This study aimed to investigate the effect of couple-centered counseling by the Gottman method on the intimacy of infertile couples in Hamadan. The results of the analysis revealed a statistically significant difference between the infertile women participating in the control and intervention groups. In other words, there was a significant difference between women who had received training and those who had not. Also, Gottman couples therapy has been effective in the marital intimacy of infertile women. According to the results of the statistical analysis and the comparison of the mean scores of intimacy in men at the post-intervention stage, it is inferred that Gottman-centered couple counseling has some effect on the marital intimacy of infertile men.

Infertility is a major stressor in the life of a couple because it is very difficult to accept the failure of a pregnancy. In this regard, many couples experience recurrent treatment without progress, and a feeling of weakness in achieving the goal (to procreate) appears in them. Although infertility is not a disease, it can cause significant emotional turmoil. This problem leaves many psychological and social complications and delays and interferes with various aspects of the couple’s performance, including sexual activity, self-confidence and emotional communication. [28]. The experience of laborious treatments and the feelings of rejection, fatigue, confusion and hopelessness are some of the cases faced by infertile couples. All of these factors can affect the couple’s emotional connection and therefore their success in treatment. [29].

Intimacy is an important human need and a dynamic process with internal roots based on mutual trust and respect. In this regard, clinical studies have shown that the root of many marital problems is the lack of intimacy between couples. Using his seven principles, John Gottman describes how a marital relationship succeeds or fails. This researcher also proposes ways to facilitate change in these relationships through educational, psychological, preventive and therapeutic interventions. These solutions, called the Seven Principles of Marriage Success, determine how well couples maintain their friendship, intimacy and passion. [30]. The goal of Gottman Couples Therapy is primarily to help couples rebuild and strengthen their friendships. [17] and ultimately lead to good intimacy and interpersonal growth [18]. Additionally, Gottman Couples Therapy helps couples learn that there are differences between them. The therapy says these differences are not indelible, and couples must learn to adapt to these lingering issues. [20].

Gottman took into account the following seven principles to achieve the goal: design a plan of love, cultivate love and admiration, turn to the other instead of avoiding each other, accept the influence of the spouse , solve solvable problems, overcome permanent problems and create common sense. He also used strategies such as gratitude, early marriage memories, and an emotional bank account to increase intimacy and love between couples. [30]on which we have also relied in the videos of the educational file.

The results of this study are consistent with those of Soheili et al. (2020), who showed that group counseling based on Gottman couples therapy has a positive effect on marital intimacy among nurses [23]. Similarly, Mortazavi et al. (2020) concluded that the relationship prevention and improvement program based on the combined approach of Gottman and Glasser is effective in marital intimacy [28].

The results of the present study are also consistent with those of Sehat et al. (2021). These researchers reported that combined emotion- and solution-based therapy is effective in marital intimacy and marital adjustment and can reduce hostile, objectionable, and controlling behaviors and communication problems, thereby improving intimacy in couples in conflict. [31]. Zarei et al. (2018) examined the effectiveness of group counseling based on choice theory and Gottman’s theory of marital intimacy and marital conflict among married women. They ultimately concluded that group counseling based on Gottman’s theory significantly increased intimacy and reduced conflict. [32]which is consistent with our findings.

The findings of the present study oppose those of Besharat Ghara Maleki (2021), who reported that counseling in forgiveness therapy method is ineffective in marital intimacy of emotionally divorcing couples. [33]. Moreover, these results contradict those of Arabpour (2012), who proposed that Glaser’s theory is ineffective in improving the intimate relationship of couples. [34].

The present study showed that couple-focused counselling, as a simple and inexpensive method, increased marital intimacy in infertile women. In fact, couple-centered counseling is a supportive and solution-seeking approach that aims to identify problems, suggest appropriate solutions, and ultimately encourage people to change their behavior. This approach covers all the effective components in interpersonal relationships. Since couple-centered education is much more effective than education for single women, many studies have suggested considering the role of education and counseling in future research.

Based on the results of the study, it can be said that Gottman places great importance on love and respect to deal with the negative aspects of marriage. In the Gottman program, effective training in communication skills can help couples establish an effective relationship for growth and prosperity and reduce the persistence of negative and destructive feelings during the marital relationship. Infertile couples may experience more emotional distress and divorce due to the stress of not having children. However, Gottman’s method helps increase the desire to continue the marital relationship, reduce marital incompatibility and conflict, and provide more intimacy and satisfaction for couples. [23].

When women participating in couple-centered counseling sessions were given various training and related exercises to achieve Gottman’s Seven Principles, it all helped them feel more intimate with their husbands. During the counseling sessions, familiarity with conflict resolution and effective communication skills helped the couples realize that some issues in their marital relationship may never be resolved and that they need to learn how to handle and deal with conflict . The couple realized that building an effective relationship with their spouse could better understand each other’s needs and desires. As a result, the degree of intimacy between them would increase. Additionally, in these sessions, couples were introduced with four incorrect communication patterns called the four horsemen: criticism, insult and humiliation, defensiveness, and building a stone wall. They received explanations of the destructive and negative effects of these four factors on marital relationships and learned how to replace correct behavior with behavior.

Overall, Gottman’s advice taught couples, especially infertile women, that they could more easily cope with many of their issues, such as infertility, by creating common sense, thereby increasing the marital intimacy among women. The intimate relationships and better communication patterns of these couples can move through the stages of infertility treatment better than before.

Limits and strengths

Unlike most intervention studies that focus on training women, the counseling sessions in the present study were based on couple relationships and Gottman’s counseling content. Another strength of our work has been the preparation of Gottman’s counseling kit (counseling videos and practice sessions) and its presentation to couples, in addition to face-to-face counseling sessions.

One of the limitations of our work was the absence of a psychologist during the counseling sessions. We solved this problem by referring couples to a psychologist at their request after the last counseling session. Another limitation was the small number of samples due to time constraints, which reduces its ability to generalize to the whole community.

In addition, the non-cooperation of some men to participate in counseling sessions slowed the sampling rate. Therefore, we have organized online counseling sessions for some of them. Additionally, others were excluded from the study due to the creation of emotional communication issues.

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