Can analysts agree? The problems of consensus and the psychoanalytic mannequin: I. A proposed solution.

Abstract

Psychoanalysis, plagued by lack of demonstrable consensus on clinical formulations, is as much endangered by overinflated agreement from stereotypical dynamic formulas: tests of psychoanalytic hypotheses derived from any such formulations may therefore rest on questionable foundations. The problems that give rise to artifactual overagreement or failure to reach agreement are here traced in earlier empirical psychoanalytic research. Review reveals that although new and inventive empirical strategies (applied in the last two decades) achieve adequate success in the area of agreement, they demonstrate little headway in ruling out that stereotypy may underlie such consensus. The present investigation offers a solution for testing agreement in complex clinical psychoanalytic propositions, in a way that sets up a "test of the mannequin": that is, whether stereotypical assumptions about the patient's dynamics are overridden (revised) by the specific character of a given patient's narrative. The mannequin concept introduces a new and epistemically crucial consideration in the making of psychodynamic formulations and is relevant to both empirically controlled and clinical contexts of observation and formulation. No psychoanalytic paradigm, whether classically ego-psychological, self-psychological, control-mastery, or object-relational, escapes this problem.