IJSP Number 4, 2022

45 - The patient is supposed to open up to the therapist, trust her - but has the impression of being attacked again and again; - The therapist makes a lot of effort for the patient, but at the same time has the feeling that her efforts are not valued at all; - The patient appreciates the therapist for her cleverness and verbal skills, but repeatedly feels “cornered” ; - The therapist empathizes with the patient ’ s world, but believes she is being manipulated in the process. These are all brief excerpts from possible “ tipping moments ” that can be overcome within an overall framework of a sustainable bond. However, relationship constellations are possible in which such “ tipping moments ” can actually change the entire picture, transforming a hitherto communal atmosphere into a hostile one. In analogy to the perceptual phenomenon, it would then have to be assumed that the ambiguity was inherent „ in the material ” from the outset, i.e. the psychological field of the patient or the field of the therapist (or both) are structured in such a way that they are “ tiltable ” in the sense that a simple change in the centring permanently transforms the entire picture of the other person and the relationship. This is conceivable if, for example, there is a tendency to think and act in a primitive- praegnant way, in primitive dichotomies like black or white, right or wrong, good or evil. Nuances, “ shades of gray ” are not allowed or are not bearable. At the moment of the “ tipping event ” there must then be - as described above - an interest on the subject side to look at the picture long enough for there to be a chance of tipping. This could be the case, for example, if a patient (or also the therapist) has had many disappointing relationship experiences - perhaps especially with people toward whom she has found herself in a weaker position - and has therefore developed a fundamental scepticism. This patient (or this therapist, too) will keep checking the relationship continuously for possible “ breaking points ” . On the other hand, the attachment to the originally seen figure/ground constellation must not be too strong, otherwise it can no longer tip over. Binding thus prevents tilting. This explains why especially the beginning of a therapy is prone to tipping: no attachment could develop yet. If a therapeutic relationship tips over into a “ against each other ” , although it has existed for a long time, one has to ask what constituted the fragility of the therapeutic situation, although it seemed to be superficially stable. 5.2. The therapeutic „ working past each other ” as a substitute action The atmosphere does not always have to tip over into hostile opposition or confrontation. A possible alternative variant is a kind of “ side by side ” , a “ working past each other“ of patient and therapist, kind of a hidden withdrawal. This juxtaposition may initially be experienced quite similarly to the “ shoulder to shoulder ” constellation described above, but with the significant difference that the achievement of the goal has been lost sight of. Both participants (possibly also just one of them) feel comfortable in the therapeutic situation, enjoy the perceived togetherness, but avoid dealing with the issues and problems at hand. In the sense of Dembo (mentioned above), this can serve as a substitute action. The relationship becomes an end in itself, a substitute goal; it loses its function with regard to the