Rather than viewing gender dysphoria as a pathology, an emerging perspective frames it as a creative adjustment — a deeply personal and adaptive response to incongruence between lived experience and societal expectations of gender. Through the lenses of Gestalt therapy and psychoanalysis, gender dysphoria can be reinterpreted as a process of meaning-making, individuation, and identity integration.

Some (rather misguided) Gestalt therapists argue that birth assigned gender is an “introject”—a swallowed, unassimilated belief imposed by society. While this view aims to critique rigid gender norms, it misapplies Gestalt theory. Rather than seeing gender disidentification as pathological or unprocessed, I argue from within Gestalt theory that gender dysphoria or gender divergence can be understood as a creative adjustment—a contactful, adaptive response to a rigid or rejecting field. In the words of Fritz Perls, therapy should aim at “re-owning parts of the self,” not pathologizing them.

Introjection is an individual’s personal interruption to contact with the organism/environment field. It is a personal process. To say that a concept of any sort is an introject, implying that “society has it wrong” is suspiciously misleading.

Gestalt Therapy: Gender as a Lived Field Experience

In Gestalt therapy, the concept of the field emphasizes the co-creation of experience between the individual and their environment. Gender, then, is not a static identity but a dynamic, emergent aspect of one’s relational field. As Darvasi (2023) argues, gender should not be problematized solely in the context of trans identity but understood as an ever-present dimension shaping perception and interaction. For some, gender becomes more figural in moments of existential crisis, demanding engagement rather than suppression (Darvasi, 2023).

The case study of “Inocencia,” a trans woman treated with narrative and dialogic Gestalt therapy, highlights this point: her transition was not born from dysphoria in the traditional sense, but from a creative alignment with her authentic self, beyond binary diagnostic models (Bennett, 2010). The introject in this case is the client’s interruption to being at the contact boundary in her life space. What that is, will be the work of therapy. This is the way to support the client. But to imply that the world has fed the client this introject renders the client choice-less.

What Is an Introject in Gestalt Therapy?

Fritz Perls defined introjection as “the mechanism whereby an individual incorporates patterns of behavior, standards, and values from the external environment without discrimination or assimilation” (Perls et al., 1951). These beliefs are “swallowed whole” and can block authentic contact and self-regulation. Introjects prevent the person from making meaning through lived experience.

As Perls said:

“Introjection is swallowing without chewing. It’s accepting attitudes, beliefs, and feelings without evaluating them” (Perls, Hefferline, & Goodman, 1951).

Therefore, to classify assigned gender as an introject is to assume it is accepted uncritically. But this contradicts the lived experience of trans and gender-divergent people who actively question, reject, or reshape their gender identity—precisely the opposite of introjection.

The Gestalt View of Creative Adjustment

Perls’ Gestalt theory describes creative adjustment as a process in which the organism (person) creatively adapts to its environment in order to maintain equilibrium. Gender dysphoria, in this light, can be a signal of misalignment in the organism-environment field. The dysphoria becomes a call to transformation — not as pathology, but as adaptive restructuring.

Gender Disidentification as Creative Adjustment

Gestalt therapy sees the self not as fixed, but as emergent at the contact boundary, shaped dynamically through interactions with the field. When the environment is hostile or invalidating toward one’s authentic gender, the individual may disidentify from their assigned gender to maintain organismic balance. This is a creative adjustment—an act of contact and agency.

As Dora Darvasi (2023), a trans Gestalt therapist, writes:

“Gender disidentification can be a necessary contact function to maintain integrity in a hostile field” (Darvasi, 2023).

Similarly, Kolmannskog (2014) supports seeing gender identity as emerging through contact, emphasizing field conditions over internal pathology:

“Gender identity work must include the client’s experience of the social field… not just internal structures” (Kolmannskog, 2014).

This aligns with Perls’ emphasis on organismic self-regulation. Disidentifying from gender norms may be the organism’s best available choice in the moment—an active stance against oppressive field conditions.

Kolmannskog (2014) supports this by framing Gestalt therapy as “trans-positive” and field-aware, allowing the individual to explore gender without prescriptive goals. The therapy emphasizes phenomenological exploration — what is, not what should be — facilitating contact with authentic identity rather than conformity .

Introject or Contactful Choice?

An introject is passive; a creative adjustment is responsive. Gender divergence in most dysphoric individuals is not the passive acceptance of external messages but the active reworking of meaning, identity, and selfhood. To label this “introjection” is to misread agency as pathology.

David Hawley (2011) critiques this oversimplification:

“Gender is not static. It is co-created in contact, and often disowned or problematized by the surrounding field” (Hawley, 2011).

Rather than reflecting unassimilated beliefs, rejecting assigned gender may reflect a well-assimilated awareness of the incongruence between identity and imposed norms specific to the individual who suffers living the norms.

Within Gestalt therapy, acknowledging assigned gender is phenomenological and grounded in physiology. It is not an introject. For some in society, trying to force theory into submitting to woke ideology is an example of “misusing” Gestalt therapy (Perls, 1992).

Reframing gender dysphoria as a creative adjustment opens pathways for holistic therapeutic engagement. Gestalt therapy offers a field-based, phenomenological stance, while psychoanalysis provides depth and symbolic insight. Together, they can support individuals in transforming dysphoria into authenticity.

Disclaimer and point to note: This article does not imply that the author subscribes to woke ideas, especially on the topic of gender reassignment for minors, which she is fully against.

Reference

Perls, L. (1992). Concepts and misconceptions of Gestalt therapy. Journal of Humanistic Psychology, 32(3), 50-56.

Barkai, A. R. (2017). Troubling gender or engendering trouble? The problem with gender dysphoria in psychoanalysis. Psychoanalytic Review, 104(1), 1–32.

Bennett, J. L. (2010). ‘Inocencia’: Case study of a transgender woman without gender dysphoria preparing for gender reassignment surgery. British Gestalt Journal.

Darvasi, D. (2023). In and out the gender pail. British Gestalt Journal. Kolmannskog, V. (2014). Gestalt approaches to gender identity issues: A case study of a transgender therapy group in Oslo. Gestalt Review, 18(3), 244.

Kolmannskog, V. (2014). Gestalt approaches to gender identity issues: A case study of a transgender therapy group in Oslo. Gestalt Review, 18(3), 244.

Tor, Y. N., Shapich, R., & Rusina, N. (2023). Psychodynamic psychotherapy in the diagnosis and treatment of gender dysphoria. Patient-Oriented Medicine and Pharmacy.