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THE EFFECT OF ATTACHMENT- BASED COUPLE THERAPY ON COUPLES' ATTACHMENT STYLE, SEXUAL INTIMACY AND SEXUAL SATISFACTION
SAEIDEH BOTLANI*1, MARZIEH SHAHSIAH 2, ZAHRA PADASH3, AHMAD AHMADI 4, FATEMEH BAHRAMI 5.
1 2

M.A IN FAMILY COUNSELING,ISFAHAN UNIVERSITY M.A IN FAMILY COUNSELING,ISFAHAN UNIVERSITY 3 M.A IN FAMILY COUNSELING,ISFAHAN UNIVERSITY 4 PROFESSOR AND FACULTY MEMBER OF ISFAHAN UNIVERSITY, COUNSELING DEPARTMENT , ISFAHAN, IRAN. 5 PROFESSOR AND FACULTY MEMBER OF ISFAHAN UNIVERSITY, COUNSELING DEPARTMENT, ISFAHAN, IRAN.

Abstract The purpose of this study is to study the effect of attachment- based couple therapy on couples' attachment style, sexual satisfaction and sexual intimacy in Isfahan in 2009. The method was semi- experimental with pretest, posttest and follow- up with experimental and control groups. The sample were 30 couples referring to counseling centers in Isfahan in 2009 and set randomly in two groups of experimental (15 individuals) and control (15 individuals). The hypothesis was the attachment- based couple therapy increases sexual satisfaction and sexual intimacy. The dependant variables were attachment style, sexual satisfaction and sexual intimacy that were assessed by their questionnaires. Independent variable was attachment-based couple therapy which was fulfilled in 8 sessions on experimental group. All the data was analyzed by SPSS. The results showed attachment -based couple therapy did not change attachment style (F=2.56, P>0/001) but increased sexual satisfaction (F=512/211, P 0.001) and sexual intimacy (F=818.63, P 0.001) significantly. This education can be used in counseling and psychological health centers. Keywords: Couple therapy, attachment theory, sexual satisfaction, sexual intimacy

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Introduction

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Intimate relationship is very important among individuals .Also it affects on physical and psychological well- being and individuals' ability in better functioning in personal, professional and family domains. Creation and continuance of intimate relationship can be reinforced by special emotional connections. Since healthy relationship has positive gains and consequences in life, dissatisfied relationship can endanger physical and psychological health. Intimacy is closeness, similarity and an emotional romantic and personal relationship with someone else. It needs his/ her cognition and understanding to explore thought and feeling which are the source of closeness and similarity.Intimacy is an interactional process and has different dimensions. The basic of this process is cognition, understanding, acceptance and empathy of some one else and also appreciation and his/ her view acceptance.Intimacy is a fundamental and real need and it is not just a wish or desire (Bagarozzi, 2001). Intimacy has an extended meaning and includes self- exposure, sexual relationship, and emotional, physical and intellectual closeness. When intimacy removes, one of the marital connection disappeares.Bagarozzi( 2001)Introduces intimacy in 9 dimensions: emotional, psychological, intellectual, sexual, physical, spiritual, aesthetic, social and creational and temporal. It's intensity and nine dimensions are different in

individuals.An intimate relationship and affective attachment with life close members such as parents, spouse and children are necessary. Trying to seek and keep this relationship with important members is a motivational basis and continues in the whole life. Attachment and relationship are necessary for psychological development, personality formation and emotional health. Attachment and trusting others affect emotional health, security feeling and mental health and, therefore, the ability to control emotion and experience empathy, needs a secure attachment. Attachment theory looks at the human beings as social existences who have potential to relate with others. Bowlby (1982) believes that attachment in a parent- child relationship transfers to a romantic relationship in adulthood and can affect on cognition, emotion and behaviors in life. An insecure relationship will have a lot of dangers and damages. Therefore, security is a core of attachment systems in relationship. A secure relationship can be made with someone who can be felt attachment. This relationship is mostly formed with

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the spouse and she/ he can be the first form of attachment and the source of security and comfortable. Those who feel secure have more clear, cohesive and continuous attachment to their spouse and have positive feeling toward him/her. They have more commitment to each other and are more satisfied with their relationship. The more satisfaction, the more continuity of the relationship. Attachment deepens our understanding of daily relational evidences such as sexual relationship which is a necessary part in a satisfied marital relationship. Couples' sexual relationship increases their attachment. Many couples have sex when their relationship reinforces and become moderate and also their attachment needs are satisfied (Hazen, Zeifman and Middleton, 1994). Sexual relation is a part of couples' romantic relationship. Romantic bonds, intimacy and satisfaction of a relationship are key factors in couples' attachment. Here, sexual intimacy is very complicated and needs more attention because its satisfaction affects on other dimensions of couples' relationship. Sexual intimacy includes sharing lovely experiences, physical touch, and intercourse and as a whole those relationship planned for sexual excitement, arousal and satisfaction. During the time, counselors have understood that sexual intimacy is very sensitive and has a lot of problems for couples. If they are aware of their differences in sexual needs and desire, they can remove sexual problems easier. On the contrary, if they are not awared of their sexual intimacy, we are faced with a lot of problems (Bagarozzi, 2001). In an intimate and happy situation, couples have more satisfied sexual relationship and their attraction is remained during the whole life. Sex is very important for an intimate relationship. Loss of intimacy and happiness in life removes vitality and affects life quality (Olson, 2003). Intimacy, sexual fulfillment,level of pleasure increase and its satisfaction are basic factors to prevent extramarital or abnormal sexual relationships (Masters and Johnson, cited by Ohadi,2001). Intimacy in a satisfied sexual relationship is related with marital life quality. The researches in sexual intimacy of successful marriages explore three basic subjects: A) the importance of sex in successful lives B) sex benefits in successful life C) sexual changes during the life (Olson, 2003). McCarthy (1999) explains there is a relationship between sexual satisfaction and satisfaction of the whole relationship.

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A satisfied sex is an important part of a relationship. Unsatisfied sex increases sexual problems and decreases intimacy and vitality in life.Of personal factors which affect on sexual intimacy and sexual satisfaction is attachment. It is an emotional and biological bond and reminds child-caregiver closeness especially in dangerous and frightening situation (Bowlby, 1982). To Schaffer (2003) attachment is close emotional relationship between two adults which is characterized by mutually affection and interest to be more close (Eysenck, 2000). Attachment is necessary for a healthy development. To Bowlby ,attachment is made when a hearty, intimate and durable relationship is created between Mother-child and it is satisfactory and vital for both. Attachment is formed gradually in the first year of life and has mutual quality, it means mother- child are gradually attached (Poorafkari, 1998). To Hazan and Shaver (1987) among different types of attachment, individuals with anxious/ ambivalent attachment style needs more intimacy. Their sexual relationship is prefered to caretaking behaviors and security and intimacy desires. They use sexual situation to retrieve their unresponded sexuality need. They may have different sexual partners. On the other hand, the individuals with avoidant attachment style are involved in extramarital affairs. They follow a complete sex and prefer more sexual partners (Hazan, Zeifman and Middleton, 1994). But secure attachment style are emphatic and experience intimacy. They are involved in such a sex which is pleasurable for both and the aim is sexual intimacy and mutual joy and pleasure (Miller and Fishkin, 1997). Since attachment theory can increase sexual intimacy and sexual satisfaction and also insecure attachment styles can affect a couples' sexual and their whole relationship and ruptures their romantic relationship and marriage, the purpose of this research is to study the effect of attachment- based couple therapy on sexual intimacy and satisfaction of couples in Isfahan, Iran. The importance and value of the article The previous researches due to the relationship among individuals' attachment styles, attitudes and sexual relationship explore their strong correlation. In a research in USA, couples' weak relationship, emotional and affective separation and unsatisfied sex were the basic factors why couples refer to counseling centers (Howton, et al, cited by Ghasemzdeh,2005). The more study showed when they have weak relationship, they

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have insecure attachment styles. On the other hand, when sexual problems removed, it was seen a better relationship and changes from insecure attachment to secure signs (Sharp, 2000). Therefore, a strong relationship between sex and attachment styles is understood. Other researches have reported the direct relationship between them. Feeney et al (1994) reports ,in comparison to other styles, avoidant attachment style individuals have shown acceptable attitudes to extramarital affair. Method The research method was semi- experimental with pretest, posttest and control group. The populations were couples referring to counseling and cultural centers in 2009 in Isfahan, Iran. The sample were accessible referring couples who were randomly set into two groups of experimental and control (15 couples in experimental and 15 couples in control). Here it is used three questionnaires: 1- Experienced in Close Relationship- Revised (ECR-R) questionnaire. It is made by Fraley, Waller and Brennan (2000). ECR-

R assesses adult romantic attachment in two dimensions of anxiety and avoidant. Avoidant dimension studies uncomfortablility to closeness and dependency but 18 questions measure each dimension. Here, this questionnaire assesses adult romantic attachment in four styles. 1- Secure 3- Fearful 2- Pre occupied 4- Dismissing attachment styles

It is a Lickert scale with 5 choices: completely agree- agree- no idea- disagreecompletely disagree. Minimum score is 8 and maximum is 90. High score in each dimension shows high avoidance and anxiety. It is performed on 140 individuals by researcher and internal correlation was 0.89 which was congruent with Fraley, Waller and Brennan (0.90). The internal correlation for avoidant scale was 0.91 and for anxiety was 0.92. Mandy K. Maunt (2005) reports 0.94 for avoidant internal correlation and 0.95 for anxiety. It is also to be noted that some questions are graded reversely. 2- Sexual satisfaction questionnaire It was the researcher- made questionnaire. Due to the literature, 19 questions were written. 18 questions were a Lickert scale with 4 choices (always, sometimes, rarely,

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never) but question 19 was graded from 0 (unsatisfaction )10 (very satisfaction )in which the participants must choose a number. Maximum score was 82 and the minimum was 0. When the score goes to 10, it shows more sexual satisfaction. Content validity was approved by professors in counseling and psychology. Alpha Cronbach coefficient is used for its reliability and was 0.83. 3- Sexual intimacy questionnaire Due to sexual intimacy literature and Bagarozzi's sexual intimacy scale (2001), the researcher- made questionnaire was prepared. It had 30 questions based on Licker scale (always- sometimes, rarely, never)from 4 to 1. Maximum score was 120 and the minimum was 30. Near maximum was higher sexual intimacy and vice versal. Again its content validity was approved by counselors and psychologists in Isfahan university and its Alpha Cronbach was 0.81. In the research process, the participants were interviewed and pretest was filled up (ECR-R, sexual intimacy and sexual satisfaction questionnaires). Then the attachmentbased couple therapy sessions were preformed for experimental group and not for control one. After the last session, posttest was filled up and finally we had a follow- up after three months. To analyzed the data, SPSS was used and the method was descriptive statistics such as mean, standard deviation and also inferential statistics such as covariance.

The findings To test to hypotheses, covariance analysis is used .In this method, posttest means were compared after modifying pretest scores. Here, Levin test was used and presumption of scores variance equality in two groups of experimental and control was approved. 1- Attachment- based couple therapy is effective on couples' attachment style. The whole mean were as follow: Pretest in experimental group: 120.8 control group: 121.73 Posttest in experimental group: 120.90 Follow- up in experimental group: 120.66 control group: 121.75 control group: 121.77

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Table 1: Covariance analysis in effectiveness of group membership and gender on attachment in posttest and follow- up

Variables

Test Posttest

Freedom degree

Sum of squires

Significance

Effective statistic measure power

1 1 1 1 1 1 1 1

1712/41

279/09

0/000 0/000 0/115 0/974 0/318 0/584 0/810 0/89

0/435 0/451 0/045 0/000 0/018 0/005 0/18 0/005

1 1 0/350 0/050 0/168 0/084 0/168 0/84

Pretest

Followup

2129/03 1068/05 15/722 2/10 6/240 0/602 0/360 3/98 2/56 0/001 1/017 0/302 0/59 0/020

Group membership

Posttest Followup Posttest

Gender

Followup Posttest

GenderGroup Followup

Table 1 shows that with pretest control, there is no significant differences among participants' attachment style scores on the basis of group membership (both experimental and control group) in posttest and follow- up (P<0.01), therefore, the first hypothesis is not approved and attachment -based couple therapy was not effective on couples' attachment style. 2- Attachment- based couple therapy increases couples' sexual satisfaction. The whole mean in sexual satisfaction were as follow: Pretest in experimental group: 55.30 control group: 53.06 Posttest in experimental group: 77.83 control group: 53.40 Follow- up in experimental group: 76.53 control group: 51.40

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Table 2: Covariance analysis in effectiveness of group membership and gender on sexual satisfaction in posttest and follow- up

Variables

Test Posttest

Freedom degree

Sum of squires

Significance

Effective statistic measure power

1 1 1 1 1 1 1 1

360/60 319/95

25/391 35/380

0/000 0/000 0/000 0/000 0/272 0/240 0/322 0/705

0/31 0/39 0/483 0/472 0/022 0/025 0/018 0/003

1 1 1 1 0/194 0/215 0/166 0/066

Pretest

Followup

Group membership

Posttest Followup Posttest

7274/593 512/211 7138/862 789/405 17/511 12/771 14/175 1/313 1/233 1/412 0/998 0/145

Gender

Followup Posttest

GenderGroup Followup

Table 2 shows that with pretest control, there is a significant difference among participants' sexual satisfaction scores on the basis of group membership (both experimental and control group) in posttest and follow- up (P<0.01). Therefore, the second hypothesis is approved and its measure is 0.483. It can be concluded that attachment- based couple therapy increases sexual satisfaction in experimental group in posttest and follow- up. 3- Attachment-based couple therapy increase couples' sexual intimacy The whole mean in sexual intimacy were as follow: Pretest in experimental group: 75.97 control group: 73.03 Posttest in experimental group: 114.50 Follow- up in experimental group: 113.96 control group: 83.50 control group: 76.13

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Table 3: Covariance analysis in effectiveness of group membership and gender on sexual intmacy in posttest and follow- up

Variables

Test Posttest

Freedom degree

Sum of squires

Significance

Effective statistic measure power

1 1 1 1 1 1 1 1

444/030 320/522 11515/8

31/56 30/72 818/62

0/000 0/000 0/000 0/000 0/440 0/947 0/866 0/911

0/36 0/36 0/48 0/46 0/11 0/000 0/001 0/000

1 1 1 1 0/119 0/050 0/053 0/051

Pretest

Followup

Group membership

Posttest Followup Posttest

17803/1 1706/63 8/50 4/67 0/404 0/132 0/604 0/004 0/29 0/013

Gender

Followup Posttest

GenderGroup Followup

Table 3 shows that with pretest control, there is a significant difference among participants' sexual intimacy scores on the basis of group membership (both experimental and control group) in posttest and follow-up (P<0.01). Therefore, the third hypothesis is approved. As it is seen, the interaction of therapeutic method and gender was not significant in attachment, sexual satisfaction and sexual intimacy variables and it means therapeutic method had the same effective on men and women in recent dimensions. Conclusions Covariance analysis revealed that there is no significant difference between experimental and control group attachment scores in posttest and follow- up (F=2.56, P>0.001) (Table 2). It means attachment- based couple therapy was not effective on couples' attachment style and did not change it. This research finding was congruent with Sirz, Vaytining and Nolis (1953,cited by FakhariNezhad,2006), Mccoby and Masters (1970), Shaver, Hazan and Bradshow (1988). Kirkpatrik and Hazan (1994), Feeney and Noller (1996), Waters, Merick, Treboux, Crowell and Albersheim. In their Sirz, Vaytining and Nolis (1953) showed that attachment quality is a quasithat

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characteristic which remains constant during the life. Based on Mccoby, Masters (1970), Shaver, Hazan and Bradshaw (1988) attachment style does not change during the time. Kirkpatrik and Hazan studied attachment style stability in adulthood and reported that about 70 percent of individuals chose the same attachment style as four years ago and it shows that it is constant. Feeney and Noller (1997) explained that attachment style is person's response model to intimate relationship and it is everlasting during the time. Here, we can say a person's internal working model is a mechanism which contains first attachment experiences and can affect his/ her whole life. These models are formed once and is constant forever. Others' internal working model are those imagination which a child forms of their expectable behaviors and characteristics. Scientists assessed attachment style through interviews and they found its permanence. As a whole, all the researches due to attachment (such as self- assessment, interview and questionnaire) assessed attachment and revealed that adult attachment signs are resistant. The results of second hypothesis shows there is a significant difference between mean scores in experimental group and control one in posttest and follow- up (P<0.001, F= 512.211) (Table 2). It means attachment- based couple therapy has increased couples' sexual satisfaction. It can predict marital and satisfaction(Cupach Veroff,1994;Lawrance and and

Comstock,1990;Greeley,1991;Henderson-King

Byers,1995; Oginns,et al,1993)sexual satisfaction is related with marital quality(AdeRidder,1990;Hinchliff and Gott,2004), childhood and marriage sexual duration and affective and and

relationship(Wilson,2007)

abuse(Nelson , Miller

Wampler,2000)depression(Tower

Kasl,1995;Sandberg

Harper,2002),sexual disorders(Hinchliff and Gott,2004),sexual activities and emotional satisfaction(Hyde and Delamater,2000) self- exposure(Byers and Demmons,1999; Cupach and Comstock,1990), marital frustration and original family

frustration(Wilson,2007), supportive relationship(Sprecher et al,1995), intimacy, physical affect, emotional satisfaction, love(Hurbert et al,1993;Lawrance,Byers,1995, Oginns,et al,1993), sexual relationship total numbers(Young and

Luquise,1998;Blumstein and Schwartz,1983); income(Oginns,et al,1993), religious commitment(Young and Luquise,1998), couples' working time(White and Keith,1990).

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It his research on 205 married couples, Kili (1999) showed secure attachment style has direct effect on sexual satisfaction and marital satisfaction. Those who had secure attachment also had sexual satisfaction and relational satisfaction. They had more commitment to relation stability. Arterburn(2002) reported that spiritual attachment has positive effect on couples' sexual satisfaction. Secure couples trust in their spouses, assesses others positively, believe in reliable love, have more self- disclosure, share their ideas and feeling, are flexible and respond their spouses' needs thoroughly. Those who are spiritually secure have higher sexual satisfaction because they believe in God. Shelley et al (2005) studied adult romantic attachment style with sexual satisfaction and conflict resolution. Those who had lower scores in avoidance and anxiety and had positive view to them and others, were more secure, had higher relational satisfaction, had less verbal aggression to their spouse and responded to their needs, prepared supportive and secure environment and as a whole had more sexual satisfaction. To Butzer and Campbell (2008), high anxiety and avoidant decrease sexual satisfaction. Those couples, who are both secure, have more sexual satisfaction. Secure individuals start sexual activities to show their love. They see sex mutually and closeness, physical intimacy is pleasurable for both. Here it is said that attachmentbased couple therapy teaches couples to improve their behaviors through increasing security and support, availability, responding to the spouses' needs, creating secure behaviors and suitable sexual relationships. Also, this theory tries to increase security and secure behaviors and decrease marital conflict and divorce through reconstructing couples' relationship in life. Its attempt is to heighten individuals' well- being and physical and psychological health. Base on attachment theory, a person's expectations to reward and compensation of a close relationship affect his/ her view to sexual relationship .For instance, those who feel others are more trustful and valuable, are more optimistic and also expect mutual sexual satisfaction. On the other hand, those who have problems in their relationship may have commitment to their sex. In the educational sessions, couples taught to create security in their relationship. Therefore, they can easily ask for their needs, support them, face positively with conflict

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and stress, have happier, satisfied and stable relationship. They know that availability and affective response are constructive factors for secure relationships. Security is remained in a relationship when the spouses are available in their needs, know their caregiver and caretaker roles. A caretaker explores his/ her unhappiness, needs and relates with his/ her spouses and is comfortable with him/ her. The third hypothesis result showed there is a significant difference between mean scores in experimental group and control one in posttest and follow- up (F=818.63, P<0.001) (Table 3). It means attachment- based couple therapy increases sexual intimacy. Attachment theory emphasizes intimacy and believes that it is individuals' need. Intimacy has biological basis and continues during the life. Desire to intimacy is very important for attachment. Intimate relationship leads to more secure attachment and vice versal. This research results are congruent with Hazan , Shaver (1987) and Shaffer. Sexual intimacy predicts the whole intimacy. Anxiety and avoidance decrease can be improved by secure behaviors and environment and its intimacy. Sexual intimacy is related with marriage vitality and happiness (Olson, 2003); problems outbreak (Bagarozzi, 2001); marital styles and sexual

behaviors(mccarthy,1999) commitment(Villegas,2005), factors such as anxiety, depression, phobia, guilt feeling, shame, conflict, biological problems (Bagarozzi, 2001). Attachment- based couple therapy taught couples to follow security to reach a base haven and the basic point in their relationship is availability and responding emotional signs. They improve relationship skills and are aware of their past and present. The less a couple explores a need to conformability, cooperation in emotional response and availability, the less will be therapeutic effect. Supportive and honestly response in close relationship and a need to emotional response improve a relationship. Since sexual relationship is very important in marital life and it is like an emotional pressure gauge in relationship so that it reflects couples' satisfaction of other relationship dimensions and it is a good scale of health and well- being (Olson, 2004).Using this therapeutic plan helps couples to increase sexual satisfaction, sexual intimacy and marital satisfaction and improves couples' relationship as a whole.

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