On Adaptive and Maladaptive Patterns (2024)

What, fundamentally, is psychotherapy about? I have been asking that question since the early 1990s when I was getting my first introduction to the many different ways psychotherapists thought about the human condition, suffering, and how therapy might help work to help people change.

If there is a central point of consensus where all the various psychotherapies converge, I believe it is found in the concept of adaptation. At the most basic descriptive level, adaptation refers to the way individuals adjust and respond to their environment. More specifically, it refers to the way individuals and groups invest in activities and seek affordances and pathways that they hope will be nourishing and help them grow, while also trying to avoid stressors, injuries, risks, and damaging costs.

As the processes of learning and development unfold, patterns of adaptation emerge. A positive adaptive pattern is where an individual adjusts to the situation in a way that results in valued outcomes, such that they are nourished and growing and feel healthy and happy. Maladaptive patterns are the reverse.

Short-term gain, long-term problems

A maladaptive pattern occurs when a typical way of responding results in short-term gain but long-term problems. Consider, for example, that what we call “anxiety disorders” are usually marked by patterns of stressful events that trigger anxious feelings and threatening interpretations, which are then followed by patterns of avoidance.

For example, consider a person with social anxiety who is invited to engage in an activity with others he does not know well. He has an image of a threat, followed by negative feelings, and then has negative reactions to both. This feeling of threat causes him to desire safety, and he returns to his bedroom and feels some relief, which means his avoidance has been reinforced in the short term. Unfortunately, the ultimate consequence is that his system of adaptation has learned that it is a dangerous world and the best thing to do is play it safe. This will likely not result in growth patterns of competency, mastery, or connection but will leave him feeling depleted, threatened, and having few pathways of nourishing investment.

Maladaptive patterns become entrenched

Because they are often reinforcing, maladaptive patterns can become entrenched. And such entrenched maladaptive patterns develop not just in our actions or habitual ways of responding, but also in our patterns of feeling, thinking, and relating to others.

Consider that many people develop “affect phobias,” such that they develop a fear of negative emotions. As a result, they work to avoid feelings and scary images that press on their hearts and live in a state of chronic vulnerability. In his excellent book, Therapeutic Communication, Paul Wachtel identifies how central anxiety and patterns of avoidance are difficulties with healthy psychological adaptation:

It has been clear to most psychotherapists for some time now that anxiety and related distressing affects usually lie at the heart of their patient’s difficulties. In large measure, people seek psychotherapy because they have become afraid of aspects of the world or aspects of their own experience that seem relatively harmless to most people. The task of the therapist consists to a significant degree in helping them to overcome these fears and live more fully, freely, and enjoyably.

Adaptation is largely a relational process

Of course, as Wachtel’s relational model of cyclical psychodynamics highlights, not all maladaptive patterns are about how we cope through actions or defend against feelings. Rather, as he and other interpersonal and family systems theorists and therapists have long noted, adaptation is largely a relational process.

Attachment theorists clearly show how caregivers and infants “co-regulate” emotion in the dance of attachment. Families will attempt to achieve a familiar homeostasis that allows for predictability and clarity of roles and boundaries, such that adaptation happens at the systems level. And, as the marriage therapist John Gottman notes, it is in the patterns of communication and relating that optimal or problematic functioning is found. He uses the metaphor of the four horsem*n of the apocalypse to describe how the ways people try to get each other to behave in desired ways often lead to stonewalling, blaming, defensiveness, or even contempt. When these strategies of relational adaptation emerge, the consequence is usually vicious maladaptive cycles of injury and frustration.

Rigid narratives create problematic cycles

The idea of maladaptive patterns is also central to the more cognitively inclined therapists who explore the interpretations, explanations, and attributions people make. Rigid, simplistic, overgeneralized, and extreme narratives about the self, the other, and the world result in feelings and actions that trap individuals into problematic cycles.

Cognitive therapists, narrative therapists, and those who emphasize psychological mindfulness help folks realize how rigid thinking or critical inner voices result in maladaptive outcomes. They help individuals reconstruct new narratives or develop reflective strategies that allow them to step outside their stream of problematic thinking.

Psychotherapy helps to change maladaptive patterns

Psychotherapy is a complicated endeavor that deals with some profound questions pertaining to the human condition, suffering, and change. Nevertheless, there does seem to be a useful way to frame the core of the enterprise, shared by many perspectives. At its fundamental base, psychotherapy can be considered to be focused on developing ways of understanding and assessing maladaptive patterns of thinking, feeling, acting, and relating and fostering a healthy, safe, healing relationship that allows patients to develop more adaptive ways of being.

Do you agree that what psychotherapy focuses on is helping maladaptive patterns become adaptive ones?

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