European Journal of Scientific Research ISSN 1450-216X Vol.43 No.4 (2010), pp.538-545 EuroJournals Publishing, Inc. 2010 http://www.eurojournals.com/ejsr.

htm

The Efficacy of Emotionally Focused Couple Therapy (EFT-C) Training with Regard to Reducing Sexual Dissatisfaction among Couples
Honarparvaran N Corresponding Author: Islamic Azad University (IAU) Science& Research Branch, Tehran. Iran Tabrizy M Dep. of Counseling Psychology, Allame Tabatabaei University, Tehran, Iran Navabinejad Sh Dep. of Counseling Psychology, Tarbiat Moallem University, Tehran, Iran Shafiabady A Dep. of Counseling Psychology, Allame Tabatabaei University, Tehran, Iran Abstract The present study was done with the aim of determining the efficacy of emotionally focused couples therapy training with regard to sexual dissatisfaction among couples. The research plan for this study was pretest, post-test and a control group. The statistical population was chosen among all couples from Shiraz who had called on the state and private consulting centers. Among these, 16 couples (32 people) whose scores on the index sexual satisfaction were less than average were randomly selected . Then they were randomly distributed into the experiment and control groups. The results were indicative of a significant difference between the groups regarding the dependent variable. In other words , the approach of emotionally focused couples therapy exerted an increasing influence on sexual satisfaction in couples. This efficacy was observed more among women. Keywords: Couple therapy, emotionally focused couples therapy, and sexual satisfaction

Introduction
Numerous research on marriage-related issues shows that sexual matters are of top importance to couples. (Duncombe, 1983, Crawford & Pop, 2003, Bradbury & Karrey, 2004, quoted from Davis, Shower & Widman , 2006). Sexual dissatisfaction leads to serious conflicts and such negative emotions as hatred against the spouse, annoyance, jealousy, competition to suppress each other, lack of self-confidence and being ignored. These problems are aggravated through tensions and conflicts and will widen the gap between couples (Christopher & Spercher, 2000).

The Efficacy of Emotionally Focused Couple Therapy (EFT-C) Training with Regard to Reducing Sexual Dissatisfaction among Couples

539

Research shows that couples have potential conflicts regarding sexual issues but consider them as private secrets and do not reveal them. (Esputen , 1998, Larson, 1998, Simun & Gagnon 2000, Mettz, 2005 quoted by Crowe, 2007) . Divorce rates have been increasing constantly since 2001 in Iran. Exports believe that 50% to 60% of divorces result from sexual problems and dysfunction (Forutan, 2007). Many Iranian couples suffer from sexual dissatisfaction but feel ashamed about bringing it up. They are unaware of its effect on marital satisfaction and life enjoyment. Consequently, it seems necessary to provide instruction and solve this problem because it can contribute to familys bonding and the mental health in the society instruction and counseling will gradually solve couples sexual problems and turn their ignorance into cognizance. This kind of instruction and counseling empowers many men and women to take effective steps to confront their sexual problems and matrimonial conflicts. (Jahanfar, 2002). One of the most significant and influential factors in sexual satisfaction is the quality of interaction between couples. Extensive research has demonstrated a direct link between sexual satisfaction and marital contentment . ( Banemen & Vogell , 1985, Ackr 1992, Duck & Barnes, 1994, Simon & Gagnos, 2000, William & Sandra 2005, quoted from Eliot & Umberson, 2008). Therefore, in this study, in order to create desirable interactive patterns between couples which will result in their sexual satisfaction increase, we have chosen EFT approaches to be taught to them. Johnson and Greenberg first developed the principles of EFT in early 1980s and built upon John Bowlbys attachment theory as their theories in 9 steps (Johnson and Greenberg 1996 quoted by Johnson and Whiffen 1999). Johnson (2004) believes that whenever the sense of attachment is violated in one of the couples, confusion is created in relationships. The attachment injuries occur when a spouses expectations of caring and comfort at critical moments are not fulfilled this mental injury carves out an unsafe relationship. Therefore, EFT-C insists on adaptive attachments through care, support and bilateral attention to ones needs and those of the spouse. Distressed couples are entrapped in a series of rigid patterns and self-reinforcing interaction cycles and their inability in sustaining the emotions lead to their further relation and irritation. (Gotman & Johnson 1989, Johnson, 1984, 1988, 2004 quoted by Woldarsky 2006). Thus EFT-C model not only pays attention to negative interaction patterns but also heeds the angry couples strong negative responses so that couples can take notice of implicit meanings in their complex reactions. Through the process of therapy, couples problems are put into perspective through new words as attachment needs and adult insecurity. The counselor asks the couple to play an active role in the therapeutical process and create new ways of communicative dialogues to create safe attachments. (Johnson & Greenberg 1995, Johnson 1996, 2003 quoted in Sherma , 2007). Empirical research on the process of transformation in EFT-C has proved that couples discovery of each others needs and communication with those needs is relevant with orientation to positive interactions (Greenberg, Ford, Alden & Johnson, 1993, Johnson & Greenberg , 1998), intimacy, strong emotional self- revelation (Greenberg & Goldman, 1998) and empathetic responses (Hunsley and Schindler, 2000). The object of this study was determining the efficacy of emotionally focused couples therapy training on sexual dissatisfaction among couples in Iran-Shiraz. Three hypotheses should be considered here: 1. The rate of men and women's sexual satisfaction is different. 2. Emotionally focused couples therapy training exerts influence on couples' sexual satisfaction rate 3. The amount of efficacy of emotionally focused couples therapy training in men and women's sexual satisfaction rate is different.

540

Honarparvaran N, Tabrizy M, Navabinejad Sh and Shafiabady A

Methodology
The research plan for this study was pretest, post-test and a control group. The statistical population was chosen among all couples from Shiraz who had been to the state and private consulting centers. They were all married for at least one year and at most ten years. First, the index of sexual satisfaction was presented to 100 couples. Among these, 16 couples whose scores on the index of sexual satisfaction were less than average were randomly selected. Then they were randomly distributed among two experimental groups and one control group.

Measure
The index of sexual satisfaction (ISS) was employed to gather the data .This index was developed in 1981 by Hudson, Harrison & Crosscup . According to Hudson (1988) the ISS operationalizes sexual satisfaction by assessing the degree, severity of a problem in sexual component of a dyadic relationship. "It measures the degree of sexual discord or dissatisfaction that is felt or perceived by a client with respect to the sexual relationship with a spouse or partner" (p.4). This scale was specifically chosen because of its attention to the relationship. Research suggests that sexual satisfaction is best assessed in the context of the relationship. Internal consistency as measured by coefficient alpha is .92 , with a standard error of measurement of 3.27, suggests high reliability for the ISS. Tests of convergentdiscriminant validity reflect that the scale correlates well with scale designed to measure the same construct and dose not correlate with those that measure a different construct (p<.001, discriminant validity =.76 ) (Charrisemeans , 2000). In the current study alpha reliability was .94 (coefficient split half =.85, coefficient Spearman & Brown = .92).

Results
The mean of ISS in the pre-test was 194.12 in the EFT group, and 195.93 in the control group.
Table 1:
component sexual satisfaction

A comparison between male and females with a view to sexual satisfaction

group Males females number 16 16 Mean 197.58 187.54 SD 16.58 21.98 *** -10.04 t 3.26 df 15 sig .01

As it can be observed in the table 1, there is a difference between the rate of sexual satisfaction in women and that of men's. Accordingly the research hypothesis is confirmed.
Table 2: A Comparison between experimental (EFT-C) and control groups with a view to sexual satisfaction through a covariance analytic test
score pretest Experimental group SS 462.39 10624.43 df 1 1 MS 462.39 10624.43 F 6.77 155.56 sig 0.05 0.01 Coefficient eta 0.34 0.92 Object power 0.67 0.999

component sexual satisfaction

According to table2, the results of the covariance analytic test show that the impact of experimental groups with 99% of statistical certitude is significant regarding the rate of sexual satisfaction. Therefore, it was concluded that emotionally focused couples therapy training has influence over the increase in sexual satisfaction rate.
Table 3:
component

Descriptive statistics of both groups with regard to sexual satisfaction

group females statistics males

The Efficacy of Emotionally Focused Couple Therapy (EFT-C) Training with Regard to Reducing Sexual Dissatisfaction among Couples
EFT control Mean -60.50 5 SD 24.26 7.23 Mean -31.00 7.12 SD 14.57 7.23

541

sexual satisfaction

Observing the means shows that women are influenced by this method to a greater extent.
Table 4: An investigation into the efficacy of emotionally focused couples therapy for sexual satisfaction in both males and females
score gender group Gender & group SS 20000.281 21479.281 1498.781 df 1 1 1 MS 20000.281 21479.281 1498.781 F 23.406 58.445 17.538 sig 0.01 0.01 0.01

component sexual satisfaction

The statistical F test showed that the interaction between sex and experimental group regarding sexual satisfaction is significant with 0.99 statistical certainty. The interactive influence means that the emotionally focused couples therapy style has influenced each sex differently. Then , in order to examine the efficacy of gender, married couples are compared in two experimental and control groups.(Table5)
Table 5:
groups EFT control

A couples comparison test on both groups under study

component sexual satisfaction sexual satisfaction tafavote ***mianginha -29.5 -2.125 t 4.77 0.988 df 7 7 sig 0.01 0.36

As the results from the table shows, the observed difference between two sexes is related to the experimental group and no significant difference is observed between the males and females in the control groups. In other words, the emotionally focused couples therapy method has not only caused increase in sexual satisfaction in both sexes, but it has had a different influence on both the males and females. Therefore, the research hypothesis, namely "the different influence of emotionally focused couples therapy method on the males and females", is confirmed. Accordingly the research the effectiveness of emotion-focused couple therapy increases sexual satisfaction more in women than in men.

Discussion
The first research hypothesis was confirmed . Studies by Beutel ,Richter and Brahler (2007) , Kliffer and Sanchez (2007) , Wiksten (2009) , Barr ,Bryan and Kenrick (2002) , Richter , Grulich , Smith & Rissel(2003) , were all in accordance with the result of this study . The meta-analytic investigation into 177 studies in the USA completed by Butel and et al (2007 ) , it was affirmed that men were reported to have more times of sexual intercourse and, on the whole, men were more sexually satisfied than women . However, in a research conducted in France, women had expressed that they feel happier with their sexual life . In another research in Australia by Richter and et al(2003), 58% of females and 67% of males reported very high sexual satisfaction whereas 11% of men and 28% of women reported low or very low sexual satisfaction . This study showed strong positive and significant relationship between satisfaction of sexual life and life quality. Kliffer and Sanchez (2007) assert that men and women experience and respond to sexual desire so differently. For men , the correlation between physiological arousal and physiological desire is very high. Therefore, one can predict and account for men's sexual desire considering their sexual arousal.

542

Honarparvaran N, Tabrizy M, Navabinejad Sh and Shafiabady A

Conversely, for women, this correlation is very low, and therefore, one cannot predict women's sexual desire with regard to their physiological needs such as estrogen, testosterone and arousal. Instead, women's sexual desire and satisfaction are very sensitive to relationship factors such as emotional sexuality. Eliot and umberson (2008) also believe that women give more importance to the existence of love in a sexual relationship. Women obtain more satisfaction in a long-term relationship both physically and emotionally. They seek commitment in their relationships and become dissatisfied when there is a lack of such commitment. In contrast, men prefer to establish short-term physical relationships. In a research conducted in 2009 by Wiksten, among 480 female and 308 male participants aged between 18 to 29, women were clearly less satisfied with their life quality as well as their sexual life. Also, they reported to have been under more pressure to have a sexual relationship. In less sexually satisfied women, frustration, aches and pains, stress and physical pains were observed more. The results demonstrate that theres a significant difference between the EFT & control group. Therefore, our hypothesis is approved. This result is in line with Johnson & Greenberg (1998) Greenberg & Goldman (1998), Goldman & Greenberg (1993), McCafee, Johnson and Vandrover (1995), Walsh (2002), Walker, Johnson , Mainon, Kloneir ( 2002) Shermas (2007) research. One of the theoretical views which has focused specifically on sexual desires is the theory of adult attachment. This theory has focused on the evolution of close emotional ties with others. The research done by Bogaert & Shadava (2002), Cooper (2006), Brinbaum (2007), Butzert & Campbell (2008) proved the close relationship between sexual satisfaction and attachment point of view. Crowly and Grant (2007) believe that sexual dissatisfaction reveals itself in the couples relationship through complaints, groans, accusations humiliation and degradation. They believe that sex goes beyond mere physical contact for couples and functions as a gateway for harmony, common activities creating, positive feeling and attachment. These researches utilized EFT-C to express passions and sexual attachment needs. The main aim of their involvement has been to change the primary avoidance patterns in interactions and create an ambience of approval and endorsement of sexual feelings and desires. What was brought to light here was that expression of such unexpressed feelings and desires and their approval by the spouse paved the way for increased safe attachment and consequently greater frequency of sex, positive sexual experiences and satisfaction. From EFTs point of view, the primary obstacles in sexual satisfaction result from unrealized threats in the fields of attachment and couples reaction to them. Couples should be able to omit threats and re-orientate their relations to a safe zone. In order to increase their satisfaction this is done through concentration on positive sensations and verbalize their unsatisfied and negative feelings without the spouses attack (wampler, Nelson and Campbell, 2003). EFT counselors have several positive effects: expansion of the clients attachment behavior, comprehension of new attachment habits, creation of trust & safe attachment. Thus EFT is effective in the field of sexuality. The observed difference between men and women in experiment group was significant and this leads to the conclusion that the effectiveness of emotion-focused couple therapy increases sexual satisfaction more in women than in men. In the study by wampler et al. (2003) which investigated the efficacy of emotionally focused couples therapy training on 28 distressed couples in Minnesota , the rate of insecure attachment in women was more. The result of this study showed that the efficacy of emotionally focused couples therapy training on women was related to areas such as reproducing negative emotions, non-avoidance of open communication, increasing discourse, attention and respect. Regarding men, it involved the recognition of underlying emotion, reproducing negative emotions and lack of control over voluntaryhurt emotions. In Macphee, Johnson and Vanderveer's research (1995), it was reported that sexual adaptation in women was better than those in the control group in the post-test. The number of sexual intercourses

The Efficacy of Emotionally Focused Couple Therapy (EFT-C) Training with Regard to Reducing Sexual Dissatisfaction among Couples

543

was particularly reported to be more than other cases. The EFT had hardly any influence on the partners of the testees. Wampler et al. (2003) believe that since women show more insecure attachment than men, they are therefore more positively influenced by the efficacy of emotionally focused couples therapy training. In their research, too, women respond more than men to this approach in vaster areas. Also , Catherall (2007) states that the existence of a feeling of shame in sexual relationships, particularly in women, causes four reactions to happen. These include the reactions of withdrawal, avoidance, anger toward the self and anger toward the husband, which show themselves as blaming the husband. Creating secure emotion, EFT-C causes change in shame reactions. Women are able to realize the secondary emotions toward this primary emotion. EFT will help them to develop the secure region through accepting their own feeling of shame, recognition of their shame story and discussing it with their sexual partners, and therefore women can create secure attachment in their sexual life. McCormack (1998) writes in his report that during EFT-C sessions, wives were able to share their feelings more than men. It was more important for women that their experiences to be validated by their husbands as well as the therapists. Although it was important for men to express their emotions, they resist more during the treatment process and had a feeling of discomfort toward it. According to McCormack, this discomfort is related to boys' cultural backgrounds according to which boys must not express their emotions and feelings. Women expressed their feelings about their partners vigorously whereas this was hardly done by men who were unwilling to reveal and talk about their voluntary-hurt emotions. During the therapeutic sessions, women achieved a new sense for revealing and speaking of their emotions and expressed that they were not aware that expressing and verbalizing emotions would be one of their needs.

544

Honarparvaran N, Tabrizy M, Navabinejad Sh and Shafiabady A Barr, A . Bryan, A & Kenrick , D. (2002). Sexual peak: socially share cognitions about desire, frequency, and satisfaction in men and women. Journal of Personal Relationships. 9 , 287-299. Beutel , M. E . , Richter , Y . S. , Brahler , E . (2007) . Sexual desire and sexual activity of men and women across their life spans. Journal Compilations . 101, 76-82. Butzer, B. & Campbell, L. 2008). Adult attachment , sexual satisfaction and relationship satisfaction. Journal of Personal Relationship. 15, 141-154. Charisse means, M . (2000). An integration approach to what women really want: sexual satisfaction. Thesis for degree of doctor of philosophy of Detroit Mercy University . Catheralle , D. R . (2007). Emotional safety . New York: Taylor & Francis Group . Christopher, F. S. & Sprecher, S . (2000). Sexuality in marriage, Dating , and other relationships. Journal of Marriage and Family. 62 , 999-1017. Crawley, J & Grant, J . (2007). Emotionally focused therapy for couples and attachment therapy. ANZJFT . 26(2), 82-89. Crowe , M . (2007). Managing couple relationship and individual psychological problems in psychosexual therapy. Journal of Sexual disorder and Psychosexual Therapy. 6(3), 95-98. Davis , D ., Shaver, P . & Widaman , k . (2006) . I cant get no satisfaction insecure attachment, inhibited sexual communication, and sexual dissatisfaction. Journal of Personal Relationships. 13, 465-483. Forutan , K . (2007 ).Sexual problems are the root of 50% of divorce in Iran . Salamat , Newspaper . NO:165. Elliott , S . & umberson , D . (2008). The performance of desire: Gender and sexual negotiation in long-term marriage .Journal of Marriage and Family . 70, 391-406. Goldman , A . & Greenberg , L . ( 1992). A comparison of systemic and emotionally focuses outcome studies . Journal of Marriage and Family . 5 , 21- 28. Greenberg , L. S. & Johnson, S. M. (1989). Different effects of experiential and problem solving interventions in resolving marital conflict .Journal of Clinical and Consulting Psychology . 63, 67-79. Johnson , S . (2004 )The practice of emotionally focused couple therapy ,second edition , NewYork: Brunner- Routledge Jahanfar , sh . (2001 ) . Text book of sexual disorder ,Tehran: Bizhe publication. Johnson , S .& Whiffern , V. E. (1999) . Made to mass sure: adapting emotionally focused couple therapy to partners attachment styles. Journal of American Psychology . 6, 366-381. Kiefer, A. Sanchez, D. (2007). Scripting sexual passivity:. A gender role perspective . Journal of Personal Relationships . 14 , 269-29. MacCormack , T. (2003) . Experiencing couple therapy: A evaluative investigation of client / therapist perceptions of selected: emotion- focused sessions . Thesis for degree of doctor of clinical psychology of Ottawa University . Macphee , D .c . Johnson , S. M. & vander veer, M . C . (1995). Low sexual desire in women: the effects of marital therapy. Journal of Sex & Marital Therapy . 21, 159-183. Richters , J. Grulich , A.E , . Rissel , C.E. (2003). Sexual and emotional satisfaction in regular relationships and preferred frequency of sex among a representative sample of adult. Australian and New zealand Journal of Public Health . 27(2) ,. 171-185. Sherma , R. (2007). A task analytic examination of dominance in emotion- focused couple therapy. Thesis for degree of doctor of psychology of York University , Toronto. Wampler , K . Nelson , B. & Kmball , T. (2003) . The adult attachment and observed couple interaction: implication for an EFT on couple therapy. Journal of Family Process . 42(4), 497515.

Reference
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22]

The Efficacy of Emotionally Focused Couple Therapy (EFT-C) Training with Regard to Reducing Sexual Dissatisfaction among Couples [23] [24]

545

Wiks ten , A.M. (2009) . Gender difference in sexuality and life quality among young people visiting Swedish youth. Clinical Adolescent Medical Health. 21(1) , 29-39. Woldarsky , C. (2006). A task analysis of forgiveness in emotion-focused couple therapy. Thesis for degree of master of arts of York University, Toronto.

Copyright of European Journal of Scientific Research is the property of EuroJournals, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.