Coping Theory and Research: Past, Present, and Future
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Coping Theory and Research: Past, Present, and Future RICHARD S. LAZARUS, PHD INTRODUCTION ytic interest in defense was clearly its forerunner. The earliest psychoanalytic interest in defense cen- In this essay in honor of Donald Oken, I emphasize tered on its role in psychopathology as a character- coping as a key concept for theory and research on istic style for managing threat. A powerful psy- adaptation and health. My focus will be the contrasts choanalytic concept, which greatly influenced per- between two approaches to coping, one that empha- sonality and clinical psychology, was that each form sizes style—that is, it treats coping as a personality of psychopathology was associated with a particular characteristic—and another that emphasizes proc- defensive style. For example, hysterical neuroses ess—that is, efforts to manage stress that change were linked to repression, obsessive-compulsive over time and are shaped by the adaptational con- neuroses to intellectualization and undoing, para- text out of which it is generated. noia to projection, and so forth. I begin with an account of the style and process approaches, discuss their history briefly, set forth This view flowed from the theoretical conver- the principles of a process approach, describe my gence postulated in Freudian theory between three own efforts at measurement, and define coping and developmental variables: (a) the psychosexual stage its functions from a process standpoint. This is fol- of childhood development at which trauma occurs; lowed by a digest of major generalizations that re- (b) the primary impulses and conflicts of each par- sulted from coping process research. The essay con- ticular stage—for example, oral dependency, anal- cludes with a discussion of special issues of coping centered struggles over the social control of instinc- measurement, in particular, the limitations of both tual drives, and phallic and oedipal conflicts; and (c) coping style and process approaches and how these the child's cognitive characteristics at each stage, limitations might be dealt with. which presumably shape the defensive style. There has been a prodigious volume of coping Despite the elegance and potential power of this research in the last decade or two, which I can only formulation, the close association between devel- touch on very selectively. In this essay, I also ignore opmental stage, the content of impulses, and cogni- a host of important developmental issues that have tive characteristics does not show up clearly enough to do with the emergence of coping and its cognitive in observation to provide adequate support for it. and motivational bases in infants, as well as a grow- The link between forms of psychopathology and ing literature on whether, how, and why the coping specific defenses is also a bit too neat to be generally process changes with aging. applicable—it is more a conceptual ideal rather than a clinical reality. In many quarters, psychosexual theory has given way to a greater emphasis on other APPROACHES TO COPING: STYLE VERSUS cognitive-motivational processes—an outlook artic- PROCESS ulated in psychoanalytic ego-psychology—such as the development of competence and control and, of In one form or another the concept of coping has course, defense. In any case, the psychosexual for- been with us for a long time, though it began to mulation has lost influence in clinical research and come into its own formally during the 1960s and practice. 1970s, along with the burgeoning interest in stress. Some of the familiar writers who were actively If we think of coping as a generic concept that pursuing variants of this psychoanalytic thesis in- includes ego-defenses, which deal with threats to cluded Rapaport et al. (1) with their influential mon- one's psychological integrity, then the psychoanal- ograph, Diagnostic Psychological Testing, Schafer (2), Holzman and Gardner (3), Witkin et al. (4), Klein (5), Shapiro (6), and their many ego-psychology and developmental mentors (see also Ref. 7 for a detailed Address reprint requests to: Richard S. Lazarus, Ph.D., 1824 historical account). These are classic works that Stanley Dollar Drive, Walnut Creek, CA 94595. Received for publication May 11, 1992; revision received Au- were greatly admired by many of us of an earlier gust 4. 1992. generation. 234 Psychosomatic Medicine 55:234-247 (1993) 0033-31/4/93/55O3-O234$O3.OO/O COPING THEORY AND RESEARCH Coping as Hierarchical Styles hierarchical view of coping, with its trait or style The work of Menninger (8), and more recently emphasis, was abandoned in favor of a contrasting Haan (9) and Vaillant (10), drew on a hierarchical approach, which treated coping as a process. From approach to coping derived from the developmental a process perspective, coping changes over time and psychoanalytic formulation. Some defenses were in accordance with the situational contexts in which said to be more healthy or less regressed than oth- it occurs. ers—presumably as a result of stress or trauma. For A hierarchy of coping strategies based on precon- example, Haan proposed a tripartite hierarchy with ceived notions about their inherent health or pa- coping as the most healthy and developmentally thology runs the danger of confounding process and advanced process of adaptation, defense as a neu- outcome, which is particularly evident in Vaillant's rotic process, and ego-failure as the most severely otherwise impressive longitudinal research. Diag- regressed and perhaps psychotic adaptive process. noses of the type of defense employed by his subjects A Chicago research group, headed by Roy Grinker, depended to some unkown extent on prior notions Sr., at Michael Reese Hospital (e.g., Ref. 11)—which, about how healthy they are as coping strategies, incidently, included Donald Oken—focused less on which may well have influenced later evaluations the strictly Freudian developmental formulations of the quality of adaptation. As we shall see, a tenet with its emphasis on early childhood and more on of process approaches is that process and outcome the contemporary scene of the patient's life. For this should be measured independently. group, too, coping and defense were also central My own approach to the study of the coping proc- concepts. ess had its origins in stress film and sound track Hierarchical, developmental approaches tended to research at Berkeley in the 1960s (see Refs. 25-29, spawn trait measures of coping, such as the contrast 76). In the late 1970s, and within a few years of each between repression (avoidance or denial in some other, a number of researchers including myself versions)—sensitization (vigilance, isolation, or in- (e.g., Refs. 30, 31; see also a review of 10 years of tellectualization in some versions). In a review of research by Lazarus and Folkman (32); also Refs. coping theory and assessment, Cohen (12) cites a 33-35) developed measurement approaches bearing number of questionnaire measures of this contrast, the same metatheoretical stamp. These pioneering treated either as a single dichotomy or a continuous efforts were followed by additional questionnaire dimension. Her list includes a questionnaire pub- versions designed also to measure and study coping lished by Byrne (13), another by Epstein and Fenz as a process and examine its consequences for ad- (14), and a non-questionnaire measure developed by aptation. These additional versions overlapped Goldstein (15), named the Coping-Avoidance Sen- heavily with earlier ones (e.g., Refs. 36, 37). tence Completion Test. She also cites two Rorschach indexes, one by Gardner et al. (16), the other by Levine and Spivack (17), which employ the related Principles of the Process Approach language of repression-isolation. Finally, two mul- tidimensional sets of measures, The Defense Mech- Below is a set of the metatheoretical principles my anism Inventory of Gleser and Ihilevich (18), and colleagues and I have enunciated over the years the Coping-Defense Measure of Joffe and Naditch that, I believe, is reasonably representative of most (19), are also mentioned. current approaches to coping as a process: Not all research on coping style draws on stand- 1. Coping thoughts and actions under stress must ardized measures, such as those cited above. Many be measured separately from their outcomes in order are ad hoc procedures using in-depth clinical inter- to examine, independently, their adaptiveness or views (20-22). Still others have employed Grounded maladaptiveness. I make the contextualist assump- Theory (23), which does not employ interpretive tion—with considerable empirical support—that criteria in advance but generates models and hy- whether a coping process is good or bad, adaptation- potheses about what is happening from spoken or ally speaking, depends on the particular person, the written products (e.g., Ref. 24). specific type of encounter, in the short or long run, and the outcome modality being studied, for exam- ple, morale, social functioning, or somatic health. There may be no universally good or bad coping Coping as Process processes, though some might more often be better In the late 1970s a major new development in or worse than others. coping theory and research occurred in which the Thus, denial, which was once regarded by ego- Psychosomatic Medicine 55:234-247 (1993) 235 R. S. LAZARUS psychologists as pathogenic, may be useful for ad- malignancy—depending, of course, on whether it is aptation under certain definable circumstances, as I near the time at which a post-surgical diagnostic proposed some years ago in discussing its costs and examination is scheduled. If it is, then the danger of benefits (38). Although a full analysis of definitional recurrence will probably be at the center of atten- and measurement problems with respect to denial tion. However, at other times thoughts about recur- has not been made—for example, to what extent rence may be avoided. Alternatively, the focus of denial is different from avoidance and illusion— threat may be having to tell a spouse, friends, par- much interest in the consequences of denial for ents, or children about what is happening.