Please no plagiarism and make sure you are able to access all resources on your own before you bid. Main references come from Murray, C., Pope, A., & Willis, B. (2017) and/or American Psychological Association (2014). You need to have scholarly support for any claim of fact or recommendation regarding treatment. Please respond to all 3 of my classmates with references separately. You need to have scholarly support for any claim of fact or recommendation like peer-reviewed, professional scholarly journals. I need this completed by 03/21/2020
Responses to peers. Note that this is measured by both the quantity and quality of your posts. Does your post contribute to continuing the discussion? Are your ideas supported with citations from the learning resources and other scholarly sources? Note, that although it is often helpful and important to provide one or two sentence responses thanking somebody or supporting them or commiserating with them, those types of responses do not always further the discussion as much as they check in with the author. Such responses are appropriate and encouraged; however, they should be considered supplemental to more substantive responses, not sufficient by themselves.
Read your colleagues’ postings. Respond to your colleagues’ postings.
Respond in one or more of the following ways:
· Ask a probing question.
· Share an insight gained from having read your colleague’s posting.
· Offer and support an opinion.
· Validate an idea with your own experience.
· Make a suggestion.
· Expand on your colleague’s posting.
1. Classmate (C. Als)
People will understand their sexuality based on their own experiences. Many couples have experienced infidelity, overcame the strain of that pain and were able to make their relationship work. You also have many relationships that didn’t survive infidelity, and, in these cases, it depended on the nature of the infidelity. Having some knowledge of infidelity, I am aware cultural, and environmental background will play a role in the recovery or demise of a relationship stemming from an affair. People understand the meaning of their sexuality based on the phases of their life span (Murray, Pope & Willis, 2017). For example: when you’re dealing with younger clients that have experienced one or both parties who have had an affair there may be a higher relationship survival rating to those who are mid to late age in life. As you tend to grow older individuals look at the meaning of relationships differently from when they were younger, and it makes it harder for the relationship to survive. However, in both incidents depending on the nature of the infidelity, cultural and religious beliefs will play a big role in the client’s decisions. The nature of the relationship means was there a baby produced from the affair, was it a best friend or relative that was involved or someone they know can all be difficult reasons for a recovery process when dealing with couples and affairs. Therefore, depending on the individual, their life span, experience, religion, cultural background and the nature of the infidelity, these will factor in the survival, or ending rating of the relationship (Murray, Pope & Willis, 2017).
When couples come in for therapy due to infidelity there are chances with therapy the couple can survive. It will take both the client’s participation to make the relationship work after an affair. As a counselor, allow both clients to openly voice their pain, concerns and their expectations from their therapy. Once the counselor obtains the information needed, the best way to facilitate a recovery is by addressing both the sexual and relational aspects that relate to the client’s immediate concerns (Murray, Pope & Willis, 2017).
Murray, C., Pope, A., & Willis, B. (2017). Sexuality counseling: Theory, research, and practice. Thousand Oaks, CA: Sage
2. Classmate (A. Smi)
Infidelity, better known as an affair, is defined as a “secretive emotional and or/ sexual involvement with a person outside of a committed couple’s relationship” (pg. 386) which violates the couples committed agreement which each other and is the frequent cause of couple or martial conflicts (Schmidt, Green , & Prouty , 2016). Unfortunately, according to Wetchler and Hecker (2015) infidelity have been proven one of the most difficult issues to treat as reported by therapist. This is due to when having an affair, there is emotional truma causing a breach in trust and insecurity to the person being betrayed (Wetchler & Hecker , 2015) Although this may indeed be the case, recovery is based on the couple and their willingness to work through the problem (Murray , Pope, & Willis , 2017). This includes not only the betrayed partner willingness to forgive, but the betraying partner willingness to take on the responsibility of the wrong they have committed (Palmo & Palmo, 2008; Wetchler & Hecker , 2015).
If a couple has chosen to recover their relationship broken by an affair, couples counseling would be helpful in resolving the “wound in the relationship” (Murray , Pope, & Willis , 2017, p. 242). In couple counseling the goals should include understanding what led up to the affair, repairing the relationship, all while reducing emotional distress of both parties (Cornish , Hanks , & Black , 2020). Counseling can offer numerous ways to help restore a relationship. This includes counseling which focuses of forgiveness, both self and the other person, building intimacy, and understanding the couple’s interaction prior the affair (Bahnaru & Runcan , 2019; Cornish , Hanks , & Black , 2020; Murray , Pope, & Willis , 2017). Counselors could use different therapeutic approaches such as emotional focused therapy, intersystem approach, integrative approach, and structural family approach (Bahnaru & Runcan , 2019). A counselor could also use behavioral couples therapy to focus on increasing initmacy, and narrative therapy for healing through storytelling (Bahnaru & Runcan , 2019). Counselors could also offer individual counseling for the couple to help with individuals issues related to the affair, as long as it is understood there is a no secret clause and both individuals agree (Smith, 2011).
Overall, a couple could indeed recover from an affair and counseling would be helpful in the reconnection process (Bahnaru & Runcan , 2019; Murray , Pope, & Willis , 2017; Smith, 2011). However, not everyone’s relationship will survive infidelity. In cases such as these individual counseling may be nessessary to help with dealing with grief and loss, depression, anxiety, etc (Murray , Pope, & Willis , 2017). For those who chooses to work it through, there are many steps counselors can take to help the couple reach their goals of relationship recovery.
Bahnaru, A., & Runcan , R. (2019). Social work and family: treating infidelity. Revista de Asistenta Sociala, 2, 39-50.
Cornish , M. A., Hanks , M. A., & Black , S. M. (2020). Self-forgiving process in therapy for romantic relationship infidelity: A evidence-based case study. Psychotherapy. Retrieved from .http://dx.doi.org/10.1037/pst0000292
Murray , C., Pope, A., & Willis , B. (2017). Sexuality Counseling. Thousand Oaks: SAGE.
Palmo, P., & Palmo, L. (2008). Couple and Family Counseling: Issues related to couples. (I. (. Laureate Education, Interviewer, & Author, Editor) Baltimore .
Schmidt, A. E., Green , M. S., & Prouty , A. M. (2016). Effects is parential infidelity and interparental conflicts on relational ethics between adult children and parents: a contextual perspective. Journal of Family Therapy, 38, 386-408.
Smith, T. (2011). Understanding infidelity: An interview with Gerald Weeks. The Family Jounral: Counseling and Therapy for Couples and Families, 19(3), 333-339.
Wetchler , J. L., & Hecker , L. L. (2015). An Introduction to Marriage and Family Therapy (2nd ed.). New Tork: Routledge.
3. Classmate (E. Mas)
Recovery from Affairs
When one or both partners have an affair in a marriage or a relationship, the results can be devastating. Murray, Pope and Willis (2017) wrote that the impact of an affair can be similar to the effects of other traumatic experiences. The individuals involved not only feel depressed but they may also grieve due to the potential loss of their relationship. An affair can certainly change the dynamics of a relationship. However, I do not think that infidelity is always an absolute means to the end of a relationship if the couple is willing to work through it.
As a counselor, there are various ways that we can guide a couple that is struggling with past or current infidelity. Murray, Pope, and Willis (2017) stated that it is important to work toward some level of forgiveness and healing. Forgiving and healing can lead to a reconnection of the couple, while also working through the issues of the infidelity. It is also important to be mindful of relationship issues that may have proceeded the affair. The couple may have previous, underlying issues that need resolving. Counseling could certainly help the couple work through these issues in order to move past the infidelity and begin their relationship once more.
Murray, C., Pope, A., & Willis, B. (2017). Sexuality counseling: Theory, research, and practice.
Thousand Oaks, CA: Sage
· Course Text: Murray, C., Pope, A., & Willis, B. (2017). Sexuality counseling: Theory, research, and practice. Thousand Oaks, CA: Sage
· Chapter 5, “Lifespan Development and Sexuality”
· Chapter 8, “Sexuality and Intimate Relationships”
· Article: Aalgaard, R. A., Bolen, R. M., & Nugent, W. R. (2016). A literature review of forgiveness as a beneficial intervention to increase relationship satisfaction in couples therapy. Journal of Human Behavior in the Social Environment, 26(1), 46–55. Retrieved from the Walden Library databases.
· Article: Brotto, L. A., Chivers, M. L., Millman, R. D., & Albert, A. (2016). Mindfulness-Based sex therapy improves genital-subjective arousal concordance in women with sexual desire/arousal difficulties. Archives Of Sexual Behavior, 45(8), 1907–1921. Retrieved from the Walden Library databases.
· Article: Faircloth, C. (2015). Negotiating intimacy, equality, and sexuality in the transition to parenthood. SOCIOLOGICAL RESEARCH ONLINE, 20(4). Retrieved from the Walden Library databases.
Sexuality in Adulthood Across the Family Life Cycle
Negotiating Intimacy, Equality and Sexuality in
the Transition to Parenthood
by Charlotte Faircloth
University of Roehampton
Sociological Research Online, 20 (4),
Received: 9 Dec 2014 | Accepted: 12 Jun 2015 | Published: 30 Nov 2015
Whilst both ‘parenting’ and ‘intimacy’ have been explored extensively in recent social scientific research (for example, Lee et al
2014,Gabb and Silva 2011 ), their intersections in the context of family life remain curiously absent. This paper presents findings from
on-going longitudinal research with parents in London, which investigates how the care of children, and particularly the feeding of
infants, affects the parental couple’s ‘intimate’ relationship. In particular, as part of this special section, it looks at couples’ accounts of
sex as they make the transition to parenthood, as a lens on the themes of gender, intimacy and equality. Far from being an easy
relationship between them, as predicted by some scholars, this research shows that they are in fact, ‘uncomfortable bedfellows’.
Keywords: Parenting, Gender, Intimacy, Equality, Sex, Couples
Negotiating intimacy, equality and sexuality in the transition to parenthood
Based on longitudinal work with new parents in London, this paper draws on research which
investigates how the care of children, and particularly the feeding of infants, affects the parental couple’s intimate
relationship. To that end, it brings together two (traditionally distinct) bodies of literature – one calling attention to
a shift in British parenting culture towards a more ‘intensive’ and ‘child-centred’ form of care, the other, looking at
changes to intimate relationships in an age of ‘reflexive modernisation’ and greater gender equality. Specifically,
this paper focuses in on couples’ accounts of sex as they make the transition to parenthood, as a lens on the
themes of gender, intimacy and equality.
Whilst intimacy itself can incorporate a range of different practices, as a vehicle for intimacy, sexual
intercourse often serves as a barometer for couples in how they assess the quality of their relationship (Weeks
1995). In line with other papers in this special section, then, the research shows that far from being a
straightforward correlation between gender equality and greater intimacy, (as predicted by Giddens et al 1992),
the two are, in fact, ‘uncomfortable bedfellows’, particularly once couples become parents. The article briefly
reviews the two bodies of literature, explains the policy context around parental leave and childcare in the UK,
discusses the study methodology, and then presents findings, analysis and discussion by way of conclusion.
Theoretical background: Intimacy and parenting
As Gabb and Silva (2011) note, the ‘conceptual challenge to researchers working in the field of family
and relationship studies…is how to carry on building concepts and finding new methods to capture the vitality of
personal relationships while keeping sight of the social contexts, patterns and practices of contemporary intimate
life’ (1.1, 2011). Famously, work by Giddens (1992), Bauman (2005) Beck (1992) Beck and Beck-Gernsheim
(1995) and others has explored shifting patterns of intimacy in the contemporary age of ‘individualisation’.
Broadly speaking, this body of work argued that, in the age of ‘reflexive modernisation’, there had been a shift
away from traditional, patriarchal couple relationships, based on an inherent inequality between men and
women, toward a more equitable, mutually fulfilling model, accompanied by the rise of a more ‘plastic’ sexuality in
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particular (Giddens 1992; this special section). Giddens argued that in the late twentieth century, in the place of
traditional patterns of marriage, for example, individuals became more aware of the need for a fulfilling
relationship, based on ‘confluent love’; one that is active and contingent. The ‘pure relationship’, which is not
bound by traditional notions of duty and obligation, has come to depend, instead, on communication and
negotiation. The implication of this work is both that greater equality leads to greater intimacy, and that this is a
desirable aspiration for contemporary relationships.
Since this work was published, however, scholars working in the field of family and relationship studies
have critiqued the model, arguing for a more nuanced perspective, grounded in the realities of everyday
experience. Specifically, Gabb and Silva identify three main strands of thinking which have been particularly
influential in shaping and reorienting contemporary UK family and relationship studies over the past 15 years,
since the publication of Beck and Giddens’ work, including Morgan’s notion of ‘doing family’ as sets of
expectations and obligations connected to kin relations (1996); Smart’s conception of ‘personal life’ beyond that
of the family (2007); and Jamieson’s notion of intimacy defined as ‘any form of close association in which people
acquire familiarity, that is shared detailed knowledge about each other’ (Jamieson 1998: 8).
The last of these is particularly relevant here, specifically as it relates to changes in the division of labour
between couples once children arrive. For Jamieson, ‘[t]he majority of people in Euro-North American societies
have lives which are sufficiently privileged to seek ‘good relationships’ which are not dominated by necessity.
However [even then] most personal relationships include a mix of love, care, sharing, understanding and
knowing, which involve a degree of relying on, needing or depending on the other, if not desperate necessity’
The intention here is to bring this perspective on intimacy to bear on the subject of parenting, my own
area of research to date (Faircloth 2013). The underlying argument of that work was that there has been a
significant shift in ‘parenting culture’ in the UK over the last twenty years. The word ‘parent’, for example, has
shifted from a noun denoting a relationship with a child (something you are), to a verb (something you do).
Parenting is now an occupation in which adults (particularly mothers) are expected to be emotionally absorbed
and become personally fulfilled; it is also a growing site of interest to policy makers, thought to be both the cause
of, and solution to, a whole host of social problems (Lee et al 2014). ‘Ideal’ parenting is financially, physically and
emotionally intensive, and parents are encouraged to spend a large amount of time, energy and money in raising
their children, often with the aid of ‘experts’ (Hays 1996). Whilst this ideology of parenting is not carried out by all
parents, or affects all parents in the same way, it nevertheless serves as an ideal standard to which all become
accountable (Arendell 2000). This ‘intensive parenting’ climate, as several scholars have now argued, has
changed how parents experience their social role, to the point that one’s style of parenting has become more and
more central to adult ‘identity-work’ (for example, whether one is a ‘Tiger Mother’, an ‘Attachment Parent’ or a
‘Gina Fordist ‘). Drawing on Goffman (1959) this term is used in place of a more static ‘identity’ to highlight the
active processes by which identity is constructed, and the inherently social nature of this enterprise, as opposed
to being simply a means of self-expression (Faircloth 2013).
Accounts of the development of this ‘intensive parenting’ culture, including my own, have emphasized
how it influences mothers in particular, noting how the demands placed on women in their role as mothers have
intensified as women have continued to enter the labour market (rather than decrease, as one might expect).
Partly as a means to counter this imbalance, which sees women working the ‘double shift’ Hochschild (2003),
British society has witnessed the construction of the ‘involved father’ – mirroring, to some extent the more familiar
‘intensification’ of motherhood (Dermott 2008, Miller 2011). Men are increasingly encouraged to be ‘engaged’ in
childcare, with a particular emphasis on the importance of creating a close emotional connection with children, in
place of the more traditional model of the patriarchal breadwinner (Dermott 2008, Lee et. al 2014). Involved
fatherhood is also promoted as a means of building stronger communities, with a particular concern about rates
of single motherhood in poorer communities (BBC 2007). Not surprisingly, then, accounts from sociologists
reveal that fatherhood is becoming more and more central to men’s ‘identity work’ in their accounts of personal
Yet whilst discursively fathers may be encouraged to be ‘involved’ in parenting and take more of an
equal load of childcare, in reality, it is women who continue to shoulder most of the responsibility for this (Dermott
2008, Lee et. al 2014). It is women who typically take extended periods of time away from paid work, and move
to part-time hours when they do return to the work place, if they return at all. What is more, despite this emphasis
on the importance of splitting responsibilities, optimal infant care as promoted by the state is an inherently
gendered, embodied one: women are strongly encouraged to breastfeed their babies by health professionals and
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policy makers, particularly in the early months, a practice which has a cascading impact on many other aspects
of infant care (such as soothing and sleeping).
To heed Jamieson’s caution again, then, we need to consider how relationships alter when children
arrive, and the increased ‘necessity’ and ‘dependence’ they create between partners. How, for example, does
‘plastic sexuality’ work in the context of parenthood, for both men and women? Does the equitable model of the
‘new fatherhood’ fit into this picture, or does the reality of life as parents inevitably engender a more traditional
family set up? And finally, how does the state provision of care affect couples’ ‘choices’ in this matter? The
analysis therefore moves to consider the role of the state in creating and sustaining gender roles in parenting
The policy context: Parental leave and childcare provision
Since April 2011 (replacing the previous arrangement of twelve months leave for mothers, two weeks for
partners) employed mothers who return to work before their child is twelve months old have been able, in effect,
to transfer any outstanding leave (of up to six months) to the father or partner. Her leave is calculated at 90% of
her previous earnings for the first six weeks, the middle 33 weeks at a statutory rate of around £130/week, and
then unpaid leave for the final 13 weeks (although some women may have this ‘topped up’ by their employers).
Additional paternity leave is calculated as the last six months of a mother’s leave – i.e, three months of statutory
leave, then three months of unpaid leave. Currently, the couple can only take this sequentially. In the last few
months, however, new proposals have been legislated which will alter this provision again, as of April 2015, so
that the couple will have more flexibility in how to divide their leave, with the entire year being taken by the
partner, after a period of medical leave by the mother, and/or leave taken concurrently (Guardian 2015).
Critics have some reservations about this new leave structure, because whilst the discourse is there
around equality, the financial support (or supportive bosses) may not be. As Asher says ‘Parents may worry
about fathers taking the earnings hit involved… Fathers may fear alienating bosses by going on extended
paternity leave. Families in which mothers can afford not to return to work earlier than twelve months may be
minded to stick with the status quo: habits within the household have already been formed at this stage in the
leave period; and women may be reluctant to give up what has been established as ‘their’ leave.’ (2011:52-3).
Indeed estimates put the percentage of eligible men who actually take up any or all of this leave at only 1.437.
Furthermore, after the initial 12-month leave period, parents often find themselves in a more financially
taxing situation than before. The average cost for a full-time nursery place/after school club for one child in
London in 2014 was £189.16/week, or nearly £10,000/annum, with only a limited amount of this paid for out of
pre-tax earnings (Daycare Trust 2014). For many couples, childcare becomes an expense narrowly second to a
mortgage repayment. In a city like London, which typically requires a considerable commute to work places,
many parents also require ‘wrap-around care’ in the form of a nanny or breakfast club to cover the period before
a nursery opens or when it closes and they are able to reach home. At three years old, all children currently
qualify for 15 hours of free nursery care per week (and some 2 year olds do in deprived areas), although this
frequently has to be taken in regular shifts (for example, five mornings between 9am-12pm), which clearly
requires considerable top-up if both parents are working.
Where childcare is largely seen as the responsibility of the family (as opposed to a state provision, as it
might be in other European countries, for example), it will clearly sit uncomfortably with a dual-earner family set-
up. The cost of care in the UK means that for many couples, what makes ‘most sense’ is for the lower-earner to
be the one who cuts back their hours, or stops work entirely, whilst the other acts as a breadwinner, particularly if
they have more than one child. (It is worth reiterating here then that whilst it is more noticeable after the birth of
children, a gender pay gap continues to exist before this point too). Indeed, even for those in professional
occupations, and earning over the average wage (£476/week or £24,750/annum) , the reality is effectively to
start living on the equivalent of one salary anyway – either because one person stops work entirely, or because
one salary’s worth of post-tax pay is spent on childcare.
This paper presents preliminary findings from an on-going study which includes repeat in-depth
interviews with 30 participants (15 first-time parent, heterosexual couples), one-off interviews with a further 10
participants (5 couples who were lesbian, gay, and/or second time parents), and a survey with a sample of 125
parents (distributed via Qualtrics to a demographically diverse panel of parents in the UK with children under a
year old). The intention of the study as a whole was to explore the relationship between gender, equality and
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intimacy as couples make the transition to parenthood.
Where other publications from the project look more specifically at the corrosive effect of this child-
centred parenting on the couple relationship, or at the theoretical contradictions of policy measures designed to
promote ‘equality’ in parenting, this paper looks more specifically at sexuality – an emergent theme from the
interviews with (some) couples when asked about ‘intimacy’. The focus is on the accounts of the dual earner
heterosexual professional couples who are first time parents, and on a selection of those couples in particular to
explore the issues at hand in depth, and map directions for future research. In addition to being those who spoke
most openly about sex, these were couples who most readily seemed to embody the conflicts between intimacy
and equality, magnifying many of the tensions common to the sample as a whole, as I explain below. The
analysis here therefore focuses on a sub-section of the main sample, in part as a result of this grounded and
iterative approach to data collection and analysis.
Drawing on past work, I was particularly interested in finding parents who internalise the injunction to ‘do
parenting’ in line with expert advice, and who consciously reflect on and articulate their decisions as an element
of their ‘identity work’. Furthermore, I wanted to work with couples who would technically be able to afford an
‘equitable’ division of parental leave, even if they chose not to. Bringing together these aims, I contacted parents
through a range of antenatal education classes and courses in London – such as the National Childbirth Trust,
recognised by a number of scholars (for example Kitzinger 1990; Thomson et al 2011) as being primarily made
up of this demographic.
I interviewed these couples in various areas of London . After meeting one or both of them at an
antenatal group or similar, and a discussion with the aid of a study information sheet, couples were asked to fill
out a brief online survey (designed and administered via Qualtrics) to collect demographic data, using sections
from the 2011 census as a template (e.g., age/marital status etc). These couples were then interviewed, usually
in their homes, at times convenient to them. The first interview (both together and separate) was before their
child was born, and then jointly when their child was 1-2 months old, at 6 months old, and then finally at 11-12
months old, when we also repeated the individual interviews. Recordings were transcribed and coded, with the
aid of relevant software. More recently, I have contacted the couples again to ask for their experiences of
childcare, now that their children are 2-and-a-half years old, and on the cusp of the 15 hours free provision, to
ask whether this would make any difference to their current domestic/working arrangements. Around a third of
these couples are now expecting their second child, which will feed in to the results of the study moving forward.
I also refer to the interview material from the heterosexual dual-earner professional couple expecting
their second baby. Much research with second-time parents has noted that that the ‘ideal’ picture of parenting
and gender norms, so strong for first time parents, tends to be a more pragmatic one for these more experienced
couples. Seeing how parents have negotiated parental leave and childcare arrangements over the course of
several years also gives an interesting contextualisation on the parental leave measures available to new
Of course, one of the key problems with writing about parenting, intimacy, or indeed any aspect of family
life, is how to go about accessing it at all. Analytically and methodologically, I drew on inspiration from Gabb’s
discussion of ‘interactive’ interviews (2010) and have taken a largely narrative approach to research here. Many
scholars have emphasized the role of language in the constitution of personhood, and have argued ‘that human
beings actually live out their lives as ‘narratives’, [and] that we make use of the stories of the self that our culture
makes available to us to plan out our lives… to account for events and give them significance, to accord
ourselves an identity’ (Rose 1999: xviii). Looking at how couples ‘accounted’ for the division of labour within their
respective partnerships was the intention of the study, analysing both anticipation and outcomes before and after
children were born.
Nevertheless, there are clearly limitations to the interview method, particularly when talking about
sensitive issues. The intention was to study intimate practices generally but not necessarily sexual practices. As
a rule, I did not ask couples directly about their sex lives, but rather, would open the space for them to address it,
either together or separately (on the whole, this topic was easier to broach with mothers in one-on-one
interviews, rather than with couples or with fathers). Typically, this would involve asking a question such as
‘Given this study is titled ‘Gender, intimacy and equality’ could you tell me what those terms mean to you?’ It was
interesting, however, that for most couples that the word ‘intimacy’ was taken as an invitation to discuss sex,
even though this was not directly intended. Indeed, the assumption that intimacy meant sexual intercourse gave
rise to this paper, with the couples featured here being most open about their expectations and experiences of
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this topic. Again, this points to some interesting assumptions around what sex is taken to stand for in
relationships, as is discussed further below.
The majority of the couples interviewed – and on whom the analysis here is based – were largely middle
class (in that they overwhelmingly had higher educational qualifications and professions) middle aged (between
45 and 29 though typically 34 or 35), white, heterosexual and married (all were living in long-term relationships,
though if they were not married ‘partner’ was used, rather than ‘husband’ or ‘wife’). The average household
income for the group ranged between £30,000 (in the case of a couple where the wife was undertaking a PhD)
and over £200,000, with the majority between £50,000 and £150,000. All interviews were conducted in English,
though some participants were born outside the United Kingdom.
As might be imagined, these couples demonstrated the sort of attitudes that the current policy around
parenting tries to foster: that it is an intensive, fulfilling and rewarding activity that both parents (notably fathers)
should want to be ‘involved’ in (a word that cropped up a lot). That said, however, these ‘attitudes’ around
equality appeared to be aspirational, rather than enacted in a practical sense (clearly chiming with the kind of
‘identity-work’ fostered in the more reflexive age, mentioned above). The majority of couples stuck to the
traditional division of parental leave – with mothers taking longer periods than fathers in all cases, and only one
couple seeming to know about the possibility of splitting leave more equitably. This is discussed further
elsewhere, but clearly this raises some interesting questions around choice, accountability and preference (that
is, how far these decisions are pragmatic, and how far they are what each partner ‘wants’).
Accounts: Intimacy and sex
In reading literature from the area of sexuality studies in preparation for writing about this aspect of the
study, it quickly became apparent that much of this concerns desire or sexual identity. There was less on
changing patterns of sexual activity over the lifecourse. To this extent, this paper – like Van Hoof’s in this special
section – contributes to what Jackson calls the ‘everyday’ aspect of studying sex and relationships (2008). In
particular, these findings reveal the importance of sexual intercourse for couples as a means of assessing the
strength of their relationships (Weeks 1995). It therefore maps the ways anticipations around sexual intercourse
matched up (or not) with realities once children were born, as a lens on changing understandings of intimacy and
equality. These accounts are foregrounded as evidence of a cultural contradiction between the competing
ideologies of intensive parenting, gender equality and fulfilling intimate relationships.
Providing a useful introduction to this subject is Clare, the only mother cited in this paper to have had a
child already. She works full-time as a secondary school teacher, having taken 6-9 months of leave with each
child, and talks about how important sex is for her and her husband – not only in the sense of being a physically
pleasurable sensation, but more for what it represents for them:
Clare: No, but do you know what? It’s so important to have sex in a relationship. You just always come back to it
because if you don’t you are very, very good friends and there’s that intimacy lacking. [My husband] and I get
scratchy with each other and we lose our connection when we don’t have sex frequently and regularly for me. If we
manage once a week I’m really proud of that and that’s pretty good, that’s what we do. I’m really quite…I feel quite
proud of that. Sometimes it goes down to every couple of weeks but if it’s not every couple of weeks then we both get
In what might be referred to as a hierarchy of intimacy, (penetrative) sex with a partner has come to
symbolise the pinnacle of intimate relations (as opposed to, say, cooking for each other, sleeping in the same
bed or massage, which might be others sorts of ‘intimate’ behaviours) (Weeks 1995). She continues – with the
benefit of hindsight as a second time mother – to talk about how this changes over a couple’s relationship, in
terms of what it symbolises:
Clare: It comes to symbolise such different things, like when you first meet somebody you’re at it all the time and it’s
a kind of bonding, it’s a really fun thing as well. Then when you move in together you’re very cosy and settled. Then
maybe when you get married it will happen more. Then when you want to have a baby you will have sex all the time
and it will become a military procedure but [then] you will probably start enjoying it again.
Anticipation and reality: Accounting for dissonance
Like the other stages Clare mentions, it was certainly true that having children meant a major shift in
sexual practices for most couples. This was something that was anticipated (albeit without much clarity as to
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what these changes would actually be) during pregnancy by many first-time parents. Interestingly, many couples
were confused as to how to negotiate actually having sex with the physical presence of a new baby in their
bedroom (the ideal sleeping arrangement parents are advised to adopt for the first six months). Like Lucy, below,
couples often spoke about the importance of maintaining their regular patterns of sex, which they hoped would
get back to normal after the disruption of pregnancy, birth and/or breastfeeding. Already on her anticipated year-
long maternity leave from work at one of the large trade unions, she is speaking a few days before she gave birth
to her first baby here:
Lucy: …you were asking about how you think it’s going to affect your relationship, one of the reasons I was saying
about the bed and sharing thing is the sexual aspect of it and I don’t want that to get lost although it has recently, he’s
been really worried about hurting me or the bump, he’s been a bit put off things, and I guess that’s one of the things
that worries me most about breastfeeding is your breasts going from being this sexual thing to a feeding practical
thing for the baby, so I think that’s one of my worries about our relationship and about breastfeeding…So we want to
try and make an effort … That’s the other thing … you shouldn’t even like leave the baby on its own in the room, not
even to have a shower, I mean I don’t know what you’re supposed to do, but if you want to have sex or whatever, are
you supposed to have the baby in the room? I haven’t thought very hard about it but … I’m sure you can leave the
baby to have a shower for 10 minutes.
Despite some awareness about embodied changes, unfortunately the experiences of post-baby sex
were worse than expected in some cases, and many women I spoke with were totally shocked by how their
bodies had undergone what one mother described as a ‘total physical onslaught’, which they felt totally
unprepared for. Speaking when their baby was around 6 weeks old, this couple, who work in HR and fashion
design respectively, point out not only the physical barrier to having sex, but emotional and practical ones too:
Katie: Ah yeah. I feel I’m neglecting [him].
Paddy: No you’re not.
Katie: And because of that I have the episiotomy, I’m really scared about having sex…So that’s really sort of…But I
mean it hasn’t even been for six weeks yet…I am scared. It feels like it’s going to be months, if not years. So, …so
yeah. But even the thought of having sex because she’s in the bedroom, I don’t even know how it would work really.
Seems a bit weird. So, yeah that’s a bit strange. And yeah it does just feel like you don’t get any time together. You’re
just talking about what you going to have to do now. ‘Do you want to cook dinner?’ ‘I’ll wash up’. That’s it really. ‘Do
you want to change the baby’s nappy?’ ‘Do you want to hold the baby?’
The same mother said at 6 months (as the main earner, she returned to work full-time when her baby
was around 10 months, whilst her partner worked part-time, and their daughter attended a nursery part-time):
Katie: We’ve only had sex three or four times since she’s been born and I didn’t think that would fall apart the way it
has. But it is just timing and opportunity and not feeling tired and being in the same room. If we had our own room, it
might be different…And the episiotomy is quite painful.
Author: Is it still quite sore?
Katie: Well, it was last time! I think all those things have contributed to … and that really worries me because you
need that for a healthy relationship…I think I knew that it would put a strain on the relationship but you can’t really
imagine it happening until it has happened. And my sister just kept saying everything that’s wrong with the
relationship is magnified when you have children and she’s going through a really bad patch with her husband. So I
did know to expect it and I don’t know, it is good and it isn’t good. But I think it’s not helped by [his] working pattern
and that situation, by him being around but not really being there to help, it’s made me a bit resentful.
Intimacy and inequality: Embodying difference
Like Clare, we can see here that Katie uses how often she has sex with her partner as a barometer for
the relationship as a whole. This points to the way in which a ‘good sex life’ is linked to notions of a ‘healthy
relationship’ – and something to be ‘performed’ (in the sociological sense) both to each other as partners, and to
friends, family (and researchers) as peers. Like Woodiwiss’s research, then (also in this special issue), we see
how powerful the discourse of ‘compulsory sexuality’ can be for individuals, at all stages of the life course. This
comes from Cathy, a 32-year-old academic at a London university, who planned to take 6 months off work, and
then return 4 days a week. Her husband, a 31 year old IT manager in a bank, was planning on taking 2 weeks of
statutory leave, and then also moving to a 4 day week when their baby was 6 months, so that they each do a day
of childcare, with a nanny or relatives covering the other three days. At this point she earned around £45,000 he
earned around £95,000.
Cathy: It’s just so hard to explain that I’ve felt like a physical continuous onslaught… this massive physical thing that
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happens to your body. Whereas other people, like Libby, had a reasonably quick and easy birth. Was back having
sex all the time within about a week or something. And they were just like, back on the…and their…they put Alice
out in the other room, after five weeks or something, because it was ruining their sex life. I was just like, I’m not…but
she was sleeping through the night from, like, three weeks old. They just had a whole completely different
experience. So I know that it can be the ideal thing. That does happen. […]
Colin: It could be that she’s lying to you.
Cathy: No. She told [Emma].
Cathy also talked about the physicality of motherhood (and breastfeeding, in particular) coming as a
shock, and a limit on her ‘intimacy time’ with her husband, which made her feel less desirable, something many
women reported as a problem of the ‘mother/lover’ division. She describes the shift from bodies being conduits of
pleasure to being sources of nutrition particularly graphically here:
Cathy: Yeah. My body was alien to me for a period of time. I embraced it more when I was pregnant, I was annoyed
by it but after, particularly with the breastfeeding, you can’t take your bra off ever. With mine, because I had such a
milk supply and I’d have to wear those breast pads all the time and how many would I get through in a day, six or
seven?… So we were buying stacks and stacks of them and as soon as I’d take my bra off, I’d go into the shower, I’d
just be squirting everywhere so it makes physical intimacy very difficult.
Whilst I do not expand on it here this couple had quite an interesting experience of the division of
childcare. They trialled their ‘4-day week each’ arrangement by using some of their holiday allowances, though
sadly – and perhaps tellingly – when her husband requested the arrangement on a more permanent basis, he
was made redundant. This meant that he had a period of several months at home, without work (but with a
generous payment package; and interestingly, rather than a period of full-time childcare; a nanny 3 days a
week). He subsequently found another job, working 5 days a week.
Given that they were so busy, they talked at length about how important it was for them to schedule other
sorts of ‘intimacy time’, including, but not limited to sex, particularly because they could no longer be
spontaneous in spending time with each other, and that their son would ‘take all of their attention’ otherwise:
Cathy: [Speaking to her husband] But even with [our son], if you were with him, I could quite easily come into the
room at the end of the day and just give [our son] all of my attention and not even kiss you hello. And it would happen
the other way round too. He takes all of our attention, you have to remind yourself that the other person is right there
and needs to be greeted and made into a person by actually being recognised!
Negotiating cultural contradiction
It is also interesting to note here the inherent contradiction between government advice to mothers
around breastfeeding and the ideological commitment to ‘shared’ parental leave. (Exclusive breastfeeding for six
months and anything up to two years or beyond clearly not being the easiest of activities to split according to a
50/50 model or similar). As we can see from these accounts, new parents often find themselves at the juncture of
several competing cultural discourses: one around the importance of intensive, embodied care carried out by
biological mothers, particularly as it relates to feeding; another about the importance of gender equality at home
and work, particularly as it relates to providing ‘child-centred’ care; and another around the importance of
maintaining a healthy couple relationship, particularly as it relates to having regular sex. No wonder many of
them reported feeling tired and ‘torn’.
If there was a ‘typical response’ amongst this group of new parents, then, this couple probably best
capture it. Reflecting on working full-time in the charity sector and taking on full-time childcare (whilst training to
be a certified child minder in place of returning to administrative work) respectively, Mark writes:
Mark: Well, we don’t have as much sex as we would like. [My wife] in particular is always tired, and I am pretty tired
too so am often easy to put off! However we try to schedule sexytime so that it doesn’t fall off the radar, as it easily
could. We both realize the importance of this, as when we didn’t have sex for some time after the birth of [our
daughter], we felt that our relationship changed. I wouldn’t call it deteriorating, but we just didn’t feel as close to each
other in a way, which we missed. Maybe we felt too much like a ‘team’ and a little less like lovers! So we are less
impulsive, but if it was left to chance it wouldn’t happen! We are getting more time on our own recently, due to family
members taking her away for weekends and longer, so that too is changing.
In her study, When Couples Become Parents based on interviews with couples in Canada, Bonnie Fox
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also observed that there was a ‘dramatic change in sexuality’ during the first year of parenthood for most of her
participants (2009:249), a loss that was more keenly felt by men. Women’s need to recuperate, their tiredness,
and the fact that they were breastfeeding reduced their desire for sex. And even when they did have sex, it was
different to before, clearly chiming with the set of accounts here around expectation not matching up to reality.
Developing a useful typology, Fox notes that these changes in sexual activity were indicative of other
kinds of changes that occurred in couples’ relationships as they negotiated the first year of parenthood. In the
first pattern (around 30 percent of couples) the relationships deteriorated, and were ‘riddled with tension and
worn down by the upset and anger of one or both partners’ (2009:252) In these cases, she describes
relationships on the brink of divorce, or ‘nonexistent’.
In the second pattern, made up of around 25 percent of couples, the relationship was marked by tension
between the partners, but ‘there was no noticeable weakening of the relationship over the year. Often the anger
was about the men’s avoidance of the newly expanded housework, for example, and it created tensions that were
new to these relationships. Nevertheless, these couples’ happiness about being parents sometimes meant that
they – especially the men- felt closer to their partners’ (2009:252).
In the third pattern, which comprised another 25 percent, the relationships neither seemed to weaken or
strengthen, but ‘clearly suffered from the absence of time for intimacy’ (2009:252). ‘In these relationships, there
was only minimal tension between partners – usually blamed on tiredness – but both people found the year to be
difficult emotionally, given how little time they spent together.’
Lastly, in the final 20 percent were couples whose relationships were improved by parenthood. These
were couples who experienced parenthood ‘largely as an addition to their relationship’ (2009:252)
What Fox notices is that in those couples that displayed the first pattern, there was a lot of anger and
resentment. This was ‘fostered by the gender-based divisions organising their daily lives and sometimes
enhanced by the insularity of their families… men’s detachment from the care of their babies and the dramatic
differences in the men’s and women’s daily experiences – especially when the women were home full-time –
were usually what undermined mutual understanding and often support. When both parties were stressed by the
high demands of their daily work, that stress could further erode empathy, negate any hope of mutual gratitude,
and produce considerable anger’ (2009:265).
Less equality, less intimacy? Accounting for cultural contradiction
Fox’s typology is useful in understanding the accounts presented here. The issue of ‘resentment’ and
feelings of inequality and unfairness were demonstrated by participants such as Katie, above. Writing about the
emergence of the ‘companionate marriage’ (as opposed to the more traditional patriarchal one), Collins (2003)
notes that ‘The keywords of companionship were intimacy and equality. Intimacy was at once achieved and
expressed through privacy, closeness, communication, sharing, understanding and friendship’ (Collins 2003:24).
However, he identifies a problem with this once children come along: parenthood accentuated the sexual division
of labour and had the potential to divide companionate couples every bit as profoundly as their patriarchal
counterparts. Whereas spouses were able to live ‘almost identical lives’ before they had children, any resulting
intimacy came under pressure from the inescapable differentiation between the two sexes once there is a child.
Particularly if women were earning less than their partners before (which in all but one case they were)
what usually emerged from the interviews is that it made ‘most sense’ that they were the ones to take time off
work, or stop work entirely. Many women ‘accounted’ for this in an understandably contradictory way as they
went about trying to narrativise it; it was both what they ‘wanted’ to do, and what they ‘had’ to do: They had an
ideological commitment to equality in career opportunities, yet a gendered ‘pull’ towards a model of intensive
parenting (or, motherhood).
It is important to contextualize these accounts in our particular historical moment, then. In line with much
sociological and popular literature, the accounts here show that the transition to motherhood is felt particularly
acutely by many women today (for example, Cusk 2001, Miller 2005). This is, no doubt, in part as a reflection of
the shift Giddens et al identify – the period before children is (discursively at least) one of equality for
contemporary men and women, particularly in the middle classes: women match their male counterparts through
the education system and (largely) have professional opportunities unfettered by gender, being able to gain
financial independence. Furthermore, they have freedom in romantic and sexual unions and are able to express
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disdain for housework and homemaking in ways unthinkable in the past (Bristow 2008, Giddens 1992).
As the narratives point to, however, something happens around the time of motherhood that means that
many women suddenly ‘get’ feminism, and indeed their biological difference to men in a more explicit way than in
the past (Bristow 2008). Bodies, which had so far been a marker of the self (and self-control) started to ‘betray’
them, as Cathy puts it. This realisation of biological difference – that Cathy points to in her account – is often
accompanied by a shift from being financially independent towards dependence whilst on maternity leave.
Similarly, when she does go back to work, like many other women in the sample, Cathy sees her career fall
more readily into the ‘mummy track’ of a 4-day week, where her husband continues with the same 5-day pattern,
despite an ideological commitment (and practical agreement) around the importance of career parity for both
Furthermore, housework is no longer a case of taking ‘turns’ to carry out chores, but a hugely expanded
task which has to be carefully orchestrated to keep all household members fed and clean. The invisibility – and
cultural de-valuation of – this labour after motherhood is something many other women in the sample also
expressed resentment about, feeling that their partners simply ‘didn’t see’ the extra work they were doing, often
by virtue of being the ones at home more often. These material and practical changes to women’s financial
situation (despite being coupled with a policy emphasis on ‘equal parenting’) often serve to magnify this sense of
injustice. And clearly, for many women, losing their previous identities as workers could create its own kind of
This has an impact on intimacy, as expressed through sex. So, where before, sex is something that is
‘kind of fun’ and ‘bonding’ for couples, as Clare puts it, afterwards, Katie talks about it like more of a gendered
currency, or something she feels she ‘owes’ her partner, despite feeling physically uncomfortable. (It is notable
too that at the point she makes that remark, she is being supported by him financially; in this instance, policy has
clearly entered the bedroom). Furthermore, many couples are simply too tired, or physically uncomfortable to
resume a ‘normal’ pattern of intercourse.
In terms of the theoretical contribution of this paper, in part, then, these observations back up the shift
Giddens et al describe – clearly, any cultural focus on female sexual pleasure and the fact that many women
were able to talk about their sexual needs and desires so openly is proof of a move towards a more equitable
focus on mutual pleasure in relationships today than in the past (1992). However, rather than moving in a
progressive fashion from patriarchal to companionate to more ‘plastic’ intimacies, for example, there appears to
be some movement back and forwards between these various arrangements, with parenthood often pushing
couples back into an unfamiliar patriarchal set up (at least financially, if not ideologically). Clearly, this shift back
into a more traditional pattern is exacerbated by a lack of resources – for many couples, there is no choice but to
opt for more gender segregated roles. As this paper has shown, however, even in the case where a couple has a
joint income of nearly £150,000 (such as Cathy and Colin) there still seems to be a ‘pull’ towards these more
traditional patterns. It is worth reiterating the impressive power of the intensive mothering ideology in shaping
women’s perceptions of themselves as good mothers, and working out how they ‘want’ to arrange their working
and home lives. Yet again we see how an equal parenting ideology meshes uncomfortably with a culturally
elaborated intensive, embodied commitment to motherhood.
Similarly, there is clearly a tension between a more ‘plastic sexuality’ and the transition to parenthood.
Whilst Giddens’ theory of a more ‘pure’ relationship might have some purchase on how sex is at least imagined
prior to the arrival of children, the idea that the couples here are only in relationships for as long as they are
individually satisfying is not substantiated by the account here: clearly parenthood creates demands and
necessities that they view as valuable, beyond their own individual sexual pleasure. Most couples acknowledged
that the first year of parenthood was a particularly tough time for their relationship, but it was, essentially, a
temporary state of affairs that would eventually pass. (Although it is true that if they did not take steps to
reintroduce ‘sexytime’, as Mark puts it, they recognised their relationship would deteriorate). Yet again, we see
how policy frameworks, and material resources, therefore shape even the most intimate of our interactions as we
go about negotiating these competing ideologies.
Conclusions and future directions
These accounts show how couples’ experience of changing sexual practices can offer us a lens on the
relationship between gender equality and intimacy. Far from being a straightforward correlation between them,
they are, in fact ‘uncomfortable bedfellows’, fraught with frustrations from all sides. In contributing both to the
literature around changes to intimate relations and parenting culture, this paper provides evidence that whilst our
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gender roles are less and less scripted before children arrive, they are very often thrown back into traditional
models once they do.
Whilst efforts to make parenting more equitable are clearly laudable, the evidence here seems to imply
that current policy is missing the point: even for couples who are ideologically committed to, and can afford, a
more equal split there seems not to be an practical commitment to sharing care. This certainly suggests that for
those social groups who cannot afford this division that such policy drives will be even more irrelevant (Gillies
2009). What is more, there is a danger that though these moves would be beneficial in giving parents more
freedom in how to divide up their time, many of the efforts to involve fathers in childcare appear only to extend a
cultural logic around parenting to men – an intensive one, which puts children at the centre of all considerations.
This has the potential to leave two parents feeling ‘torn’, rather than, for example, challenging our view of children
as requiring one-on one care by a biological relative, or alleviating a cultural guilt around the place of childcare.
This has its own knock-on effect on couple intimacy. Mark and his wife talk about feeling more like a ‘team’ of
partners, rather than ‘lovers’, as they have little space to think about themselves as a couple beyond being
parents to their daughter (although this raises its own interesting considerations around how sexual desire
intersects with ‘gender equality’).
How ‘equality’ and ‘intimacy’ work themselves out in a couple’s practices is demonstrably deeply
uncomfortable for their ‘identity work’ as gendered beings, in negotiating dissonance between expectation and
outcome. For many parents in this study, struggles around how to negotiate competing cultural discourses –
about good parenting, about good relationships and about gender equality – are indicative of an interesting
historical moment in social life. Rather than showing a straightforward correlation between (or continual
progression towards) greater intimacy and equality, these accounts show the two are in a state of flux. As this,
and other papers in this section demonstrate, then, attention to these ‘everyday’ experiences, provide interesting
intellectual reflections, far beyond the bedroom.
Gina Ford is one of the best selling parenting experts in the UK, advocating a structured approach to
infant care, with practices such as scheduled feeding and sleeping routines.
Ethical approval for the study was granted by the University of Kent’s Review Board, in accordance with
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- Negotiating Intimacy, Equality and Sexuality in the Transition to Parenthood
Keywords: Parenting, Gender, Intimacy, Equality, Sex, Couples
Negotiating intimacy, equality and sexuality in the transition to parenthood
Theoretical background: Intimacy and parenting
The policy context: Parental leave and childcare provision
Accounts: Intimacy and sex
Anticipation and reality: Accounting for dissonance
Intimacy and inequality: Embodying difference
Negotiating cultural contradiction
Less equality, less intimacy? Accounting for cultural contradiction
Conclusions and future directions
Mindfulness-Based Sex Therapy Improves Genital-Subjective
Arousal Concordance in Women With Sexual Desire/Arousal
Lori A. Brotto1 • Meredith L. Chivers2 • Roanne D. Millman3 • Arianne Albert4
Received: 3 February 2015/ Revised: 3 November 2015/ Accepted: 30 December 2015/ Published online: 26 February 2016
� Springer Science+Business Media New York 2016
tioning. To date, this literature has been limited to self-reports of
degree of agreement between self-reported sexual arousal and
ofwomenwithsexualdesire/arousaldifficulties(n =79, M age
40.8 years) who participated in an in-laboratory assessment of
subjective sexual arousalconcordance significantlyincreasedfrom
pre-treatment levels, with changes in subjective sexual arousal
predicting contemporaneous genitalsexual arousal (but not the
reverse). These findings have implications for our understand-
ment may lead to an integration of physical and subjective arousal
mightconsider theadoption of sexual arousal concordance as a
relevant endpoint in treatment outcome research of women with
sexual desire/arousal concerns.
Keywords Sexual desire � Sexual arousal �
Vaginal photoplethysmography � Mindfulness � DSM-5 �
Lack of motivation for sex affects up to 40% of women aged
16–44 (Mercer et al., 2003; Mitchell et al., 2013) and is the
most common reason prompting women to seek sex therapy.
(Shifren,Monz,Russo,Segreti, & Johannes,2008).The 5th edi-
tion of the Diagnostic and Statistical Manual of Mental Disor-
2013) and a diagnosis is made when any threeof six criteria are
met for a minimum duration of 6 months and accompany clin-
for sex, (2) lack of sexual thoughts/fantasies, (3) lack of initia-
physical sexual arousal response.
terone in surgically menopausal women (reviewed by Davis,
2013). Moreover, estimates suggest that 4.1 million prescrip-
tions for off-label testosterone are made annually in the U.S.
in Europe (for surgically menopausal women with low sexual
desire), it is currently unavailable in North America. Various
other pharmaceutical agents have been the subject of clinical
& Lori A. Brotto
Department of Gynaecology, University of British Columbia,
Department of Psychology, Queen’s University, Kingston, ON,
Department of Psychology, Simon Fraser University, Burnaby,
Women’s Health Research Institute, Vancouver, BC, Canada
Arch Sex Behav (2016) 45:1907–1921
flibanserin is the only medication approved in the U.S. for this
Because cognitive distraction during sexual activity is prevalent
among women with sexual dysfunction, and negatively impacts
this provides justification for the application of cognitive chal-
lenging strategies (i.e., identifying, challenging, and replacing
bothcognitivechallengingaswell as behavioral strategies) toa
wait-list control in 74 couples in which women met criteria for
of women no longer met diagnostic criteria for HSDD, andthis
stabilized to 64% after 1-year follow-up. In addition to signifi-
quality ofmaritallife andperception ofsexualarousal,butthe
cal settings. Another treatmentoutcome study of10sessions of
tion in the proportion of women who had significant concerns
in many domains of physical and psychological health.
Defined as present-moment, non-judgmental awareness with
fulness meditation has been a major addition to the psycholog-
stance use,childhoodbehavior problems,andahost of medical
concerns, includingpain, irritable bowelsyndrome, fibromyal-
gia,and highbloodpressure (Grossman, Niemann, Schmidt,&
by which mindfulness is associated with symptom relief is not
merely as mental events (Teasdale et al., 2002). Over the past
10 years, mindfulness has beenapplied to and found effective
for the treatment of sexual dysfunction in women (Brotto,
& Rellini, 2012b).
ments in women with sexual dysfunction are not entirely clear
ual activity from a third person perspective—a decrease in anx-
iety, encouraging an attitude of acceptance and non-judgment,
and/or an increasein perception ofphysical sexual response. In
maryanalysisfocusedon interoceptive awareness,thecapacityto
vention. Interoception has long been of interest to emotion research-
shown a series of 31 pictures containing sexual and non-sexual
the insula cortex.
apooledsampleof n = 2345women,thatvariationinwomen’s
ological factors such as the number of stimulus trials in a given
was associated with using stimuli that varied in content, inten-
sity,ormodality(r = .49)andmethodofcalculating
(between-subjects[r = .29]versuswithin-subjects[r = .43]).
Chivers et al. also found that concordance among women was
perature (e.g., labial thermistors and thermographic imaging)
toplethysmography (.55 vs. .26, respectively), although thermo-
graphic methods of assessing genital response also produce wide
1908 Arch Sex Behav (2016) 45:1907–1921
inter-individual variation in sexual concordance, similar to vagi-
2010). Regardless of measurement method, broad variation in
Low sexual concordance can manifest in one of two ways:
or sexual affect may not be simultaneously reported (Chivers
et al., 2010). This pattern is also common among women with
DSM-IV-TR characterized as self-reported impairments in
genital vasocongestion (American Psychiatric Association,
stimuli in the laboratory but showed a robust genital response,
similar to women without sexual arousal problems (Laan, van
Driel, & van Lunsen, 2008; Meston, Rellini, & McCall,2010).
In their meta-analysis, Chivers et al. reported the average cor-
(n =1144), the correlation was .26 (.21 to .37).
cordance as a primary outcome.
In light of mounting evidence that mindfulness improves
sensations, and that concordance between genital and self-re-
group mindfulness-based sex therapy (MBST) on concordance
between genitalandsubjectivesexualarousal; (2)examine the
effects of treatment on self-reported sexual arousal and, sepa-
rately, on genital arousal; and (3) test the relationship between
(i.e., sexual desire and sex-related distress) with treatment. A
of this MBST compared to a delayed treatment control group
dtreatment=0.97; dcontrol =0.12) (Brotto & Basson, 2014). Sex-
related distress also significantly improved with treatment, and
did not significantly differ from the control group (Cohen’s d
encinggeneral and genital arousal responsesnon-judgmentally,
analysis, we also included age, diagnosis of FSAD, andarousal
in sex-related distress.
Participants werepart ofa largerstudy evaluatingoutcomesof
cerns from the British Columbia Centre for Sexual Medicine,
to participate. Inclusion criteria included: age between 19 and
psychophysiological sexual arousal assessment) at three time
points. Women with difficulties in achieving orgasm were also
with dyspareunia (chronic genital pain not resolved with a per-
women who provided pre-treatment assessment data. The data
Arch Sex Behav (2016) 45:1907–1921 1909
who were assigned to the immediate treatment group and 38
wait-list period. Only pre- to post-treatment data for women in
for their two pre-treatment assessments, so the present analyses
did not compare the effects of treatment versus wait-list control
onconcordance.Themeanage ofthesample was40.8years(SD
11.5, range 20–65). A total of 84.6% were in a committed rela-
tionship, 6.4% were casually dating, and 9.0% were single. The
mean relationship length was 13.2years (SD 10.7). Most partic-
Asian (7.6%) and South Asian (2.5%). This was a highly edu-
catedgroupin that 67.1% hadsome post-secondary education,
and 22.8% had an advanced graduate degree.
atric Association, 2000) diagnostic criteria for HSDD and 24
(30.4 %) women met criteria for FSAD. The remaining 22
(27.8 %) women met criteria for both HSDD and FSAD.
Assessment of Psychophysiological Sexual Arousal
Genital response was measured with a vaginal photoplethys-
acrylic vaginal probe, inserted in private by the participant. The
probe (Behavioral Technology Inc., Salt Lake City, UT) contin-
analog to digital, using a Model MP150WSW data acquisition
unit [BIOPAC Systems, Inc.]), and transformed psychophysi-
ological data, using the software program AcqKnowledge III, Ver-
research assistant performed artifact smoothing of the signal fol-
film for each sexual arousal assessment.
Contemporaneous Assessment of Subjective Sexual Arousal
the neutral and erotic films with an arousometer that was con-
Rellini et al. (2005). This device consisted of a computer optic
mouse mounted on a plastic track with 10 intervals, and was
easily move the mouse, while simultaneously reclining and
viewing stimuli. Women were instructed to move the mouse
up and down the track over the course of the film to indicate
Highest Level of Sexual Arousal, 0 = No Sexual Arousal, and
-2= Sexually Turned Off.Wehavepreviouslyusedthisdevice
sexual arousal response was obtained every 30-s, producing six
erotic film, corresponding with the 30-s epochs of VPA data.
Discrete Measure of Sexual Response and Affect
The Film Scale, a 33-item self-report questionnaire, was used
each). The scale has been found to be a valid and sensitive mea-
a 7-point Likert scale from Not at All (1) to Intensely (7). Pre-
treatmentreliability for the Film Scale duringthe neutral phase
the erotic phase (Cronbach’s alpha = 0.94).
Likertscalefrom0(did not complete homework/did not attend
sessions)to2(notable efforts at completing homework/attend-
Female Sexual Arousal Disorder symptoms
Subscales of‘‘Arousal’’and‘‘Lubrication’’on the Female Sex-
eration analyses. The FSFI is a 19-item self-report questionnaire
considered to be the gold standard measure of sexual function in
these two domains was excellent (a=0.89 and a=0.93, respec-
tively) for the current sample.
Sexual Desire was measured with the 14-item Sexual Inter-
scores range from 0 to 51, with higher scores indicating higher
nal consistency (Cronbach’s a=0.90). Item-total correlations
1910 Arch Sex Behav (2016) 45:1907–1921
were high for‘‘Receptivity,’’‘‘Initiation,’’‘‘Desire-frequency,’’
(r[.70), good for‘‘Relationship-sexual,’’‘‘Affection,’’‘‘Arousal-
sample was a=0.76.
Sexual Distress was measured with the 12-item Female Sex-
ual Distress Scale (FSDS) (DeRogatis, Rosen, Leiblum, Burnett,
& Heiman,2002).Scorescan rangefrom0to48,where higher
scores represent higher levels of distress. The FSDS has been
shown to have good discriminant validity in differentiating
between sexually dysfunctional and sexually functional women,
with 88% correct classification rate, and found to have satis-
factory internal consistency (ranging from 0.86 to 0.90) (DeRo-
gatis etal.,2002).Reliabilityfor the current samplewas excel-
lent at a =0.92.
mation about the treatment content, and informed women about
a consent form. The return of a signed consent form indicated
informed consent, at which time women were assigned to par-
ticipate in either the immediate treatment group or the delayed
treatment group. Whenever possible, we utilized random assign-
ment to group; however, in cases where participants’ schedules
line sexual arousal assessment to take place in a sexual psy-
questionnaires and asked to return them completed at the time of
their sexual arousal assessment. These same questionnaires and
sexual arousal assessment were repeated 2–4 weeks after the
completion of their MBST group as well as 6 months later. The
duration between baseline and the two subsequent assessments
was relatively equal across all participants, with no more than
2-week variation, typically at the follow-up assessment.
The sexual arousal assessment took place in a sexual psy-
housed a comfortable reclining chair, a large screen TV, and an
intercom. A thin blanket was placed over the seating area of the
chair. Following written consent, participants were tested by a
female researcher. Women were first shown the vaginal photo-
to insert it. The female researcher then left the room, while
participants inserted the probe and informed the researcher via
intercom of their readiness. In order to habituate to the testing
environment, participants were encouraged to relax on a com-
fortable reclining chair for a 10-min period after the probe was
inserted. Subjective sexual arousal and affect were assessed at
the end of the adaptation period using the Film Scale, which
erotic film sequence.
Before the film sequence began, women were reminded to
use the arousometer to capture their subjective sexual arousal
throughout the film sequence. The researcher instructed partic-
ipants to:‘‘Monitor your subjective feelings of sexual arousal to
the film by using this device. By ‘subjective feelings of sexual
arousal,’ we mean how mentally sexually aroused you are in
your mind while you’re watching the film.’’Further instructions
were given on the numerical demarcations on the device and
imagine) andlower (sexually turned off) anchorsreflect. Partic-
ipants practiced moving the arousometer in the presence of the
researcher and any questions on its operation were addressed
before the film sequence began.
The researcher then initiated the video sequence from the
adjoining room. The audio component was delivered via wire-
less headphones to the participant. Women watched a 3-min
neutral documentary about Hawaii followed by a 7-min erotic
film that depicted a heterosexual couple engaging in foreplay,
oral sex, and penile–vaginal intercourse. There were three dif-
ferent film sequences counterbalanced across women and ses-
sions so that participants viewed the same film only once over
them to evaluate their subjective sexual arousal and affect to
meet the researcher in a separate room. After a debriefing period,
the researcher disinfected the probe in a solution of Cidex OPA
(ortho-phthalaldehyde 0.55%), a high level disinfectant (Advanced
Sterilization Products, Irvine, CA, USA), promptly following
All procedures were approved by the Clinical Research
couver Coastal Health Research Institute. All procedures were
ical Association Declaration of Helsinki.
Mindfulness-Based Sex Therapy
TheMBST(Brotto,Basson,&Luria,2008b)was based onan
integration of psychoeducation, sex therapy, and mindfulness-
based skills, the latter of which have received extensive empir-
ical support in other populations (Grossman et al., 2004). Stem-
ming from evidence that women with sexual desire/arousal dif-
ficulties are often distracted during sexual activity and/or judg-
primarily aimed at orienting the woman to the present experi-
Arch Sex Behav (2016) 45:1907–1921 1911
events’’—something to be noticed but not focused on. Consis-
depression relapse (Teasdale et al., 2000), MBST aims to help
aging women to practice mindful self-awareness in non-sexual sit-
ture fromtheir typicalmodeof being,whichmayhave beenchar-
practice was to encourage participants to develop a regular mind-
to focus instead on being fully in the present. Goals for the group
were not elicited.
In the current study, treatment was delivered by two group
facilitators (selected from a trained pool of six sexual medicine
physicians, psychologists, and upper-level residents/graduate
each 90min session was spaced 2 weeks apart.
Session 1 provided educational information on the prevalence
andknown etiologyof low desire and arousal. Mindfulness was
thenintroducedthroughin-sessionpractice of the‘‘BodyScan,’’
which is also the foundational practice in mindfulness-based
therapies (Teasdale et al., 2000). By orienting attention to var-
ious parts of the body, women were encouraged to become
aware of sensations in that region and any subsequent‘‘mental
daily at home, and were provided an audio-recorded guide.
Session 2 provided an opportunity for in-depth homework
review, followed by psychoeducation on sexual anatomy and
In-session mindfulness practice centered on‘‘Breath and body’’
as the focus of attention. Like the Body Scan, participants were
guided to notice and attend to various parts of the body, includ-
ing sensations associated with breathing and the breath itself. In
mindfulness-based therapy for depression (Basson, 2001), this
‘‘seeing meditation’’with their genitals as the focus of the prac-
tice. They were asked to observe their genitals with a hand-held
mirror, and in addition to noticing moment-by-moment visual
and bodily sensations, they were also asked to take note of any
follow-on thoughts, emotions, or beliefs as a result of the seeing
Session 3 began with an in-depth review of the home body-
oriented mindfulness practice, and participants were encour-
aged to start to think about the relevance of this practice to their
sexuality more broadly. Next, there was in-session psychoedu-
cation on Gottman’s principles for lasting relationships (Gott-
man& Silver,1999).The guidedin-sessionpractice utilized
cussion on the high prevalence of automatic thoughts/logical
errors of thinking, and using the cognitive behavioral model to
illustrate the association between thoughts, emotions, and beh-
aviors. The discussion also highlighted how mindfulness skills
are aimed at simply bringing awareness to negative/judgmental
thoughts and were contrasted with CBT skills, which are aimed
at identifying and challenging problematic thoughts. For home
practice, women were encouraged to repeat the mindfulness of
genitals exercise from the previous 2 weeks in which they obs-
but this time were also encouraged to incorporate the sensation
of touch. This was framed as a non-masturbatory exercise
designed to enhance mindful awareness of genital sensations.
Session 4 was devoted to home practice review followed by
an introduction of sensate focus to be used with a partner (if
available). The facilitator explained the first (of three) phase of
sensate focus as originally defined by Masters and Johnson
(1970). Specifically, sensate focus was described as having the
goals of: tuning into sensations (and in this way, women were
encouraged to use the mindfulness skills they had been devel-
vided to womentoelicita sexualarousal response usingone of
these tools, and then use those sensations as the focus during a
1912 Arch Sex Behav (2016) 45:1907–1921
mindfulness practice, and they were encouraged to try this at
these erotic aids, we hypothesized greater facilitation of inte-
non-sexual aspects of their lives. Whenever possible, the facilita-
tors referenced published findings on the efficacy of mindful-
brain function. All materialwas compiled intoa facilitator and
participant manual that included space for personal practice
notes and observations (Brotto et al., 2008b).
We predicted a significant effect of MBST on increasing con-
cordance between genital and subjective sexual arousal. Mul-
tilevel methodology was used to assess this question as it allows
for the examination of changes within an individual (rather than
averages across individuals) and has specifically been used to
software program (HLM 6.08) (Raudenbush, Bryk, & Cong-
from pre-treatment to post-treatment, and again at six-month
We used a two-level model with repeated measures modeled
the start of the erotic film) and trajectories of change (slopes) in
asstandardized betas. All coefficientswere modeled as random
First, we assessed the effect of the intervention on the con-
between genital and continuous subjective arousal (i.e., whether
genital arousal predicted contemporaneous subjective arousal,
ferences in the outcome of interest at the different assessment
Second, we conducted five Level 2 moderation analyses to
determine if age, homework compliance, or FSAD status [asse-
ssed in two ways; firstly, as a dichotomous variable according to
whetherthe womanhadaclinicaldiagnosisof FSADornot,and
secondly using continuous scores on the lubrication and arousal
concordance between genital and subjective sexual arousal at
each of the time points.
To aid in the interpretation of the magnitude of concordance
within-subjects and between-subjects Pearson r correlation coef-
ficients on VPA and continuous self-reported arousal during the
could be compared to the mean concordance values from a
et al., 2010).
We predicted that treatment would be associated with significant
improvements in self-reported sexual arousal and affect but not
with any significant changes in genital sexual response measured
the erotic stimulus minus mean scores during the baseline period,
onthese difference scores.Toexamine the effectsof treatmenton
genital sexual response, a similar mixed within-between repeated
which was calculated as follows: (mean erotic VPA minus mean
neutral VPA) divided by mean neutral VPA, as per Clifton et al.
symptoms—namely, sexual desire,and sex-related distress.
the estimate of concordance between VPA and subjective aro-
usalforeachwomanat eachtime point(pre-,post-treatment,and
used as a fixed variable in a mixed-effects model examining the
and concordance over time points, or FSDS scores (measuring
sex-related distress) and concordance. The models included con-
cordance, time point (pre-, post-treatment, and follow-up), and
their interaction, as well as participant ID as a random nesting
Concordance Between Genital and Continuous
Subjective Sexual Arousal (Hypothesis 1)
Results ofthecontemporaneous analysesare shown inTable 1
and indicated that genital and subjective arousal covaried
Arch Sex Behav (2016) 45:1907–1921 1913
predicted contemporaneous increases in genital arousal, and
in subjective arousal.
Subjective Arousal Predicting Genital Arousal
When examining the association between subjective arousal
and contemporaneous genital arousal, SAPre-treatment (tophalf of
Table1) represents this association during pre-treatment. This
coefficient was significant, indicating that for every one stan-
dardized unit of subjective arousal increase, women showed an
average corresponding increase of 0.008 millivolts in VPA,
equivalent toa 0.16standarddeviationincrease inVPA.SAPost-
treatment and SAFollow-up were also statistically significant, indi-
cating that for every one standardized unit of subjective arousal
increase, women showed an average corresponding increase of
0.00525 millivolts in VPA at post-treatment and 0.00501 mil-
average increase of 0.15 standard deviations in VPA at post-
treatment and 0.12
standard deviations at follow-up.
To examine whether sexual concordance significantly dif-
fered at pre-treatment, post-treatment, and follow-up, we
examined the model with no constraints and compared this to
models constraining every unique pair of concordance ratios to
be equal. The models were compared using standard v2 differ-
ence tests in which the goodness-of-fit for two models is differ-
no constraints is retained. After applying the conservative Bon-
ferroni correction for multiple tests (a=0.05/3= .017), results
of all v2 difference tests comparing the unconstrained and con-
strained models, pre-treatment=post-treatment, v2(1)=10.40,
p = .001; pre-treatment= follow-up,v2(1)= 10.34, p = .001;
other time point. Further, these differences were in the expected
lesschangeingenital arousal associatedwith thesame level of
subjective arousal over time).
Genital Arousal Predicting Subjective Arousal
In examining the association between genital arousal and con-
temporaneoussubjective arousal, VPAPre-treatment (bottom half of
Table1) represents this association during pre-treatment. This
coefficient was significant, indicating that for every one stan-
dardized unit of genital arousal increase, women showed an
average corresponding increase of 1.79 units of subjective arou-
sal, equivalent to a 1.16 standard deviation increase in subjective
sexual arousal. VPAPost-treatment and VPAFollow-up were also sta-
tistically significant, indicating that for every one standardized
tively. This corresponds to an average increase of 0.76 standard
deviations in subjective sexual arousal at post-treatment and 0.64
standard deviations at follow-up.
at pre-treatment, post-treatment, and follow-up, we again exam-
ined the model with no constraints and compared this to models
Table1 Contemporaneous reciprocal associations between genital and subjective arousal
Coefficient SE t ratio p
SA ? VPA
0.005 10.92 \.001
0.004 16.68 \.001
0.005 12.85 \.001
0.004 1.99 .05
0.001 3.50 .001
0.001 3.40 .001
VPA ? SA
Pre-treatment 1.82 0.26 6.87 \.001
Post-treatment 1.88 0.23 8.22 \.001
Follow-up 1.70 0.19 8.97 \.001
VPAPre-treatment 1.79 0.50 3.58 .001
VPAPost-treatment 1.37 0.28 4.96 \.001
VPAFollow-up 1.08 0.26 4.20 \.001
VPA Vaginal pulse amplitude (genital arousal), SA subjective arousal
1914 Arch Sex Behav (2016) 45:1907–1921
constraining every unique pair of concordance ratios to be equal.
Results of all v2 difference tests comparing the unconstrained
difference in fit, pre-treatment= post-treatment, v2(1) = 0.71,
p = .40;pre-treatment=follow-up,v2(1)=-0.56,p = .46;post-
treatment=follow-up, v2(1)=1.49, p = .22, indicating that the
degree of concordance between genital and subjective arousal at
subjects correlations and these are shown in Table 2. Across
subjective sexual arousal was larger for within-subjects correla-
tions (range .28 to .33) than for between-subjects correlations
(range.13to.22).Usinga pairedsamples t test comparingpre- to
cordance estimates (Table2).
Focusing specifically on the within-subjects correlations, the
A total of 19.1% had negative concordance (defined here as
r B -.25), 10.6% had noconcordance (definedhereas-.24\
r\.24), and 70.2% had positive concordance (defined here as
r C .25).Atpost-treatment,therangewassimilarlylarge:-.80
concordance, and 65% having a positive concordance.
Moderation of the Association Between Genital and
Continuous Subjective Arousal
Five separate Level 2 moderation analyses were conducted to
determine if age (n =79), homework compliance (n =78), or
FSAD status (assessed dichotomously according to whether
women had a clinician-determined diagnosis of FSAD or not;
n = 79), and using mean scores on the lubrication (n = 62) and
arousal(n = 62)domainsoftheFSFI(measuredcontinuously)
changed the degree of concordance between genital and sub-
were included in the moderation analyses for age and FSAD
status, while only post-treatment and follow-up were included
in the moderation analyses involving
(homework had not yet been assigned at pre-treatment).
Neither age, diagnosis of FSAD, continuous FSFI scores on
the lubrication and arousal domains, nor homework compliance
moderated the association between contemporaneous subjective
and genital arousal as an outcome (ps ranged from .21 to .79).
Similarly, neither age nor FSAD status (assessed dichotomously
(ps ranged from .35 to .92) association between genital and sub-
jective sexual arousal as an outcome. Degree of homework com-
pliance was, however, found to moderate this association, such
dardized unit increase in genital arousal (Table3). Specifically,
a marginally significantly greater increase in subjective arousal
withmorehomeworkcomplianceatpost-treatment(t =1.67,p =
greaterhomeworkcomplianceatfollow-up(t = 2.13, p = .04).
Effects of Erotic Film and Treatment on Self-Reported
Sexual Arousal and Affect (Hypothesis 2)
To test the ability of the erotic film to significantly increase self-
film and after the erotic film at post-treatment. There was a sig-
nificant increase in perception of genital sexual arousal, t(78)=
-10.53, p\.001, d = 1.93;subjectivesexualarousal, t(78) =
-8.66, p\.001, d = 1.38; positive affect, t(78) = -6.43,
p\.001, d =1.20; autonomic arousal, t(78)=-7.36, p\.001,
d =1.23;negativeaffect,t(78)=-3.47,p = .001,d =0.59,anda
significant decrease in self-reported anxiety, t(78)=2.62, p =
.011, d =-0.42,followingtheeroticfilm.Thesefindingssuggest
that the erotic film was effective at eliciting a subjective sexual
response at post-treatment
A repeated measures ANOVA didnot find a significant effect
of treatment on subjective sexual arousal difference scores, F(2,
156)\1, p = .861, d =0.05frompre-topost-treatment;d =0.06
from post-treatment to follow-up. Perception of genital sexual
156)\1, p = .747, d =0.07frompre-topost-treatment;d =0.05
ment to follow-up.
significant effect of treatment on the change in positive affect
Table2 Concordance between genital and continuous subjective sexual
correlations across three time points
Within-subjects correlations used responses during the erotic segment of
the film only and continuous measures of subjective sexual arousal.
Sample sizes vary due to missing data. Paired samples t test revealed no
significant difference from pre- to post-treatment, t(46)=-0.21, p =
.835;orfrompost-treatmenttofollow-up, t(58)=0.76, p = .448.Between-
arousal from neutral to erotic film conditions, and using the difference
between neutral to erotic film conditions for discrete self-reported sexual
arousal.Fisher’s r-to-z transformationfoundnosignificantdifferencefrom
pre- to post-treatment, z =0.61, p = .542; or from post-treatment to fol-
low-up, z =-0.06, p = .952
Arch Sex Behav (2016) 45:1907–1921 1915
fromneutraltoeroticfilmconditions, F(2,156)=2.54, p = .082,
d =0.14 from pre- to post-treatment; d =0.08 from post-treat-
with no significant effect of treatment, F(2, 156)\1, p = .948,
d =0.00 from pre- to post-treatment; d =0.04 from post-treat-
ment to follow-up.
Arousal (Hypothesis 2)
A paired samples t test revealed that the erotic film significantly
increasedVPAatpre-treatment, t(78)=-2.00, p = .049;atpost-
treatment, t(78) = -2.00, p = .049;atpost-treatment, t(78) =
-2.78, p =.007; and at follow-up, t(78)=-2.19, p =.032, veri-
fying the sexually arousing properties of our erotic stimuli
To examine the effects of treatment on VPA percent change
scores, a repeated measures ANOVA across all three time points
156) = 2.58, p = .079; d = 0.28 from pre- to post-treatment;
d = -0.34 from post-treatment to follow-up.
Association Between Sexual Concordance and Clinical
Symptoms Using the Sexual Interest/Desire Inventory
and the Female Sexual Distress Scale (Hypothesis 3)
Significance of the interaction term and the main effects were
estimated using likelihood-ratio tests comparing the fit of the
removed. p-values\.05 were considered as indicating a signifi-
cant relationship between the term of interest and the outcome
variable. There was no significant interaction between time and
tic [LRT]=3.9, p = .15, and LRT=3.2, p = .21, respectively).
This suggests that any relationship between concordance and the
clinical symptoms of desire (SIDI) and distress (FSDS) did not
differ significantly over the time periods. If the interaction terms
were removed, there wasstill no significant relationship between
either SIDI or FSDS and concordance (LRT=0.2, p = .68, and
LRT=0.0, p = .99, respectively); however, there was a signifi-
cant effect of time period for both outcomes (SIDI: LRT=17.3,
p=.0002;FSDS:LRT=9.0, p =.01),withSIDIscoresincreasing
significantly post-treatment and remaining high at follow-up,
and FSDS scores decreasing significantly at post-treatment
and remaining low at follow-up.
genital and contemporaneous subjective arousal as an outcome
Coefficient SE t ratio p
VPA(T) ? SA(T)
Low HC 1.76 0.20 8.94 \.001
High HC 2.79 0.36 2.83 .006
Low HC 1.45 0.14 10.46 \.001
High HC 2.50 0.33 3.22 .002
Low HC 0.94 0.23 4.16 \.001
High HC 1.57 0.38 1.67 .10
Low HC 0.59 0.12 5.06 \.001
High HC 1.14 0.26 2.13 .04
VPA vaginal pulse amplitude (genital arousal), SA subjective arousal, HC
arousal, anxiety, and vaginal pulse amplitude (VPA) from neutral to erotic films at pre-treatment, post-treatment, and follow-up
Pre-treatment Post-treatment Follow-up
Neutral Erotic Neutral Erotic Neutral Erotic
Subjective arousal 2.91 1.14*** 4.27 1.41 3.04 1.19*** 4.47 1.30 2.97 1.10*** 4.32 1.34
Perception of genital arousal 1.45 0.58*** 2.80 1.31 1.51 0.66*** 2.93 1.36 1.46 0.59*** 2.83 1.29
Positive affect 1.71 0.64*** 2.49 1.41 1.63 0.66*** 2.57 1.46 1.54 0.53*** 2.57 1.38
Negative affect 1.38 0.44*** 1.52 0.57 1.26 0.36*** 1.40 0.50 1.28 0.35*** 1.43 0.53
Autonomic arousal 1.58 0.54*** 2.25 0.92 1.56 0.62*** 2.37 1.00 1.52 0.61*** 2.35 0.96
Anxiety 2.06 1.08** 1.66 1.19 1.68 0.87** 1.39 0.90 1.59 0.81 1.41 0.84
VPA (mV) .044 .063* .058 .037 .043 .063** .063 .029 .044 0.67* .060 .043
Data represent means and SD
* p\.05, ** p\.01, *** p\.0001 paired samples t test from Neutral to Erotic conditions. All variables, except VPA, have a 1–7 range
1916 Arch Sex Behav (2016) 45:1907–1921
We examined the effects of a group mindfulness-based sex
therapy on concordance between genital and subjective sexual
and/or arousal using a series of hierarchical linear models, first
with subjective arousal predicting genital response and then the
reverse. We found evidence of significant sexual concordance at
all time points, with subjective arousal predicting contempora-
neous genital arousal, and significant increases from pre- to post-
treatment, such that there was less change in genital arousal
associated with the same level of subjective arousal, suggesting
greater coherence between these two aspects of the sexual res-
predicted significant increases in subjective arousal contempo-
sexual concordance as a function of treatment. Within-subjects
correlations revealed the magnitude of the association (between
tive sexual response rather than genital response.
Interestingly, although the erotic film significantly increased
each time point, there was no significant effect of treatment on
gesting that the change in sexual concordance following treat-
ment was not a straightforward consequence of increases in self-
reported or genital response. Clifton et al. (2015) also found
passionate-romantic scores showing higher genital-subjective
concordance, despite no significant association between individ-
ual predictors and genital or subjective sexual response sepa-
be more in tune with their body’s physiological responses to sex-
ual stimuli, even though the magnitude of their actual physio-
logical or subjective sexual response is no different from women
of mindfulness treatment on concordance (compared to pre-
treatment levels) but not on genital or subjective sexual response
separately, suggesting that treatment may have contributed to
women’s capacity to detect and integrate their experience of
FSAD diagnostic status and FSFI lubrication and arousal
at any of the time points. This was a surprising result, given both
clinical domains improved after treatment (Brotto & Basson,
2014), and other research has notedrelationships between sexual
functioning and sexual concordance in healthy women (Brody
et al., 2003) andin women with sexual difficulties(Chivers et al.,
2010). Our findings suggest, perhaps, that sexual concordance
and self-reported clinical symptoms of (low) desire and sexual
distress reflect different, unrelated aspects of the female sexual
response, accounting for their lack of significant association.
up. This suggests that recommended daily at-home mindful-
affect and well-being, but not with indices of medical health
were assignedbygroupfacilitators;therefore,future studies
could haveparticipantsmonitor amountofat-home practiceto
correlate mindfulness practice with changes in outcomes.
Sexual Concordance as a Potential Study Endpoint?
Our findings suggest that skills aimed at enhancing a woman’s
concentration training and compassionate self-acceptance may
be associated with greater integration of physical and mental
sexual responses to erotic stimuli in a laboratory setting. Con-
sidered in the context of prior research showing similar effects of
attention training on sexual arousal (Meston, Rellini, & Telch,
2008), and the specificity of mindfulness interventions (versus
cognitive behavioral sex therapy) on changes in sexual concor-
dance (Brotto et al., 2012b), we propose that sexual concordance
be overlooked when examining only self-reported or psychophysi-
support for the possibility of sexual concordance being a more
relevant and sensitive study endpoint.
Arch Sex Behav (2016) 45:1907–1921 1917
Mechanisms of Action
The direction of concordance effects, with subjective arousal
suggests that mechanisms underlying change in sexual concor-
dance are predominantly, as expected, top-down, as opposed to
ferent foci—whether the breath, body, sounds, or thoughts—this
may have translated into an improved ability to detect sensations
stimuli in women following mindfulness training. Given that the
insular cortex mediates interoceptive ability (Critchley, Wiens,
the various mindfulness exercises contributed to the improved
concordance between genital and subjective arousal.
Because sexual concordance was not significantly different
with treatment when genital arousal predicted subjective sexual
arousal, this suggests that it was unlikely that genital sensations
which then drove an increase in concordance. A top-down mecha-
moment-by-moment sensations over the course of treatment,
In addition to mindfulness practice increasing awareness of
visceral (and likely genital) cues, current models of the mecha-
response withoutattemptingtoalter them.Teperetal.surmised
during sexual encounters may significantly predict sexual diffi-
thereby tune into and accept their visceral sensations.
treatment included a combination of (primarily) mindfulness exer-
benefits were due to one specific component of treatment or to
concordance and the orgasm domain given the large proportion
we limited the upper age to 65 in recognition of the large hetero-
women with sexual desire complaints.
sexual concordance and sexual functioning was limited by
examining these relationships in a clinical sample only, such that
range restriction in sexual functioning may have hampered the
considerable variability in the range of concordance estimates
Also, in the absence of a no-treatment control group, the magni-
tude of any change in subjective or genital sexual response with
treatment cannot be established and should be the focus of future
To examine whether sexual concordance changed during two
pre-treatment assessments before treatment was administered,
the erotic film segment were analyzed for 25 women who
tions were calculated, then statistically compared using a depen-
dent samples t test. There was no significant difference between
the concordance estimates at the two pre-treatment assessment
points (data not shown), suggesting that the repeated assessment
1918 Arch Sex Behav (2016) 45:1907–1921
of concordance does not significantly impact the concordance
estimates themselves. Furthermore, this finding strengthens our
conclusion that the increases in sexual concordance observed
with treatment are not likely attributable to the passage of time.
The incentive motivation model (Both, Everaerd, & Laan, 2007)
previously, sexual desire and arousal were viewed as distinct and
sequential phasesof sexual response (Masters & Johnson, 1966).
and positive appraisal of physiological response may be integral
as a study endpoint may be fruitful for disambiguating the long-
debated relationship between sexual arousal and desire.
Overall, the present findings contribute to an emerging liter-
ature supporting the clinical application of mindfulness for the
treatment of sexual dysfunction in women (Brotto, 2013; Brotto
& Goldmeier, 2015). Given women’s frequent claims of‘‘feel-
data suggest that mindfulness may improve the integration
study did not identify individual differences predicting treat-
inconcordanceestimates across participants suggests that future
research could identify characteristicsassociated with treatment
ever medication for the treatment of women’s sexual desire (fli-
identifying individual patient characteristics predictive of a
positive response to treatment such that therapies (whether psy-
chological or pharmacological) can be individually tailored to
Acknowledgments The authors wish to thank Yvonne Erskine for
Compliance with Ethical Standards
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- Mindfulness-Based Sex Therapy Improves Genital-Subjective Arousal Concordance in Women With Sexual Desire/Arousal Difficulties
Assessment of Psychophysiological Sexual Arousal
Contemporaneous Assessment of Subjective Sexual Arousal
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Association Between Sexual Concordance and Clinical Symptoms Using the Sexual Interest/Desire Inventory and the Female Sexual Distress Scale (Hypothesis 3)
Sexual Concordance as a Potential Study Endpoint?
Mechanisms of Action
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A literature review of forgiveness as a beneficial
intervention to increase relationship satisfaction
in couples therapy
Ross A. Aalgaard, Rebecca M. Bolen & William R. Nugent
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literature review of forgiveness as a beneficial intervention to increase relationship satisfaction
in couples therapy, Journal of Human Behavior in the Social Environment, 26:1, 46-55, DOI:
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A literature review of forgiveness as a beneficial intervention to
increase relationship satisfaction in couples therapy
Ross A. Aalgaard, Rebecca M. Bolen, and William R. Nugent
College of Social Work, University of Tennessee, Knoxville, Tennessee, USA
Forgiveness between couples is identified as a strong predictor of relation-
ship satisfaction. Yet forgiveness is often overlooked as a potential inter-
vention to help couples increase their relational satisfaction. The purpose of
this literature review is to examine the use of forgiveness as a therapeutic
intervention to increase relational satisfaction for opposite- and same-sex
couple dyads. Forgiveness is also introduced as an effective component of
marital interventions in the context of infidelity. Specific areas that are
addressed within this article include forgiving personalities, which benefits
stress and health, forgiveness affecting marital and family functioning,
forgiveness and relationship satisfaction with mediating mechanisms, and
limitations of forgiveness interventions.
for practice are
forgiveness; marital conflict;
Exploring relationships that are compromised by interpersonal conflicts and transgressions offers
opportunities to examine forgiveness as an effective therapeutic component for enhancing relational
satisfaction. Paleari, Regalia, and Fincham (2009) described three pathways in which people offer
forgiveness to others. Offense-specific forgiveness is a particular forgiving act for a precise offense
within a defined interpersonal framework. Dyadic forgiveness is the inclination to forgive one’s
partner for numerous offenses. Trait forgiveness relates to the comprehensive disposition of a person
who has the tendency to forgive individuals for offenses across multiple circumstances, including
interpersonal situations that involve a variety of relationships. Despite the pathway that forgiveness
is derived, Maio, Thomas, Fincham, and Carnelley (2008) note the process of forgiveness encom-
passes consciously moving away “from negative thoughts, feelings, and behaviors toward the
transgressor to more positive thoughts, feelings, and behaviors” (p. 307).
Considering the different contexts in which forgiveness occurs, Gordon, Burton, and Porter
(2004) explored whether the concept of forgiveness among women experiencing domestic violence
is truly forgiveness or a conscious rationalization to help them move on. Their results showed that
“The less women interpreted their partner’s behavior as malicious and intentional, the more likely
they were willing to forgive the behavior and consider continuing the relationship” (p. 336). Since
forgiveness should never be used to excuse endangering or harmful behaviour, clinicians may
identify times within couples’ therapy to explore clients’ interpretations of their partners’ behavior
and address enabling responses (e.g., forgiveness) to help maintain their safety.
If forgiveness however can offer longevity, health, and healing within relationships, then adding
this component to assist couples with enhancing their relationship satisfaction and maintaining their
marriage is worthy for consideration. The purpose of this literature review is to examine current
evidence related to the effectiveness of forgiveness as a therapeutic intervention to increase relational
satisfaction for opposite- and same-sex couple dyads. Additionally, forgiveness is introduced as a
CONTACT Ross A. Aalgaard email@example.com Minnesota State University, Mankato, TN358 Trafton Science Center
North, Mankato, MN 56001-6055, USA.
© 2015 Taylor & Francis
JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT
2016, VOL. 26, NO. 1, 46–55
component of marital interventions in the context of infidelity, which supports the concept of
forgiveness as a cornerstone of relationship success (Baucom, Gordon, Snyder, Atkins, &
Christensen, 2006). This literature review does not address forgiveness within relational contexts
that involve threatening behavior or domestic violence.
A database search for peer-reviewed articles was conducted using PsycARTICLES, PsycINFO, Social
s, Sociological Abstracts, ERIC, and Campbell Collaboration. Keywords used for the
search included couple*, therapy OR counseling OR intervention, forgiveness, and satisfaction. The
search was limited to articles from 2001 to 2013. A distinction was made between forgiveness as a
religious concept and as a therapy intervention. Titles and abstracts were reviewed for forgiveness
and relational/relationship/marital satisfaction. The three terms for the types of satisfaction were
considered interchangeable in this search. Articles that did not identify one of the three types of
satisfaction were excluded. The articles found were than reviewed to ensure that relational satisfac-
tion was an outcome and forgiveness as an intervention was discussed. After applying inclusion and
exclusion criteria four papers qualified for review.
Forgiveness, relationship quality, stress, imagination, and physical and mental health
Berry and Worthington (2001) studied 19 undergraduate men and 20 undergraduate women ranging
in age from 18 to 42 years old (M = 22.9) who were attending a mid-Atlantic urban state university.
The sexual orientation of the participants was not identified. Students were initially recruited
through posted announcements on campus and information shared in class to let potential partici-
pants self-select themselves for consideration. Without knowing the nature of the study or the
inclusion criteria for involvement, potential participants were asked to fill out a screening form that
included questions regarding demographics, information about current or recent romantic relation-
ships, and a measurement to detect happiness. To qualify for the study, potential participants had to
endorse that they had been in a relationship for at least 6 months and provide responses to questions
related to their romantic relationships. If someone’s relationship had ended, he or she could still
qualify provided his or her relationship had lasted at least 6 months and ended no more than 3
months prior to the study. To assess the health impact, participants also had to agree to have their
cortisol levels tested and blood samples drawn. Researchers later decided to abandon the blood
samples and refocus the study on the detection of relationship stress through salivary cortisol
because of time constraints.
A nurse collected baseline saliva cortisol samples by having participants chew a cotton swab from
a salivette kit for one minute. The samples of saliva on the swabs were then stored in a freezer.
Participants next engaged in an imagery activity that involved imagining a typical scene that was
common to their relationship they had with their partners. They were instructed to consider as many
details as possible and to reexperience the feelings that emerged as strongly as possible for 5 minutes.
The time between baseline saliva samplings and postimagery samples varied from 5 to 40 minutes
(Berry & Worthington, 2001).
Participants also completed several standardized tools to fulfill the study. The Trait Anger Scale
(Spielberger, Jacobs, Russell, & Crane, 1983) was administered to measure anger as a personality
disposition of participants. The Transgression Narrative Test of Forgiveness (α = .82), (Berry,
Worthington, Parrott, O’Connor, & Wade, 2001) was used to assess the ability to forgive transgres-
sions across situations and over time. The Trait Unforgiveness-Forgiveness Scale (α = .89) (Berry &
Worthington, 2001) was given to assess the disposition to forgive of participants. The Dyadic
Adjustment Scale (α = .98) (Spanier, 1976) was used to measure relationship adjustment. The Love
JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 47
Scale (α = .96) and Liking Scale (α = .98) (Rubin, 1970) were utilized to measure the participants’
current attitudes about the relationship partner. The Relationship Imagery Questionnaire (α = .83)
from the Vividness of Visual Imagery Questionnaire (Marks, 1973) captured how vividly respondents
imagined their relationship interactions.
The study by Berry and Worthington (2001) confirmed that trait anger and dispositional
forgiveness personality predicted the quality of close relationships and impacted a person’s mental
and physical health. Subjects who were asked to imagine past transgressions by a partner that had
not been forgiven increased cortisol levels, which supports a stress-related response. The hypothesis
that an intimate relationship of poor quality is associated with physiological stress was supported,
because higher cortisol reactivity was associated with poorer quality of relationship. The research
results further supported that individuals who had more dispositional forgiveness had a higher
quality of romantic relationship.
Researchers have concluded that the personality traits of being forgiving or unforgiving predicted
both physical and mental health (Berry & Worthington, 2001; Thoresen, Harris, & Luskin, 2000;
Williams, 1989). Although forgiving personality and loving relationship did not predict cortisol
reactivity, Berry and Worthington (2001) stated, “Statistically, the results could suggest that a loving
relationship affects cortisol reactivity indirectly through affecting a forgiving personality” (p. 452).
The explanation given for this was that personalities predate relationships. The study provided
support linking one’s better health outcomes with better quality of close relationships and with more
forgiving personality traits. The reverse was not supported, because those with chronic relationship
stress did not have poorer health outcomes.
Berry and Worthington (2001) identified three limitations of this study: the assumption that a
brief imagery task can produce the same stress response as an ongoing relationship, the varied time
intervals for collecting the cortisol samples, and the small participant sample size. Although the
researchers made adjustments for the varied time intervals when determining the cortisol reactivity
results, a standardized approach would have made this a stronger study. In addition, the use of a
convenience sample does not allow for generalization of conclusions beyond the study.
Potential costs to forgiveness
McNulty (2008) investigated the effects of heterosexual spouses’ tendencies to forgive their partners
in a longitudinal study of 72 couples over a 2-year period. The newlywed couples who participated
had been married an average of 3.2 months. McNulty hypothesized that forgiveness could have long-
term costs. The research found forgiveness having long-term costs when moderated by the role of
negativity and the context in which the forgiveness occurred, including the frequency of the spouse’s
offenses. He also hypothesized that greater forgiveness among couples would be related to more
stable marital outcomes and satisfaction in marriages where negative verbal behavior is reduced.
Couples were mailed a questionnaire packet with a letter asking each partner to complete them
independently. The completed surveys were taken to a laboratory meeting where couples partici-
pated in two 10-minute videotaped discussions designed to assess the frequency of negative verbal
behavior. One was a private taping of each spouse identifying what she or he considered the source
of tension in the marriage. The other recording was of the couple together working out a resolution
or agreement about the previously acknowledged cause of tension. Each videotaped discussion was
coded for observed behaviors by trained raters. Following the initial evaluation, couples continued to
complete questionnaires every 6 months over 2 years to assess marital satisfaction and problems
Couples completed the following inventories regarding marital satisfaction and marital problems
(McNulty, 2008). Assessment of marital satisfaction was conducted using the Quality Marriage Index
(Norton, 1983). The internal consistency ranged from .93 to .96 for husbands and .94 to .95 for wives
over the four phases. Marital forgiveness was measured using Transgression Narrative Test of
Forgiveness (α = .89 for husbands and α = .86 for wives) (Berry et al., 2001). The spouses’ negative
48 R. A. AALGAARD ET AL.
verbal behaviors were measured using the Verbal Aggression Subscale of Form N of the Conflict
Tactics Survey (CTS) (α =.84 for husbands and α = .84 for wives) (Straus, 1979). Trained observers
used the Verbal Tactics Coding Scheme (Sillars, Coletti, Parry, & Rogers, 1982), which is defined to
have adequate reliability, for the recorded videos.
McNulty (2008) found that spouses who reported being more forgiving were happier in their
relationships, had less severe problems, and behaved less negatively. Over time however, wives
became significantly less satisfied in their marriages. Results showed that wives perceived relation-
ship problems as more severe while husbands viewed relationship problems as having no significant
change. Within this study, gender influenced relationship satisfaction.
McNulty’s (2008) study results further revealed that increased forgiveness by spouses for partners
who engaged in reduced negative behavior was beneficial over time but less forgiveness was harmful
to the relationship. For spouses married to partners who often enacted negative behavior without
reduction, increased forgiveness became harmful to the relationship, and the quality of the relation-
ship deteriorated over time. Conversely, decreased forgiveness for those who frequently enacted
negative behavior was beneficial over time. Finally, relatively healthy marriages experienced more
positive benefits than troubled relationships from the effects of forgiveness.
McNulty (2008) suggested that an intervention that includes forgiveness might help bring
relationship stability over time for benevolent partners. However, these findings question whether
forgiveness interventions in high-conflict marriages will have positive outcomes, especially in light of
the potential for forgiveness to cause a decline in marital satisfaction over time.
Although researchers used a longitudinal design, the study was limited by the use of a conve-
nience sample (McNulty, 2008). Still, these research results provide some evidence for adding
forgiveness interventions as a component to couples therapy. Future research should investigate
the effects of incorporating forgiveness interventions with same same-sex couples.
Forgiveness in marital and family functioning
Gordon, Hughes, Tomcik, Dixon, and Litzinger (2009) examined the role of forgiveness in marital
and family functioning by utilizing a cross-sectional study that was conducted as part of a larger,
longitudinal study on relational family functioning. Emphasis was placed on “devastating relational
conflicts” such as “infidelities, major lies, drastic unilateral financial decisions, and other similar
humiliations and betrayals,” which often have long-term negative effects on marital functioning (p.
1). Forgiveness was conceptualized as two constructs—negative forgiveness and positive forgiveness.
Negative forgiveness was defined by grudges, withdrawal or avoidance, and the desire for revenge or
punishment toward the betraying partner. Positive forgiveness was delineated as the readiness to
forgive, increased empathy, greater dyadic trust, and release of anger. Both negative and positive
forgiveness were examined for the impact they have on couples’ relationships and how they affect
elements of both dyadic and family functioning (Gordon et al., 2009).
Gordon et al. (2009) hypothesized that couples’ self-report of relationship satisfaction would
increase, with both more positive forgiveness and less negative forgiveness occurring within the
relationship. Going beyond the couples’ intimate relationship, the parenting alliance was predicted to
become stronger when more positive forgiveness occurred. Finally, it was expected that marital
conflict would be related to more negative child functioning. Therefore, reports by the parents of
more positive forgiveness and less negative forgiveness were anticipated to coincide with the
children’s reports of less negative interactions and less familial threats.
Participants were recruited from mailing lists of families in the researchers’ community and were
contacted by phone to determine interest for involvement. To qualify for inclusion one member of
each couple had to report a betrayal, as defined by the participants, in the relationship and that the
couple had a child in the home from ages 11 to 16. Packets including the measurement tools, consent
forms, and a cover letter asking for surveys to be completed independently were mailed to a group of
111 married couples and their children. Separate envelopes were made available for husbands, wives,
JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 49
and children. Only fully completed materials that were returned qualified for the study. The final
total sample included 91 couples and youth. Couples averaged 16 years of marriage and 2.6 children.
Nine families were blended families. Eighty-seven wives and 74 husbands reported a betrayal
(Gordon et al., 2009). The Forgiveness Inventory (Gordon & Baucom, 2003) was used to measure
both positive and negative forgiveness. The alpha coefficient on the negative forgiveness subscale was
.91 for women and .87 for men. The alpha coefficient for the positive forgiveness subscale was .84 for
women and .87 for men (Gordon et al., 2009).
Gordon et al. (2009) found that both husbands and wives reported that greater negative forgive-
ness predicted poorer perception of marital satisfaction. The subjects’ perception of their relation-
ship remained the same when marital conflict and dyadic trust variables were evaluated. Husbands
and wives that reported greater positive forgiveness predicted their own perceptions of the higher
quality of the parenting alliance. Further, husbands’ greater positive forgiveness predicted their
perception of greater dyadic trust, whereas the husbands and wives’ greater negative forgiveness
predicted their reports of greater conflict behaviors and lesser dyadic trust levels. When dyadic
conflict was controlled, both husbands’ and wives’ reports of greater negative forgiveness predicted
their perceptions of poorer marital satisfaction, with dyadic trust and conflict behaviors partially
mediating the relationships. These results support the possibility that failing to resolve betrayals may
impact a couple’s relational functioning and, in turn, lower relationship satisfaction.
Gender differences were found within this study. For wives, greater negative forgiveness predicted
their perceptions of poorer marital satisfaction, greater trust, and greater conflict behaviors. The
husbands’ patterns were slightly different, but only for greater dyadic trust, which was also predicted
by greater positive forgiveness. In separate analyses, wives and husbands’ greater negative forgiveness
predicted their children’s views of greater parental conflict but only when forgiveness dimensions
were the only variables entered into the regression. When wives’ forgiveness was entered together
with the husbands’ reports of marital conflict and parental alliance, only the husbands’ reports of
greater conflict predicted the children’s perceptions of marital conflict. When the husbands’ for-
giveness was entered together with the wives’ reports of marital conflict and parental alliance, only
the wives’ reports of marital conflict and the parental alliance were significant. Wives’ report of
greater conflict and a worse parental alliance were related to children’s reports of greater marital
conflict (Gordon et al., 2009).
In cross-spousal reports, the husbands’ greater negative forgiveness was mediated as a strong
predictor of their wives’ reports of poorer parenting alliances, and the wives’ greater negative
forgiveness strongly predicted their husbands’ reports of poor parenting alliances. Further, wives’
lesser negative forgiveness predicted the husbands’ greater relational satisfaction, and husbands’
lesser negative forgiveness predicted the wives’ greater relational satisfaction. For both wives and
husbands, their greater negative forgiveness predicted the opposite partner’s reports of marital
conflict (Gordon et al., 2009).
One concern with these results is that wives’ positive and negative forgiveness were strongly
correlated, as was the wives’ and husbands’ negative forgiveness, suggesting that multicollinearity
might be a concern in certain analyses. Further examination however found that multicollinearity
diagnostics did not suggest a problem (Gordon et al., 2009). Further research needs to be conducted
to explore the role of positive forgiveness in women’s relational functioning.
Because this study is cross-sectional (Gordon et al., 2009), findings cannot be taken to suggest
direction of effect. A longitudinal study should be conducted to see if these findings can be replicated
and to determine direction of effect and causality. Since no comparison group of couples with low or
no betrayal was included, it is not clear whether these findings are specific only to couples in which
one member committed a significant betrayal. This study was also limited geographically, and the
data were collected from a convenience sample indicating that findings cannot be generalized. Since
these results were based on self-report measures they need to be interpreted cautiously. Notably,
however, previous research results does support the findings of this study and adds support to the
importance of adding a forgiveness component as a therapeutic intervention with couples.
50 R. A. AALGAARD ET AL.
In summary, forgiveness of major betrayals by a spouse was significantly related to marital
satisfaction, the parenting alliance, and to children’s perceptions of marital functioning (Gordon
et al., 2009). In addition, gender differences may exist in areas such as conflict behaviors and
relationship trust. These gender differences need further examination not only with heterosexuals,
but also with same-sex couples. If these findings continue to be replicated, they will lend support for
using forgiveness as an intervention within family therapy as well as with couples.
Forgiveness and relationship satisfaction
More recently, Braithwaite, Selby, and Fincham (2011) studied the mediating mechanisms of the
pathway between trait forgiveness and relationship satisfaction. They conceptualized forgiveness as
promoting not only a reduction in negative responses but also “increased goodwill toward the
transgressor” (p. 551). They also considered possible mediators between trait forgiveness and
relationship satisfaction, specifically interpersonal conflict and self-regulation. Important interperso-
nal conflict tactics examined were positive communication, negative communication, and physical
assault. “Altering behavior to inhibit a dominant response, usually in the service of longer term
goals” was the definition used for self-regulation (p. 552). They believed that relationship satisfaction
was improved by relationship efforts to reduce problematic conflict patterns.
Braithwaite et al. (2011) completed two studies. The first study included 523 young adult
participants who reported they were currently in a committed romantic relationship. This sample
was part of a larger study being conducted in a university introductory family studies course. The
second study gathered data from 446 young people who were followed for 2 months to evaluate the
relationships among forgiveness, conflict tactics, relationship effort, and relationship satisfaction.
The potential role of commitment was also included.
The researchers utilized a number of measures to assess the primary constructs of the studies
(Braithwaite et al., 2011). Within the first study, trait forgiveness (i.e., the tendency to forgive) was
captured using a four-item scale of dispositional or trait forgiveness with an alpha of .66 (Brown,
2003). In Study 2, the nine-item forgiveness tool had a consistent alpha of .85 over an 8-week test-
retest period of time. The CTS-2 (Revised Conflict Tactics Scales) (Straus, Hamby, Boney-McCoy, &
Sugarman, 1996) was used to capture how couples resolved conflict and how much an individual
works at their relationship by regulating behavior to improve the relationship quality. The CTS-2 had
an alpha score of .94 in Study 1 and an alpha score of .84 in Study 2. Other constructs captured were
constructive communication patterns with the Communication Patterns Questionnaire (Heavey,
Larson, Zumtobel, & Christensen, 1996), self-regulation with the Behavioral Self-Regulation for
Effective Relationships Scale—Effort Scale (Wilson, Charker, Lizzio, Halford, & Kimlin, 2005),
relationship satisfaction with the Couples Satisfaction Index (Funk & Rogge, 2007), and the desire
to persist in spite of obstacles in a romantic relationship (Finkel, Rusbult, Kumashiro, & Hannon,
2002). All alpha scores ranged between .80 and .94 (Braithwaite et al., 2011).
The first study (Braithwaite et al., 2011) collected data from participants through online surveys.
Forgiveness was not directly related to relationship satisfaction but was related to increased beha-
vioral self-regulation and decreased negative interpersonal behaviors, which were in turn related to
relationship satisfaction in the expected directions. Thus, these mediating relationships were sup-
ported. Because the first study could not establish causality, the variable of commitment to the
relationship was not included, and the relationships between forgiveness and the other variables were
small a second study was conducted.
For Study 2 Braithwaite et al. (2011), followed the same procedures that were conducted in the
first study with the exception of adding a second time period 2 months after the first. The
researchers designed and utilized a nine item, six-point scale measure on forgiveness which had a
consistent alpha score of .85 and strengthened construct validity and increased confidence in the
observed findings. This measure operationalized forgiveness by assessing respondents’ avoidance,
benevolence, and retaliation, unlike the first study, which compared vengeance and neuroticism,
JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 51
dispositional forgiveness, perspective taking, and agreeableness. Stanley and Markman’s (1992) four-
item scale to assess the desire to persist in romantic relationships despite obstacles was used to
determine commitment. Braithwaite et al. (2011) extended the findings of the first study by revealing
a longitudinal relationship between forgiveness with correlations of self-regulation and negative
interpersonal tactics mediating relationship satisfaction and forgiveness. The tendency to forgive
related to later relationship satisfaction. Limitations of the second study included the use of a
convenience sample and not having a control group.
This literature review examined the effectiveness of forgiveness as an intervention and the correla-
tion between forgiveness and relationship satisfaction. Berry and Worthington (2001); Braithwaite
et al. (2011); Gordon et al. (2009); and McNulty (2008) all concluded that forgiveness offers a way of
dealing with a transgression and is related to a positive relational outcome. Braithwaite and
colleagues (2011) described that “Forgiveness seems to short circuit the use of negative conflict
strategies allowing the couple to exit from the negative reciprocity cycle that leads to distressed
relationships” (p. 557). Relationship effort was found to strongly improve relationship satisfaction
(Braithwaite et al., 2011). Relationship satisfaction was related to the reduction of negative inter-
personal behaviors and an increase in the use of self-regulation. Relational effort was also related to
increases in relationship satisfaction (Braithwaite et al., 2011). McNulty (2008) found that forgive-
ness benefited healthy relationships rather than troubled ones.
McNulty (2008) cautions that using forgiveness as part of an intervention is not beneficial for
all relationships, but there is evidence that it can be positive for couples who have experienced
minor transgressions and major betrayals between them (Braithwaite et al., 2011; Gordon et al.,
2009). Having unresolved betrayal lingering within a relationship hinders relational satisfaction
(Gordon et al., 2009). Therefore, when conflict occurs between couples in therapy, it may be
wise to explore if any previous unresolved betrayals exist. If betrayal is acknowledged, therapists
should explore forgiveness as an intervention to increase relational quality for couples because
forgiveness appears to help couples move forward and enhance their relationships.
On the other hand, when forgiveness is constantly given to a partner without any evidence of a
reduction of negative behavior, it may become detrimental to the relationship (McNulty, 2008). This
may be one reason relationship effort mediates the role of forgiveness in relationship satisfaction
(Braithwaite et al., 2011). The effort by both partners to change can bring about positive enhance-
ment to a relationship. However, when only one person makes such an investment, the likelihood of
relational success is reduced (McNulty, 2008). Nonetheless, research evidence shows when an effort
is made by one partner to reduce negative behavior and act more kindly, the other partner often
reciprocates (Braithwaite et al., 2011).
These examined studies further indicate that individuals with more forgiving tendencies (i.e.,
traits) are more likely to self-regulate and set a goal of improving their relationship (Braithwaite
et al., 2011; Berry & Worthington, 2001). In addition, they are more likely to inhibit behavior
that would damage their relationship and more likely to abandon negative interpersonal strate-
gies such as hitting, berating, and avoiding their partners. Braithwaite and colleagues (2011)
suggest that trait forgiveness is primary to motivational transformation, which is defined as
being operational in repressing negative instincts and enhancing positive action. To use forgive-
ness as a way to increase relationship satisfaction for couples, counselors can encourage clients
to repress negative instincts and instead behave positively toward their partner.
Forgiveness interventions in couples counseling are currently available, specifically in the area of
marital infidelity (Baucom et al., 2006). For less severe transgressions, or when couples therapy is at a
52 R. A. AALGAARD ET AL.
stalemate, a psychoeducation component on forgiveness could be introduced (Braithwaite et al.,
2011). This is especially relevant for correcting misconceptions about forgiveness (e.g., that forgive-
ness is a sign of weakness or an excuse for bad behavior). Braithwaite et al. (2011) advocated for
providing a psychoeducational approach to assist couples with forgiveness and work toward
increased relationship satisfaction. Evidence-based research, however, still needs to determine the
effectiveness of psychoeducation.
Berry and Worthington (2001), Gordon et al. (2009), and Braithwaite et al. (2011) all supported
including forgiveness as an intervention in couples counseling. Berry and Worthington (2001)
suggested addressing stress-related health conditions due to relationship distress, as well as the
positive effect of forgiveness on relationship quality. They suggested that counselors use modeling
and encouragement to advance forgiveness for clients who may be inclined not to forgive. Gordon
and colleagues (2009) pointed out that Emotionally Focused Therapy (Makinen & Johnson, 2006)
addresses past attachment issues and includes a forgiveness component to help couples with
current problems. Braithwaite et al. (2011) also discussed a cognitive-behavioral and insight-
oriented marital intervention by Baucom et al. (2006) that uses forgiveness as a technique for
couples experiencing the substantial distress of infidelity. This intervention guides couples through
a change of understanding for the reason the infidelity occurred and creates a new meaning for the
Other psychotherapy methodologies have been advocated for as potential approaches for advan-
cing forgiveness with couples in treatment. These methodologies include the aforementioned
Emotionally-Focused Therapy (Makinen & Johnson, 2006), Bowenian Therapy, and mindfulness
or acceptance-based approaches to therapy (Sandage & Jankowski, 2010). Carson, Carson, Gil, and
Baucom (2004) studied a mindfulness-based relationship enhancement approach. The research
found that relationship satisfaction increased through the use of mindfulness techniques with
relatively happy, nondistressed couples. The participants benefited by enhancing current relationship
functioning and improving personal well-being.
A limitation of this study is the small number of research studies reviewed. To strengthen future
literature reviews, the search criteria need to include evidence-based forgiveness interventions and
the date parameters of the search should be expanded. Two limitations that were identified across all
the studies reviewed included the use of convenience samples and the lack of comparison groups.
These methodological issues lower the level of confidence in their findings, and they do not allow for
generalization of findings.
Forgiveness appears to enrich close intimate relationships, personal health, and well-being (Berry
& Worthington, 2001). Although helpful in supporting the benefits of forgiveness within relation-
ships, this study’s search did not find any studies that tested an intervention that included forgive-
ness as a component, nor did the search locate any forgiveness therapies that provided an increase in
relationship satisfaction as an outcome. Thus, this research reveals that there is a gap in the literature
regarding the value, utility, efficacy, and effectiveness of using forgiveness as an intervention with
couples to increase relational satisfaction.
Additionally future research needs to be conducted within clinical settings with couples utilizing
forgiveness as a component of the intervention. The creation of new interventions that includes
forgiveness as part of the treatment process for couples is also needed. Evidence-based practice
theories, such as cognitive-behavioral therapy, mindfulness, or acceptance-based therapies, may be
conducive to developing and implementing a forgiveness component to an intervention with a goal
of facilitating increased relationship satisfaction for couples.
Finally, researchers conducting studies on couples therapy need to include both heterosexual and
same-sex couples within their samples. Considering marriage equality advancing in the United
States, gay and lesbian couples need to be included as participants in the research regarding
JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 53
forgiveness and marital satisfaction. Same-sex couples were blatantly absent in the papers reviewed.
By comparing the effects of forgiveness interventions on opposite-sex relationships, lesbian relation-
ships, and gay relationships, counselors can become more culturally sensitive in their practice. With
the prominent changes our society is encountering, helping couples that are beginning newly defined
relationships is an important step forward.
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Forgiveness, relationship quality, stress, imagination, and physical and mental health
Potential costs to forgiveness
Forgiveness in marital and family functioning
Forgiveness and relationship satisfaction