therefore be understood as creative adjustments that retain their own intentionality and function within the relational field.

In the case of erectile dysfunction, for example, a person may reject sexual intercourse without recognizing this as their own intentional movement, instead attributing the difficulty to their body, to a “penis that does not work.” Therapeutic work then involves recognizing the split between these two “parts” of the self, which reflect two different intentionalities, and bringing the conflict back to its original relational level, supporting the possibility of saying “I don’t want to” rather than “I can’t.”

When the symptom is brought back into the relational field, its function can be understood, and the person can be supported in finding alternative ways to express what the symptom organizes. From this perspective, taking responsibility for one’s lack of desire means reopening the conflict within a framework that offers greater support and awareness and, above all, responsibility.

Fully taking responsibility for a conflictual situation means questioning one’s own aggression and the ways in which one satisfies one’s needs.

This is where the central shift in therapeutic work takes place: from domination to responsibility, from the need to prove oneself right at the expense of the other person to the possibility of sustaining the complexity of the relational field without reducing it to victory or defeat. This transition is grounded in what might be called the “strength of not being right,” which Simone Weil referred to as the “strength of vulnerability” (1941) and which is described in several songs, including Niccolò Fabi’s Vince chi molla (2016): the capacity to remain within conflict without turning it into war.

From this perspective, sexual aggression represents a more complex and integrated form of organizing aggression than the dominant force we internalize within patriarchal culture. The intersubjective drive inherent in sexuality contains and limits the individualistic drive, creating a balance that fosters creativity.

LOVING WITHOUT FUSING: SEXUAL AGGRESSION

Gestalt Therapy generally approaches conflict in terms of polarities rather than figure-ground relationships. For Perls, polarity refers to the presence of opposing yet complementary aspects of the personality. Therapeutic work involves recognizing, accepting, and integrating these polarities rather than identifying exclusively with one side.

Aggression and sexuality can be understood in terms of a polar relationship or, alternatively, a figure-ground relationship (for a more detailed discussion, see Pizzimenti’s 2015 paper “Aggression and Sexuality,” in which the author explores the concept of sexual aggression).

Freud’s contribution was to highlight the vital force of sexuality from birth throughout development and adulthood (1905).

Gestalt Therapy reinterprets sexuality in terms of the contact boundary and therefore in its inextricable relationship with aggression (Pizzimenti & Bellini, 2022).

Sexuality is the drive to unite what has been separated (secare). It becomes particularly intense when we fall in love because it serves to bring two strangers together and foster intimacy. It makes boundaries permeable so that exchange can occur and supports the experience of the self in which, during full contact, boundaries recede into the background and we feel deeply connected with the other person and everything around us. Orgasm is an example of this experience, described by some people as a petite mort (little death).

The boundaries remain present; otherwise, the experience would be psychotic. However, we no longer need to be consciously aware of them. We can reclaim our boundaries at any moment, as we would if a burglar entered our home while we were making love.

Aggression, in turn, is necessary to bring differences into focus and disrupt established equilibria. Its function is to separate and, precisely by creating distance, to make intersubjective recognition possible.

When the other person makes choices with which I disagree, reveals aspects of themselves that I cannot tolerate, or fails to do what I want, I may begin to try to change them. At that point, a mutual struggle begins: one person attacks, while the other defends themselves, withdraws, or retreats into silence. From this perspective, aggression becomes destructive and sexuality disappears.

In a polar relationship, when one polarity dominates, the other disappears, as in the relationship between day and night or yin and yang. In a figure-ground relationship, by contrast, aggression and sexuality can coexist and support one another.

Sexuality, as a drive that unites and makes boundaries permeable, needs aggression to make differences visible and support individuation. Aggression, in turn, needs sexuality as a containing force to prevent it from becoming excessively destructive. When these polarities exclude one another, defensive or destructive behaviors emerge, potentially manifesting through sexual symptoms, particularly in moments of surrender when the person experiences greater vulnerability, exposure, and intimacy.

Sexual aggression involves a form of exchange sustained by aggression and sexuality within a figure-ground relationship, in which both are simultaneously present and mutually supportive.

FROM POWER STRUGGLES TO RESPONSIBILITY: THE STRENGTH OF NOT BEING RIGHT

To move from individualistic, dominant aggression toward sexual aggression, we must work with the dimensions of power and responsibility, which are closely interconnected (Bellini & Magarelli, 2024).

If we move from a “one-power” model to a “two-power” model (Philippson, 2020), the nature of the relationship changes. In the first model, only one person holds power at a time — a father, therapist, or leader — and the relationship is based on hierarchy. In the second, multiple people can exercise power simultaneously, and power ceases to be power “over the other person.”

To avoid an overly idealistic view, we will continue to want the other person to change and do what we can to help them understand our point of view. However, the power we exercise will no longer be directed solely toward changing the other person. Instead, it will develop through an increased capacity to respond to the situation, that is, through becoming more response-able.

As the etymology of the term suggests, responsibility encompasses both the ability to respond to a situation (respons-ability) and the ability to bear its burdens (res-pondus-ability).

When all responsibility for a conflict is attributed to the other person, we remain trapped in our own expectations and develop frustration and anger because the environment does not meet our needs. We feel powerless and tend to react automatically or defensively. The more we avoid taking responsibility, the more we risk experiencing ourselves as objects of other people’s actions rather than as active, creative subjects within the situation.

The more responses I can offer and the more burdens I choose to bear, the greater my freedom becomes. Conversely, if the only possible solution is for the other person to change, I become powerless and begin to see them as bad because they are responsible for my imprisonment and unhappiness.

Moving away from perceiving the other person as an enemy and beginning to see them as a subject makes it possible to reclaim an active position within the relational field. From this position, one can remain at the contact boundary, allowing greater permeability and, consequently, mutual influence.

In therapy, the couple is supported in reclaiming their projections, through which the other person is perceived as an enemy, while simultaneously recovering the capacity to remain within the conflictual situation with a form of strength that is no longer expressed through attack, but through vulnerability and the emotional acceptance of fear and disappointment.

This requires laying down one’s weapons as a unilateral choice and experiencing a form of strength that differs from the patriarchal model, grounded in being right and rigidifying boundaries. Instead, it is a strength associated with making one’s boundaries more open and receptive.

This is not an easy process, because the person we love is also the person who can pose the greatest threat: they can leave us, criticize us, withdraw, lose desire, fail to understand us, or make us feel inadequate.

For Simone Weil, approaching conflict through dominant power destroys every form of sociality, because the other person becomes an object and ceases to be a subject. Moving beyond power means relinquishing domination. Weil frequently speaks of décréation, or decreation: the movement through which the self gives up placing itself at the center of the world. This is not a form of pathological self-erasure, but a renunciation of the desire to dominate reality (1989).

From this perspective, moving beyond domination means:

• relinquishing absolute control;
• accepting the limits of one’s own will;
• recognizing the autonomy of the other person;
• replacing appropriation with attention.

When we manage to recognize the other person’s boundary, we can begin the work of taking responsibility, through which we acquire a different form of power, one that is distinct from domination.

If I cannot directly change the other person, I can change my active participation in the relational field.

Therapeutic work therefore consists of helping each person take 100% responsibility for the conflictual situation. This means assuming 100% responsibility for one’s own participation in the field, not 100% of the event’s causality, which would lead us toward a framework of “blame” and intensify the cycle of mutual anger.

Taking only 50% responsibility opens the way to power struggles, in which people adopt the logic of “I’ll do this only if you do that.” Change, by contrast, must begin unilaterally.

Taking responsibility for “everything” does not mean being responsible only for one’s own behavior, but also taking responsibility for how one responds to the other person’s behavior. If the other person does something disappointing, the task is to choose not to react automatically, but to remain with the fear without immediately turning it into a counterattack, thereby opening up space for curiosity about the other person’s boundary.

Taking responsibility for the other person’s behavior does not mean controlling them, nor does it mean assigning blame. It means recognizing that their behavior affects and moves through us and, above all, that our own response contributes to shaping the relationship. Nor does it imply a position of omnipotence, because it requires us to acknowledge the limits imposed by the environment: we cannot change the other person.

From this perspective, responsibility is no longer an abstract moral principle, but an embodied practice that continually reshapes how we participate in a relationship. It does not eliminate conflict but transforms its quality: instead of confrontation as a clash of wills, it creates a field in which we can remain present without reducing the other person to an enemy or ourselves to victims.

It is precisely within this fragile yet active space that power ceases to be domination and becomes the capacity to respond: not control over the outcome, but a willingness to remain in relationship even when the other person does not change. Perhaps it is precisely this willingness that opens up the possibility of change in how both people participate in the situation.

CONCLUSIONS

Sexual dysfunctions can be understood as phenomena emerging from the interplay between body, relationship, and culture. From a Gestalt perspective, the symptom does not simply represent an individual deficit, but a way in which the relational field organizes conflicts that have found no other means of expression.

Throughout this article, we have proposed that many sexual difficulties are connected to a particular way of managing aggression. When aggression takes the form of dominance, control, or the struggle to be right, sexuality tends to withdraw or become a battleground. The genitals then become the site where conflicts that cannot find expression at the relational level are embodied.

Sexual aggression, by contrast, represents a more evolved form of aggression, capable of sustaining differentiation and intimacy simultaneously. It allows us to maintain our boundaries without relinquishing contact and to recognize the other person as a subject without turning them into an enemy. In this sense, sexuality is not synonymous with fusion, but with the possibility of loving one another without erasing differences.

The fundamental therapeutic shift therefore involves moving from a logic of domination to a logic of responsibility. Through the transition from the one-power model to the two-power model, power ceases to be exercised over the other person and becomes the capacity to respond to the situation. Responsibility is neither blame nor omnipotence, but the recognition of one’s active participation in the relational field.

From this perspective, healing does not consist of gaining greater control over the environment or eliminating conflict, but of developing the capacity to remain within it without turning it into war. This is what Simone Weil describes as the renunciation of domination and what, in Gestalt terms, we might call the strength of vulnerability: the capacity to remain open to mutual influence while maintaining one’s own distinctiveness.

Relational freedom emerges precisely here: not when the other person changes, but when we recover the ability to participate creatively in shaping the relationship. Within this space, aggression ceases to be destructive and becomes a force for contact; sexuality ceases to be a battleground and once again becomes a meeting place between two subjectivities capable of recognizing one another.

BIBLIOGRAPHY

• Bellini B. (2015), Il linguaggio segreto della sessualità, in Pizzimenti M., a cura di, Aggressività e sessualità. Il rapporto figura/sfondo tra dolore e piacere, FrancoAngeli, Milano, pp. 73-98
• Francesetti, G., & Roubal, J. (2020). Field Theory in Contemporary Gestalt Therapy, Part 1: Modulating the Therapist’s Presence in Clinical Practice. Gestalt Review, 24(1), 5–28.
• Freud S. (1905), Tre saggi sulla teoria sessuale, in: Opere. Vol. IV, Bollati Boringhieri, Torino, 1970.
• Perls F. (1949). L’io, la fame, l’aggressività. L’opera di uno psicoanalista eretico che vide in anticipo i limiti fondamentali dell’opera di Freud. Franco Angeli. Milano: 2011
• Perls F., Hefferline R.F. e Goodman P. (1951), Teoria e pratica della terapia della Gestalt. Vitalità e accrescimento nella personalità umana, Astrolabio, Roma: 1971; 1997.
• Philippson P. (2020), One-Power and Two-Power Therapy: With thanks to Bob Resnick, Manchester: Manchester Gestalt Centre, 2020.
• Pizzimenti M., Bellini B. (2022). Sessuologia della Gestalt. Manuale imperfetto per continuare la rivoluzione sessuale. Franco Angeli. Milano: 2022.
• Robine, J.-M. (2008). Le fond du champ. En arrière-plan du concept. Cahiers de Gestalt-thérapie, 22(1), 197–210.
• Sartre J.P. (1943), L’essere e il nulla. Saggio di ontologia fenomenologica, Il Saggiatore, Milano: 1997.
• Weil S. (1941), L’Iliade o il poema della forza, Adelphi, Milano: 1990.
• Weil S. (1949), La prima radice. Preludio a una dichiarazione dei doveri verso l’essere umano, Ed. SÉ, Milano:  1990.
• Weil S. (1955), Riflessioni sulle cause della libertà e dell’oppressione sociale, Adelphi, Milano: 1983.
• Weil S., La gravità e la grazia, Adelphi, Milano: 1989.

WEB

• Bellini B. (2017). Aggressività sessuale. Figure Emergenti n. 1/17 – https://figuremergenti.it/pratica-e-teoria/aggressivita-sessuale/
• Bellini B., Magarelli V. (2018).  “Sessualità e potere.” Figure Emergenti, n. 2/2018.  – https://figuremergenti.it/pratica-e-teoria/sessualita-e-potere/
• Bellini B. (2019). Il malessere nella coppia. Uno sguardo sulla terapia di coppia. Figure Emergenti n.3/19  – https://figuremergenti.it/pratica-e-teoria/il-malessere-nella-coppia-uno-sguardo-sulla-terapia-di-coppia/
• Bellini B., Pizzimenti M. (A cura di Montella, 2025). Il patriarcato: uno sguardo gestaltico. – https://figuremergenti.it/interviste/il-patriarcato-uno-sguardo-gestaltico/
• Pizzimenti M. (2018), La co-creazione e il superamento della cultura della dominanza. Figure Emergenti, N. 4/2018 – https://figuremergenti.it/pratica-e-teoria/la-co-creazione-e-il-superamento-della-cultura-della-dominanza
• Pizzimenti M. (2023), Il mondo fa paura. La paura fa il mondo. Figure Emergenti, N. 6/2023 – https://figuremergenti.it/pratica-e-teoria/il-mondo-fa-paura-la-paura-fa-il-mondo/

 

FILMOGRAPHY

• Resnick, R. W., & Resnick, R. F. (2016). Coming Home [Video]. Gestalt Associates Training Los Angeles.
• Resnick, R. W., & Resnick, R. F. (2016). Sound of the Silence [Video]. Gestalt Associates Training Los Angeles.

SONGS

• Fabi, N. (2016). Vince chi molla. In Una somma di piccole cose. Universal Music Italia.
• Fossati, I. (1981). La costruzione di un amore. In Ho sognato una strada. RCA Italiana.