Susan Folkman

Introduction

Susan Folkman is an American psychologist whose work reshaped how researchers understand stress. Working with Richard S. Lazarus at the University of California, Berkeley, she helped build the transactional model of stress and coping, which treats stress not as a property of events but as a relationship between a person and an environment that the person has appraised as taxing or exceeding their resources. In her doctoral thesis she introduced the terms problem-focused coping and emotion-focused coping, a distinction that is now standard vocabulary in health psychology, organizational psychology, and clinical practice. Their 1984 book Stress, Appraisal, and Coping became the most widely cited work in its field. Folkman spent the second half of her career applying the model to people facing serious illness, first among the caregiving partners of men with AIDS in San Francisco, and later in the context of chronic stress and bereavement.

Early Life and Education

Susan Kleppner was born on March 19, 1938, in New York City to Beatrice and Otto Kleppner. She earned a Bachelor of Arts in history from Brandeis University in 1959, the year after marrying David H. Folkman, and then spent roughly twelve years at home raising their four children.

Her return to academic work was itself a source of the questions she would later study. Watching women re-enter school and start careers, she noticed that some coped well under the strain and others floundered. She enrolled in 1972 in a master's program in counseling psychology at the University of Missouri, St. Louis, completing the M.Ed. in 1974. She was about to begin doctoral study at Washington University in St. Louis when her husband was offered a position in California, and she instead entered the doctoral program in educational psychology at the University of California, Berkeley.

At Berkeley she joined the stress and coping research group led by Richard Lazarus. Her 1979 dissertation, Analysis of Coping in an Adequately Functioning Middle-Aged Population, drew on a community sample of middle-aged adults asked to report their daily stressors. It was here that she proposed the distinction between coping aimed at changing the situation and coping aimed at regulating the emotional response to it.

Academic and Professional Career

After receiving her PhD in 1979, Folkman stayed at Berkeley as a research psychologist and continued community-based work with Lazarus until 1987. That year Thomas J. Coates, director of the newly funded Center for AIDS Prevention Studies at the University of California, San Francisco, invited her to build a research program on stress and HIV/AIDS. She moved to UCSF in 1988 and joined the faculty as a professor of medicine in 1990.

In 1989, at the height of the epidemic, she secured National Institutes of Health funding for a longitudinal study of stress and coping among the caregiving partners of men with AIDS, following them through caregiving and bereavement. It produced some of the first systematic evidence on what sustained caregiving does to the immune system, to depressive symptoms, and to the course of HIV infection in the caregivers themselves, and it established that bereavement in this population carried measurable psychiatric and physical risk. From 1994 to 2001 she was co-director of the Center for AIDS Prevention Studies. Utrecht University awarded her an honorary doctorate in 1997.

In 2001 she became the first full-time director of UCSF's Osher Center for Integrative Medicine and was named the Osher Foundation Distinguished Professor of Integrative Medicine, a post she held until retiring in 2009, after which she was named professor emerita in the Department of Medicine. She chaired the Consortium of Academic Health Centers for Integrative Medicine from 2005 to 2007 and helped organize the first North American Research Conference on Complementary and Integrative Medicine. She served on the National Advisory Mental Health Council of the National Institute of Mental Health from 2000 to 2004 and later on the advisory council of the National Center for Complementary and Integrative Health, and co-chaired an American Psychological Association task force on ethics in research with human participants. In 2010 the California Psychological Association gave her its Lifetime Achievement Award.

Major Contributions to Psychology

The transactional model

The model Folkman developed with Lazarus relocates stress from the stimulus to the transaction. An event becomes stressful only after primary appraisal, in which the person judges whether anything is at stake, and secondary appraisal, in which they weigh whether they have the resources to meet the demand. Coping is then defined as the continually changing cognitive and behavioral effort to manage those demands, rather than as a stable personality trait. The implication was unfashionable in 1984: the same event is stressful for one person and not another, so no inventory of life events can by itself predict outcomes.

Two families of coping

Folkman's most widely used contribution is the contrast between problem-focused coping, which changes the elements of the stressful situation, and emotion-focused coping, which regulates the emotional response when the situation cannot be changed. Her empirical work showed that neither is inherently superior: controllability of the stressor determines which is adaptive, and most people use both in the same episode.

Meaning-focused coping and positive affect

Folkman's own data eventually forced an amendment to the model. Studying AIDS caregivers, she found that people under sustained, extreme stress reliably reported moments of positive emotion, love, and meaning, which her existing framework could not accommodate. Working with Judith Tedlie Moskowitz, she argued that revising goals, finding meaning, and sustaining positive affect are not merely outcomes of successful coping but active processes that support emotion regulation and allow people to keep going over long periods. Meaning-focused coping was subsequently added as a third family of coping strategies.

Applications in health and policy

By publishing caregiving research in journals such as JAMA and the New England Journal of Medicine, Folkman helped move psychological coping research into mainstream medical and policy discussion, and her measures were adopted widely in intervention research on chronic illness and bereavement.

Major Publications

Analysis of Coping in an Adequately Functioning Middle-Aged Population (1979) — Folkman's Berkeley doctoral dissertation, in which the problem-focused and emotion-focused distinction was first proposed.
Folkman, S., & Lazarus, R. S. (1980). "An analysis of coping in a middle-aged community sample." Journal of Health and Social Behavior, 21(3), 219–239.
Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. Springer. — The systematic statement of the transactional model; the most cited book in the stress and coping literature.
Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). "Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes." Journal of Personality and Social Psychology, 50(5), 992–1003.
Folkman, S., Chesney, M. A., Pollack, L., & Phillips, C. (1992). "Stress, control, coping, and depressive mood in HIV-positive and HIV-negative gay men in San Francisco." Journal of Nervous and Mental Disease, 180(7), 409–416.
Folkman, S. (1997). "Positive psychological states and coping with severe stress." Social Science & Medicine, 45(8), 1207–1221.
Folkman, S., & Moskowitz, J. T. (2000). "Positive affect and the other side of coping." American Psychologist, 55(6), 647–654.
Folkman, S. (Ed.). (2011). The Oxford Handbook of Stress, Health, and Coping. Oxford University Press.

Impact and Legacy

Folkman's vocabulary is now close to unavoidable: appraisal, problem-focused and emotion-focused coping, and meaning-focused coping appear in textbooks, clinical protocols, and intervention trials across health psychology. Her willingness to move from laboratory theory into an unfolding public health crisis gave the field a body of longitudinal data on caregiving and bereavement that did not previously exist.

The model has also drawn sustained criticism. Its central constructs are measured by self-report, often after the outcome is known, which makes it difficult to rule out reverse inference: people who are doing badly may simply describe their appraisals and coping more negatively. Critics argue that because almost any pattern of results can be fitted to some combination of appraisal and coping, the theory is hard to falsify. The classification itself has been contested as well. Stanton and colleagues showed that some forms of emotion-focused coping, which they called emotional approach coping, predict better adjustment rather than worse, undermining the implicit hierarchy in which problem-focused strategies are treated as more mature.

Three further lines of attack are worth separating:

A rival theory was built against it. Stevan Hobfoll's conservation of resources theory, introduced in 1989, was advanced as an explicit alternative: stress is fundamentally about the threat or actuality of resource loss, and resources — objects, conditions, personal characteristics, energies — are objective enough to be assessed without asking people how they appraised anything. Hobfoll's objection was that appraisal models put cognition first when the loss is what does the work, and that asking people to report their appraisals is close to asking them to report their mood.
The measurement never stabilised. The factor structure of the Ways of Coping instrument varies by sample, by occasion, and by the instructions given, and items that load as one strategy in one study load differently in the next. Critics have argued that this is not a technical nuisance but a sign that "coping" is being asked to do too much work as a variable.
Coping is hard to separate from its outcomes. Several critics, including Coyne and later reviewers, have argued that coping checklists frequently ask respondents about states that are themselves symptoms or results — worrying, withdrawal, self-blame — so that correlations between coping and distress may simply restate the association between distress and itself.

There is also a quieter question about her later career. Folkman moved from a mainstream NIH-funded caregiving programme into the directorship of an integrative medicine centre, a field in which therapies with weak or contested evidence sit alongside well-supported ones. Her defenders note that she used the position to argue for the same randomised designs she had always used; her critics see a distinguished stress researcher lending prestige to a less disciplined institutional neighbourhood.

The most consequential revision was Folkman's own. Her caregiving data demonstrated that the original two-category model could not account for the positive emotions people report during prolonged hardship, and she argued openly that the theory needed a third category rather than a defense. Supporters of the framework note in response that coping-effectiveness training and other interventions derived from it have produced measurable benefits, and that its clinical usefulness does not depend on resolving every measurement dispute.

Learn More

Jon Kabat-Zinn — whose mindfulness-based stress reduction is a clinical outgrowth of the coping literature.
Lisa Feldman Barrett — whose theory of constructed emotion reframes the emotion categories coping research measures.
Positive Psychology — the movement's central hub on well-being and human strengths.
Coping Strategies — the transactional model of stress and coping.
Saul Shiffman — whose momentary-assessment methods made relapse measurable as it happens rather than in retrospect

References

Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. Springer.