Applying Bowenian And Structural Theories

Theory-based treatment planning, the type you will use throughout this course, is informed and guided by your theoretical orientation. Incorporating your theoretical orientation into treatment planning will help you set goals and choose treatment techniques and interventions appropriate for the client(s) you serve (Gehart & Tuttle, 2003). This week, you apply two counseling theories, Bowenian and structural, to formulate your treatment planning and apply appropriate interventions.

In this Assignment, you watch videos of counselors demonstrating the use of Bowenian and structural theories in family counseling. You then formulate treatment plans for the couples and/or families in the videos, applying the theories in question and justifying the use of appropriate interventions.

The Assignment (2–3 pages)+treatment plan

Based on the theory demonstrated in both videos:

  • Define the problem in each video.
  • Create a theory-based treatment plan, including short- and long-term goals for the couples and/or families.
  • Explain two theory-based interventions you would use and justify your selection.
  • Explain one anticipated outcome of each theory-based intervention.

Support your Assignment with specific references to all resources used in its preparation. You are asked to provide a reference list for all resources, including those in the resources for this course.

https://waldenu.kanopy.com/video/structural-family-therapy

https://waldenu.kanopy.com/video/bowenian-family-therapy

The relationship between family-of-origin experiences and sexual satisfaction in married couples

James G. Strait,a Jonathan G. Sandberg,bc Jeffry H. Larsonc and James M. Harperb

This study examined the relationship between perceptions of family-of- origin experiences, sexual satisfaction and marital quality. The sample consisted of 3953 married couples who responded to the relationship evaluation. The results showed that more positive overall family-of-origin experiences and parent–child relationships were related to higher sexual satisfaction. Overall, family-of-origin experiences and parent–child rela- tionships were predictive of higher sexual satisfaction; however, that relationship was significantly mediated by marital quality. There was a strong positive relationship between marital quality and sexual satisfac- tion. No major gender differences emerged from the findings. The results suggest that family-of-origin experiences play a key role in the sexual satisfaction of married couples, especially when mediated by marital quality, and should be considered in treatment, education and research.

Introduction

Sexual satisfaction in couple relationships has become an increas- ingly important topic in therapy (Frieze, 2004; Hawton, 1992; Hertlein et al., 2009). Despite changes in societal attitudes and open- ness over sexuality, there is little known about how family-of-origin relationship experiences impact upon sexual satisfaction in adult- hood. This study sought to shed light on the relationship between family-of-origin experiences and sexual satisfaction in an effort to educate clinicians on the intersection of two central topics in couples’ therapy.

a Marriage and Family Therapy Programs, Brigham Young University b School of Family Life, Brigham Young University and 266 John Taylor Building

(Comprehensive Clinic), Brigham Young University, Provo, UT, 84602, USA, e-mail: jonathan_sandberg@byu.edu

c Professor, School of Family Life, Brigham Young University

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Journal of Family Therapy (2015) 37: 361–385 doi: 10.1111/1467-6427.12007

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Hof and Berman (1989) discuss sexuality as a cycle. A person’s sexual attitudes and behaviour are impacted on by dynamics within the system of a family and inversely, the system is affected by indi- vidual family members’ sexuality. Scholars have frequently researched how family-of-origin experiences impact upon marital quality (Martinson et al., 2010; Topham et al., 2005). Similarly, researchers have investigated the relationship between marital quality and sexu- ality in marriage (Holman and Birch, 2001; Larson et al., 1998). However, few studies have focused on the relationship between family-of-origin experiences and subsequent sexual experience in marriage (Hof and Berman, 1989). Scholars and theoreticians based in attachment theory assume there is continuity (Bowlby, 1969) linking family-of-origin experiences and sexuality in adult relation- ships. This perspective may prove helpful when studying family of origin and sexuality.

Review of literature

The theoretical frame of attachment

Many of the popular approaches to family therapy are driven by attachment theory (Nichols, 2008). Attachment theory posits that there is a connection between children and parents that affects chil- dren’s functioning throughout their life. Attachment theory, initially proposed by the ground-breaking observational and theoretical work of John Bowlby (1969) and the research of Mary Salter Ainsworth (1973, Ainsworth et al., 1978), describes an ‘inborn regula- tory system’ central to ‘social behavior’ and the development of ‘emo- tional stability, mental health, and satisfying, close relationships’ in all human beings (Mikulincer and Shaver, 2007, p. 28). These core attachment concepts, including the inborn drive to seek and develop secure attachment relationships, have held up over many decades and across ethnic, racial, and cultural differences (van Ijzendoorn and Sagi-Schwartz, 2008). Bowlby (1973) described accessibility and responsiveness as a key form of behaviour in relationships that largely determine a person’s state of security, anxiety or distress. When loved ones are consistently available and are willing to respond to calls for support, help or protection, which Bowlby calls ‘ready accessibility’, a strong relational bond can be formed (Bowlby, 1973, p. 201). Strong attachment bonds can provide a safe haven and a secure base for a person, which help to ‘buffer against the effects of stress and uncer- tainty’ as well as ‘promote the confidence necessary to risk, learn, and

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continually update models of self, others, and the world’ (Johnson, 2003, p. 5).

A number of clinicians and theorists have proposed thoughtful integrations of attachment and family systems theories (Akister and Reibstein, 2004; Kozlowska and Hanney, 2002), noting that family-of-origin experiences with connection and attachment can influence adult beliefs about romantic relationships and their behav- iour in such relationships. Despite continuity, it is noteworthy that attachment styles in adulthood are fluid (Mikulincer and Shaver, 2007). Secure attachment to adults throughout life can modify inse- cure attachments from childhood. This perspective is relevant to studies of family of origin and sexual satisfaction because it provides possible explanations for the differences in individuals’ sexual expe- riences. Understanding the subtleties of sexual relationships will increase clinicians’ effectiveness in conceptualizing and intervening in adult romantic relationships.

Sexual satisfaction in marriage

Sexual satisfaction in marriage has been a key topic of interest among family scholars (Christopher and Sprecher, 2000). Research- ers have explored relationship dynamics predictive of sexual satisfaction at all stages of marriage (Larson et al., 1998; Lawrance and Byers, 1995; McNulty and Fisher, 2008; Matthias et al., 1997). Self-esteem, stability and communication during the premarital rela- tionship have been shown to be predictive of sexual satisfaction in early marriage (Baker, 1986; Larson et al., 1998). Sexual expecta- tions for women and sexual frequency for men seem to be related to satisfaction for newly married couples (McNulty and Fisher, 2008). Sexual satisfaction in marriage during mid-life to late stages of life has been linked to many factors, including attitudes to sex, sexual activity, age, culture and couple dynamics (Lawrance and Byers, 1995; Haavio-Mannila and Kontula, 1997; Matthias et al., 1997). A study examining mid-stages of life found that cultural differences impacted upon sexual satisfaction of couples consisting of non-Asian American husbands and Korean wives (Song et al. 1995). For elderly individuals (mean age 77.3 years) Matthias et al. (1997) found that high sexual satisfaction was best predicted by higher sexual activity and positive mental health. In summary, there is rich empirical information on the subject of sexual satisfaction in marriage at all stages of life.

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Marital quality and sexual satisfaction in marriage

The systemic idea that marital quality is associated with levels of sexual satisfaction is heavily supported in the research literature (Frank et al., 1979; Health, 1978; Larson et al., 1998; Young et al., 1998; Newcomb and Bentler, 1983). Young et al. (1998) examined possible correlates of sexual satisfaction in marriage and found overall satis- faction in marriage to be the most highly correlated with sexual satisfaction. It is interesting to note that the highest correlates to sexual satisfaction in their study were non-sexual aspects of the marital relationship such as shared goals, respect and recreational companionship.

Likewise, Darling et al. (1991) found that women are more likely to report higher sexual satisfaction when they feel emotionally close to their partner. In addition to the previously mentioned empirical studies, many theoretical models support the link between marital quality and sexual satisfaction. Among them are the inter- personal exchange model of sexual satisfaction (IEMSS) (Lawrance and Byers, 1992, 1995) and social exchange theory (Sprecher, 1998). The IEMSS proposes that sexual satisfaction is affected by the quality of the nonsexual aspects of the relationship (Byers and Macneil, 2006). The social exchange theory (Sprecher, 1998) offers explanations of how partners’ interactions with each other affect their sexual relationship dynamics. The relationship between marital quality and sexual satisfaction is an area that has received much attention from researchers. This research gives evidence of findings highlighting the positive correlation between the two variables.

Family-of-origin experiences and sexual satisfaction

Current literature regarding the impact of family-of-origin experi- ences on sexuality in adulthood is largely framed through discus- sions of attachment theory (Birnbaum et al., 2006; Cooper et al., 2006; Mikulincer, 2006). In the late 1980s Shaver and others (Hazan and Shaver, 1987; Shaver and Hazan, 1988; Shaver et al., 1988; see also Mikulincer and Shaver, 2007) suggested Bowlby’s ideas on attachment might be extended to better understand romantic love in adult relationships. They posited that an attach- ment style in adulthood is reflective of childhood attachment styles. Research testing these hypotheses provides evidence that more anxious and avoidant attachment styles are related to the quality of

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adult romantic relationships, including perceptions of the sexual experience. Birnbaum et al. (2006) found attachment anxiety to be associated with an ambivalent interpretation of sexual experience, where aversive feelings coexist with sexual excitement and strong desires for sex and love. Attachment avoidance was found to be associated with more aversive responses to sexuality, which may be explained by discomfort with closeness and negative models of others. Another study reported a significant association between attachment avoidance or anxiety and the emotional, physical, and control aspects of sexual satisfaction (Davis et al., 2006). Similarly, lower levels of sexual satisfaction were found in a sample of Cana- dian couples when individuals reported higher levels of attachment anxiety and avoidance (Butzer and Campbell, 2008). In the same study lower levels of sexual satisfaction were associated with more avoidant spouses. These and other studies suggest that adult attach- ment styles are related to sexual satisfaction for adults.

Furthermore, empirical examinations of family-of-origin variables and sexual satisfaction suggest that positive childhood experiences are related to higher levels of satisfaction. Bridges (2000) found that higher levels of physical affection and positive attitudes about sex in the family of origin are linked to higher overall sexual satisfaction. Additional research reports that father care is positively related to the feminine dimension of sex-role identification, which was related to higher sexual satisfaction in adulthood (Hingst et al., 1985). These and other studies examine family-of-origin dynamics outside the attachment perspective. Multi-generational theories argue that family issues from the past are influential but people can come to terms with them and experience healthy functioning in adult romantic relation- ships (Framo, 1992; Kerr and Bowen, 1988; Martinson et al., 2010). Beyond the research from an attachment perspective and the few studies mentioned, there is little research on the association between perceptions of family-of-origin experiences and sexual satisfaction in adulthood.

Family of origin, marital quality and sexual satisfaction in marriage

As discussed, most of the research examining the direct relationship between family-of-origin experiences and sexuality in marriage centres on attachment theory. There is some support for the idea that childhood experiences impact upon sexuality in marriage (Bridges, 2000; Hingst et al., 1985; Shaver et al., 1988) but no studies

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controlled for marital quality when searching for a direct associa- tion. The purpose of this study was to examine aspects of the child- hood experience and their direct relationship to sexual satisfaction in marriage, while controlling for the possibility that the association is mediated by nonsexual aspects of marital quality. For this study, marital quality was tested as the mediator (instead of sexual satis- faction) because it was considered to be a higher level of relationship functioning that includes both sexual and nonsexual aspects of the relationship. It was believed that the nonsexual aspects would mediate between family of origin and sexual aspects of the relation- ship. The hypotheses were based on the rationale that the family- of-origin experiences measured would affect a person’s attitude towards relationships, the scripts they could use in relationships and their expectations of relationship security, resulting in changes in marital quality and sexual satisfaction. The hypotheses examined were that (i) family-of-origin experiences and sexual satisfaction in marriage are directly related; specifically, more positive perceptions (more secure attachment) of overall family-of-origin experiences, parents’ marriage and relationship with the parent of the opposite sex are related to higher marital sexual satisfaction and (ii) the relationship between family-of-origin experiences and sexual satis- faction in marriage is fully mediated by marital quality; specifically, scores for marital quality increase with more positive perceptions of childhood experiences, which are related to increased marital sexual satisfaction.

Gender differences

Much of the research conducted on marital sexual satisfaction has included controls for gender. Overall, men report higher levels of satisfaction than their wives (Song et al., 1995). Men’s sexual satis- faction is shown to be largely affected by their spouse’s self-esteem, open communication, and relationship stability (Larson et al., 1998). Research links women’s sexual satisfaction to their own self-esteem, open communication, their husband’s empathic communication and the emotional closeness they feel with their partner (Darling et al., 1991; Larson et al., 1998). Studies also show similarities in predictors of sexual satisfaction for men and women including self-esteem, levels of positive regard, empathy, and cohesion (Song et al., 1995). This current study attempted to identify gender differences among predictors of sexual satisfaction for married couples.

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Method

Participants

For this study, data were analysed from 3953 married couples who participated in the relationship evaluation (RELATE). The mean age for female respondents was 32-years old, ranging from 19 to 83-years old. The mean age for male respondents was 34-years old, ranging from 20 to 79-years old. In terms of education, 3.7 per cent of women had completed high school and 96.3 per cent had some college education or above. For men, 5.4 per cent had completed high school and 94.6 per cent had some college education or above. Their median personal yearly gross income was $20,000–39,999 for women and men, with 48.7 per cent of women and 31.1 per cent of men reporting an income under $20,000. The sample was predomi- nantly Caucasian. Female respondents identified as 84 per cent Cau- casian, 2.9 per cent African (Black), 5 per cent Asian, 3.6 per cent Latino, with very small mixed percentages of others. Male respond- ents self-identified as 84.9 per cent Caucasian, 3.2 per cent African descent, 3.9 per cent Asian and 3.3 per cent Latino, also with small percentages of others. There was an interesting spread of religious affiliation in the sample. Major categories for women were Latter- day Saint (Mormon) (32.4 per cent), Protestant (25.7 per cent), Catholic (15.5 per cent), none (13 per cent), other (9.9 per cent) and Jewish (2 per cent). For men, the major categories were Latter-day Saint (Mormon) (32.3 per cent), Protestant (24.9 per cent), Catholic (15.9 per cent), none (15.2 per cent), other (8 per cent) and Jewish (2 per cent).

Procedure

Data for this sample were collected using the RELATE questionnaire (Holman et al., 1997) from 2003 to 2009. The questionnaire is a multidimensional measure consisting of more than 250 items. Couples responded to items about perceptions of themselves and their partner in four major contexts: (i) individual, (ii) couple, (iii) family and (iv) social. The assessment was accessed online and couples were referred by therapeutic professionals, professors, researchers and various forms of advertising. The participants were able to choose to receive a printout (also viewable online) showing an evaluation of their responses. The cost of RELATE is $20 per couple to obtain access to the extensive evaluation of responses.

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The RELATE measures (beginning in 1997) have withstood rigor- ous validity and reliability testing, showing test-retest and internal consistent reliability and content, construct, and concurrent validity (Busby et al., 2001). Reliability coefficients for most of the measures have scored between .70 and .90 for internal consistency and two test-retest samples, including a test-retest of a Hispanic version. Con- struct validity testing has shown that 92 per cent of the items load on the correct subscale and further investigations of overlap showed appropriate correlations for similar items while still remaining distant (range between .45 and .65). To measure concurrent validity, meas- ures of RELATE have been compared with scales from the revised dyadic adjustment scale (Busby et al., 1995). Correlations were strong and in the right direction with every subscale compared. For this particular sample from RELATE, Cronbach’s alpha was calculated for all latent variables and observed variables consisting of more than one item (see section on measures for alpha values). Internal consistency (George and Mallery, 2003) ranged from acceptable (alpha > 0.70) to excellent (alpha > 0.90).

Measures

The variables measured using RELATE were perceptions of each partner’s own family of origin and reported sexual satisfaction in the marriage, with marital quality as a possible mediating variable (see Table 1 for descriptive statistics). Several scales were used in measur- ing these variables. Many scales were reverse-coded so that, in all cases, higher scores reflect more positive responses. To measure

TABLE 1 Descriptive statistics

Min–max

Men Women

Range Mean SD Range Mean SD

Overall family or origin 4–20 16 16.50 3.15 16 16.10 3.55 Parents’ marriage -3–15 18 10.22 4.02 18 9.60 4.08 Parent–child -3–15 18 11.80 2.72 18 10.35 3.49 Satisfaction 6–30 28 27.55 5.10 28 27.56 5.38 Stability 3–15 12 12.53 2.27 12 12.43 2.38 Problem areas 10–50 40 44.55 6.58 37 44.49 6.63 Sex problems 1–5 4 3.81 6.58 4 3.76 1.16 Sexual satisfaction 1–5 4 3.97 1.11 4 4.02 1.03

Note: higher scores reflect more positive responses.

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perceptions of family of origin the scales from the family processes section were used. The subscales from this section were overall evalu- ation of family processes, parents’ marriage and parent–child rela- tionships (separate items for mother and father). Overall evaluation of family processes (male alpha = .857; female alpha = .886) contained items that were measured on a five-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’. An example item from this section reads, ‘From what I experienced in my family, I think family relationships are safe, secure, rewarding, worth being in, and a source of comfort’. The use of attachment language contained in these items is apparent (i.e. safe, secure, anxiety-provoking, inconsistent, unpredictable).

The items contained in the parents’ marriage (male alpha = .915; female alpha = .915) and mother–child (male alpha = .741) and father–child relationship (female alpha = .815) subscales were meas- ured on the same Likert scale for overall family of origin but with an added value of -1 for ‘doesn’t apply’. Only opposite sex parent rela- tionships were considered. A sample item from father–child relation- ships read, ‘My father and I were able to share our feelings on just about any topic without embarrassment or fear of hurt feelings’.

The measure of marital quality (male alpha = .726; female alpha = .754) consisted of three variables: relationship satisfaction (male alpha = .853; female alpha = .862), relationship stability (male alpha = .792; female alpha = .801) and problem areas (male alpha = .806; female alpha = .790). Relationship satisfaction was measured with seven items using a five-point Likert scale ranging from very dissatisfied to very satisfied. Relationship stability contained three items measured with a five-point Likert scale ranging from never to very often. An example item read, ‘How often have you and your partner discussed ending your relationship (or marriage)?’ Problem areas contained eleven items (ten when intimacy/sexuality is removed for analysis purposes) including areas like communication and time spent together. It was measured with the same scale and range as relationship stability.

The variable used to measure marital sexuality was sexual satisfac- tion (male alpha = .744; female alpha = .741) which was made up of two, one-item measures. Researchers often discuss how to accurately measure sexual satisfaction (Renaud et al., 1997; Young et al., 1998). They argue that reports of sexual satisfaction are a demonstration of the balance between positive perceptions of sexual satisfaction and the lack thereof. This study used items that allowed participants to respond to both. The first measure, sex problems, was from the

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problem areas checklist and was based on a Likert scale ranging from never a problem to very often a problem. The item read, ‘intimacy/ sexuality’. The second part of the satisfaction variable was from the relationship satisfaction section using a Likert scale ranging from very dissatisfied to very satisfied. The item read, ‘the physical intimacy you experience’.

Analytic strategy

The study was designed to propose and test a model of marital sexuality where the influence of a person’s overall perception of family of origin, perception of parents’ marriage, perception of the father–child or mother–child relationships and marital quality could be measured simultaneously (see Figure 1). The multivariate- correlational procedure, structural equation modelling (SEM), was utilized for its ability to establish relationships between latent variables given a theoretical perspective (Schumacker and Lomax, 1996). The

.39***/.34*** (.28/.26)

.01/.00 (.01/.00)

.15***/.13*** (.76/.73)

-.01**/-.01* (-.05/-.04)

.01/.01 (.02/.03)

.00/.00 (.00/.01)

R2 = .11/.9

R2 = .55/.52

.74/.77 .65/.66 .85/.89

.69/.71

.85/.83

Marital quality

Satisfaction Stability ProblemAreas

OverallFOO

ParentsMarriage

ParentChild

Sexual satisfaction

SexProblems

SexSatisfaction

.13***/.11*** (.08/.08)

Figure 1. Structural equation model with unstandardized and standardized coefficients, R2 and factor loadings for male and female models.

Note: * P < 0.05; ** P < 0.01; *** P < 0.001. Values reported: men/women. Standardized values in parentheses. R2 represents the amount of variance accounted for in endogenous variables. The variable ParentChild represents participants’ opposite sex parent.

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statistical software programme, Analysis of Moment Structures (AMOS) (Arbuckle, 2006) was used to analyse direct and indirect relationships for both men and women. To test hypotheses a nested model was run with family-of-origin variables and sexual satisfaction and a full model including marital quality was also run. Strength of indirect relationships was examined using the Sobel test (Preacher and Leonardelli, 2006; Soper, 2010). Standardized effects, unstand- ardized estimates, and correlations of all observed variables are shown in Table 2 and Figure 1.

Figure 1 is a structural representation of the full conceptual model. SEM includes several measures to test the model’s ability to accurately represent the data. ‘If the model is determined to ‘fit’ the data well, the relationships depicted are determined to be an adequate repre- sentation of those that exist in the data’ (Newcomb and Locke, 2001, p. 1226). Hoyle and Panter (1995) suggest that model fit is best reported using both absolute fit and incremental fit indices. They state that chi square is a good indicator of absolute fit and the Tucker and Lewis index (TLI) and the comparative fit index (CFI) are good indicators of incremental fit. Values for the TLI and CFI range from zero to one with values over .95 indicating a good fit (Byrne, 2001). It is worth noting that sample size affects fit measures and should be considered when judging the extent to which they can be trusted. A larger sample size reduces the likelihood of an insignificant chi square but increases the accuracy of incremental fit measures such as the TLI

TABLE 2 Correlations of observed variables

1 2 3 4 5 6 7 8

1. Overall family of origin

1.00 .66* .53* .24* .18* .27* .16* .16*

2. Parents’ marriage .63* 1.00 .54* .17* .12* .19* .13* .13* 3. Opposite sex

parent–child .48* .36* 1.00 .18* .13* .18* .12* .14*

4. Relationship satisfaction

.27* .17* .19* 1.00 .59* .68* .51* .66*

5. Relationship stability .19* .15* .12* .57* 1.00 .50* .34* .30* 6. Relationship problem

areas .29* .18* .17* .63* .48* 1.00 .65* .46*

7. Sex problems .17* .13* .10* .50* .34* .67* 1.00 .59* 8. Sexual satisfaction .18* .12* .14* .70* .30* .47* .59* 1.00

Note: * P < 0.001. Female correlations above the diagonal; male correlations below the diagonal (the 1.00 diagonal; horizontal numbers are same as vertical).

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and CFI (Hu and Bentler, 1995). In addition to chi square, TLI, and CFI, root mean square error of approximation (RMSEA) is recog- nized as one of the most informative criteria in SEM (Byrne, 2001). A RMSEA value below .05 is indicative of a good fit (Byrne, 2001). Due to the large sample size of this study (3953), chi square is reported but the other fit measures were used to determine goodness of fit.

Results

Male model

The sample size for the male model was 3953. The model produced mixed results of fit to the data. For the full model, a chi square of 46.908 (df = 9) was significant (0.000). The nested model produced a significant (0.004) chi square of 11.212 (df = 2). A chi square difference test suggested that the full and nested models are significantly (0.000) different. Because chi square is affected by the large sample size, other tests were used to determine goodness of fit. For the full model, the TLI (.991), the CFI (.997), and RMSEA (.033) suggest a good fit to the data. For the nested model, the TLI (.991), the CFI (.998), and RMSEA (.034) also suggest a good fit. Eleven per cent of the variance in marital quality and 55 per cent of the variance in sexual satisfaction was accounted for by the full model and 5 per cent of the variance of sexual satisfaction was accounted for by the nested model.

Direct paths

Several significant paths were found in the male models (see Figure 1). In the nested model, higher scores for the mother–child relationship and perception of overall family-of-origin experiences were significantly (P < 0.001) related to higher sexual satisfaction. Perception of parents’ marriage was not significantly related to sexual satisfaction. In the full model, the mother–child relationship and marital quality were significantly related (P < 0.001), suggesting that higher levels of marital quality are related to positive perceptions of a man’s childhood relationship with his mother. The mother–child relationship was not significantly related to sexual satisfaction. Inter- estingly, more positive perceptions of overall family-of-origin experi- ences were significantly related to both higher marital quality (P < 0.001) and lower sexual satisfaction (P < 0.003). Perception of parents’ marriage was not significantly related to either marital quality or

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sexual satisfaction. Lastly, higher marital quality was significantly (P < 0.001) related to higher sexual satisfaction.

Indirect paths

Two indirect relationships were significant. First, the model suggests that positive perceptions of a man’s childhood relationship with his mother are related to higher sexual satisfaction when mediated by marital quality (Sobel statistic = 4.33, P < 0.001). Second, perception of overall family-of-origin experiences and sexual satisfaction were posi- tively related when mediated by marital quality, suggesting that more positive perceptions of overall family-of-origin experiences are related to higher levels of marital quality, which is related to higher levels of sexual satisfaction (Sobel statistic = 13.00, P < 0.001). Sobel tests (see Preacher and Leonardelli, 2006) indicated significant mediating effects in both cases. Correlations of observed variables support this finding (see Table 2).

Female model

The sample size for the female model was 3,953. Results of tests for goodness of fit produced similar results to that of the male model. For the full model, a chi square of 33.355 (df = 9) was significant (0.000). The nested model produced a non-significant (0.612) chi square of .982 (df = 2). A chi square difference test suggested that the full and nested models are significantly (0.000) different. Because chi square is affected by sample size, other tests were used to determine goodness of fit. For the full model, the TLI (.995), the CFI (.998), and RMSEA (.026) suggest a good fit to the data. For the nested model, the TLI (1.0), the CFI (1.0), and RMSEA (.000) also suggest a good fit. Nine percent of the variance in marital quality and 52 per cent of the variance in sexual satisfaction was accounted for by the full model and 5 per cent of the variance in sexual satisfaction was accounted for by the nested model.

Direct paths

Results for the female model were similar to that of the male model (see Figure 1). In the nested model, higher scores for the mother– child relationship and perception of overall family-of-origin experiences were significantly (P < 0.001) related to higher sexual

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satisfaction. Perception of parents’ marriage was not significantly related to sexual satisfaction. In the full model, the path between father–child relationship and marital quality was significant (P < 0.001) suggesting that more positive perceptions of a woman’s child- hood relationship with her father are related to higher marital quality. The path from father–child to sexual satisfaction was not significant. More positive perceptions of overall family-of-origin experiences were significantly related to higher marital quality (P < 0.001) and lower sexual satisfaction (P < 0.022). Parents’ marriage was not significantly related to marital quality but was related to sexual satisfaction near trend level (P < 0.104) suggesting that, for women, more positive perceptions of parents’ marriage might be related to higher levels of sexual satisfaction. Furthermore, higher marital quality was signifi- cantly (P < 0.001) related to higher levels of sexual satisfaction.

Indirect paths

Two indirect pathways were significant. First, the model suggests that positive perceptions of a woman’s childhood relationship with her father are related to higher sexual satisfaction when mediated by marital quality (Sobel statistic = 3.67, P < 0.001). Second, and similar to the male model, overall perception of family of origin and sexual satisfaction were positively related when mediated by marital quality, suggesting that more positive perceptions of family-of-origin experi- ences are related to higher marital quality, which is related to higher levels of sexual satisfaction (Sobel statistic = 11.33, P < 0.001). Sobel tests indicated significant mediating effects in both cases (see Preacher and Leonardelli, 2006). Correlations of observed variables support this finding (see Table 2).

Gender differences

The male and female full models were analysed, comparing them for equivalency. When evaluating the similarity of models for different groups, AMOS compares a model where the path coefficients are constrained to be equal between the two groups with an uncon- strained model where paths are free to vary. A chi square statistic is produced that is the difference in the chi square value for the con- strained and unconstrained models. If this chi square difference is significant, the structural models are not considered equivalent for the two groups (Arbuckle, 2006). The difference in the chi square

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values for the constrained and unconstrained models comparing women and men with 28 df was 99.01, which was significant (P < 0.001), indicating a lack of equivalence for the structural model of the two groups.

Of the fourteen path coefficients analysed for equivalency, only one was significantly different for men and women (4.184, which exceeds the threshold of 1.98). The significant coefficient for the relationship between marital quality and sexual satisfaction was larger for men.

Discussion

Direct effects (Hypothesis 1)

The first hypothesis suggested that more positive perceptions of the family-of-origin experiences would be related to higher marital sexual satisfaction. The direct paths in the nested model between the family- of-origin variables and sexual satisfaction tested this hypothesis. Sig- nificant direct relationships were the same for men and women.

Significant relationships were found between sexual satisfaction and both perceptions of the parent–child relationship and overall family-of-origin experiences. These two measures of family of origin use language that relates to childhood attachment. The findings suggest that more high scores on the family-of-origin measures are related to higher levels of sexual satisfaction for both men and women. Attachment theory offers a possible explanation for this rela- tionship. Continuity of attachment (Bowlby, 1969) is the idea that children learn to expect certain things from relationships depending on the experiences they have with adult caregivers and they carry the expectations and scripts into adult relationships. Previous research assumes continuity (Bowlby, 1969) of attachment (in this case meas- ured by overall family of origin and parent–child relationships) and claims there is a positive association between childhood experiences and sexual satisfaction in adult relationships (Birnbaum et al., 2006; Butzer and Campbell, 2008; Davis et al., 2006). The nested model of this study supports the assumption of continuity.

The full model offers further clarity about the relationship between the family-of-origin variables and sexual satisfaction. Direct paths between perceptions of the parent–child relationship and sexual sat- isfaction were not significant in the full model. Interestingly, the relationship between overall family-of-origin experiences and sexual satisfaction was negative when controlling for marital quality, suggest- ing that more positive perceptions of family of origin are related to

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lower levels of sexual satisfaction. However, higher scores in both family-of-origin measures were significantly related to higher levels of marital quality. As discussed in subsequent sections, it may be that the model is fully mediated by marital quality. Moreover, any non- mediated direct effects of family-of-origin experiences on sexual satisfaction were not clinically significant.

Without evidence of similar findings in other studies, it is difficult to explain what accounts for the negative association of family-of-origin experiences and levels of sexual satisfaction. The IEMSS provides a possible answer with what is termed comparison level or relative sexual rewards and costs (Byers and Macneil, 2006). When combined with the idea that attachment styles can change across relationships (Mikulincer and Shaver, 2007), the influence of comparison on sexual satisfaction becomes clearer. An analysis of the measures shows that respondents gave a subjective assessment of their experiences that is affected by many factors, including their experience and expectations. In comparison to a person with a positive family-of-origin experience, one who views their family-of-origin experience as negative might consider the same sexual relationship as more positive and satisfying due to the comparative factor. One might say, ‘This is much safer and more comfortable than what I grew up with; I’m very satisfied’. Changes in attachment throughout life may challenge the accuracy of the effects assumed to come from continuity. Further research is needed to determine the extent of the specific factors involved in continuity of childhood attachment across relationships and into adult sexual relationships.

Indirect effects (Hypothesis 2)

Of particular impact in this study was the variable marital quality which was both a significant predictor and mediator in the male and female models. The second hypothesis proposed that marital quality would increase with more positive childhood experiences which would be related to increased marital sexual satisfaction. Lending support to the hypothesis, significant direct paths were found from overall family-of-origin experiences and parent–child relationships to marital quality and from marital quality to sexual satisfaction. The full model accounted for much larger amounts of the variance in sexual satisfaction than the nested model. This finding supports the research on the interrelatedness of family of origin, marital quality and sexual satisfaction (Bridges, 2000; Davis et al., 2006; Larson et al., 1998);

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however, there is little empirical evidence on how family-of-origin variables interact with sexual satisfaction. The results of this study suggest that marital quality is a strong mediator of the relationship between childhood family-of-origin experiences and sexual satisfac- tion in adulthood.

Attachment theory provides conceptual support for the idea that family of origin is connected to sexual satisfaction through marital quality (see Bowlby, 1969; Mikulincer and Shaver, 2007). The theory posits that children learn how to relate emotionally and physically to those around them through their experiences with family, offering an explanation for the significant indirect paths. Positive attachment feelings of such as those of trust, comfort and safety may continue into a marriage, affecting the quality of that relationship and spreading into connected areas such as sexual satisfaction. Negative childhood experiences might be overcome by positive experiences with a spouse, lending itself to increased sexual satisfaction.

There is a longstanding debate on the absolute continuity of child- hood attachment. Some theoreticians support the view that attach- ment from childhood will always affect aspects of adult romantic relationships, including sex. However, others argue that new experi- ences in adulthood can counter the effects of childhood experiences (Kobak, 1994). This study lends support to the latter argument, sug- gesting that the quality of one’s marriage might help to buffer the impact of childhood experiences.

Also worthy of note is the relationship between children and their opposite sex parent. Methods of showing and receiving affection are communicated through interactions and applied to scripts for use in other relationships. The findings of this study point to marital quality as the conduit for scripts learned from the mother–son and father– daughter relationships into sexual satisfaction in adult romantic relationships.

Sobel tests confirmed significance of the indirect pathways from overall family of origin and parents’ marriage to sexual satisfaction in both the male and female models. Interestingly, perception of parents’ marriage was not a significant predictor in the full or nested models, suggesting that the individuals view their parents’ marriage may not be indicative of what is carried into adulthood in terms of scripts and expectations. One point to consider is that this variable measured how participants viewed the degree to which their parents were happy in their marriage and the extent to which the participants would like their own marriage to be like that of their parents. Perhaps a measure

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of parents’ marriage using attachment language would be better suited to the model. For example, an item might read, ‘My parents’ marriage was safe and a source of comfort’ or ‘My parents could trust each other in their marriage’. Future research should explore the potential effects of perceptions of parents’ marriage more closely in order to better understand which aspects may be related to marital quality and sexual satisfaction.

Gender differences

Examinations of gender differences in the literature have produced mixed results. There is some evidence that negative family-of-origin experiences may be harder to overcome for women (Martinson et al., 2010). Furthermore, research has identified some gender differences in predictors of sexual satisfaction (Darling et al., 1991; Larson et al., 1998); however, these differences do not seem to outweigh gender similarities. It may be that the sexuality of men and women are similarly affected by family-of-origin experiences and marital quality, as attachment theory does not claim a greater hold on men or women. It is assumed that both genders wish for closeness, security, trust and consistency in relationships and when they are not present, it is likely that both genders experience increases in attachment insecurity.

The only difference found when comparing the male and female models was the relationship between marital quality and sexual satis- faction. Men had a larger coefficient than women, suggesting that the sexual satisfaction of men may be more affected by the quality of their marriage. The difference in the coefficients, although statistically sig- nificant, was minimal and points to more clinical similarity than dif- ference. This finding does not support the commonly held belief that women are more affected sexually by non-sexual aspects of the rela- tionship. Larson et al., (1998) found interesting and related results that suggest that the strongest predictors for sexual satisfaction for men are spouse-centred, as opposed to women, whose strongest pre- dictors were individual and spouse-centred. Researchers should con- tinue to examine gender in the interactions of family of origin, marital quality and sexual satisfaction in order to further clarify similarities and differences.

Overall model

Past examinations have provided evidence for a relationship between family-of-origin experiences and marital quality (see Mikulincer and

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Shaver, 2007) and a relationship between marital quality and sexual satisfaction (Larson et al., 1998; Young et al., 1998). This study pro- posed that the conduit from attachment related family-of-origin expe- riences to sexual satisfaction may be marital quality. Accordingly, the full model proposed in this study accounted for 11 per cent (men) and 9 per cent (women) of the variance in marital quality. Even more striking, 55 per cent (men) and 52 per cent (women) of the variance in sexual satisfaction was accounted for by the full model. A positive experience with some aspects of one’s family of origin may be influ- ential on higher marital quality, which is likely to be a large factor in sexual satisfaction ratings. On the other hand, it is possible that a sexual experience may be slightly negatively affected by a more posi- tive experience with one’s family of-origin when controlling for marital quality. Further examinations are needed to investigate the subtleties of the effects of childhood family-of-origin experiences on sexual satisfaction.

Implications for clinical practice

This study gives support to the argument that issues with family of origin and marital quality should be considered relevant to treating marital sexual dysfunction and dissatisfaction (Hertlein and Weeks, 2009). Hertlein et al. (2009) propose the intersystems approach to sex therapy, stating (p. 3):

At its basis, the Intersystems (approach) … sees a connection between an individual’s inner and outer worlds, the intrapsychic processes that impact and are impacted upon by a variety of factors, including inter- personal dynamics, physiology, psychology, culture, and social situation.

It is imperative that clinicians understand the connectedness of the different systems impacting the sexual relationship in order to more fully address issues that may be influencing it.

The process of sex therapy should include a comprehensive sexual history (Hertlein et al., 2009). This study suggests that part of that history should include a genogram of family history, including sexual and nonsexual aspects. Moreover, a portion of the sex therapy process may include addressing issues from families-of-origin and maybe even including members from that family system in the therapy process. Clinicians need to understand that the sexual relationship is inter- twined with nonsexual aspects of the relationship. Sex therapy should always include work with the entire relationship.

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Another implication of the study is that clinicians may wish to consider utilizing therapeutic approaches that connect with the deep influences of emotional connection, attachment and family-of-origin experience. The finding of marital quality as a strong mediator of family of origin and sexuality suggests that issues from one’s child- hood can be overcome and new experiences can define how individu- als view their relationship safety. Emotionally focused therapy (EFT) stems from an attachment basis, claiming that relationships are at the core of the human experience (Makinen and Johnson, 2006). EFT is an approach that assists couples and families in exploring and processing negative experiences from past relationships and focusing on building trust and security. New experiences are created, giving participants new scripts and expectations. Empirical research has validated the effectiveness of EFT, showing an effectiveness rate of approximately 90 per cent when used with nonviolent clients (Johnson et al., 1999). EFT may be an effective addition to couple and family therapy when sexual topics are the focus (for more informa- tion, see the International Centre for Excellence in Emotionally Focused Therapy [2007]).

In addition, many courses are taught in universities, professional schools, workshops, high schools and others, which address the topic of marital quality. In part these courses are often focused on sexual aspects of the relationship. This study provides information on pre- dictors of marital quality and sexual satisfaction. Educators should seek to include family of origin as a factor in all aspects of marriage education, including sexuality. Lastly, it should not be assumed that people are more or less influenced by family-of-origin experiences as a result of their gender. Clinicians should consider family of origin and marital quality as factors in the sexual experience of both men and women.

Limitations and future research

Perhaps the biggest limitations of this study are that it was cross- sectional and childhood measures were based on historical report. A better test of the relationship between childhood experiences or attachment would be longitudinal and begin in childhood, following participants into adult romantic relationships while tracking changes in attachment styles across relationships. However, studies of that magnitude are difficult to conduct while maintaining good validity and reliability. Recent additions to the RELATE questionnaire

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(RELATE, n.d.) will provide clarity regarding adult attachment styles. Future research will be able to utilize these measures and compare them with the variables of this study. Moreover, sexual satisfaction was measured by combining two one-item measures (sex problems and sexual satisfaction). Including variables that reflect sexual behaviour (such as frequency of sex, promiscuity) and sexual attitudes (that is, the importance placed on sex) may increase understanding of the relationship between family of origin and the sexual experience in marriage.

Another limitation of this study is that it did not control for violence or abuse in childhood or adulthood. The measure for overall family- of-origin experience does not specify what family members or events are involved; the questions allow participants freedom to include all family members (including siblings and grandparents) and all events that are relevant to their experience. Future examinations of family of origin may want to include abuse and violence controls, as well as any number of other specifics, in order to increase understanding about influencing factors and changes across stages of life.

There was also some sampling bias which may make generalizabil- ity difficult. Many participants were recruited in a university setting and most respondents had some level of higher education. This edu- cational bias makes it impossible to apply these findings to groups with fewer opportunities for educational attainment, which is often a larger socioeconomic issue as well. Moreover, the sample contained a higher percentage of Caucasian participants than the national population and about a third of the participants were religiously affiliated to the Church of Jesus Christ of Latter-day Saints.

Conclusion

The purpose of this study was to contribute to the understanding of the relationship between family-of-origin experiences and sexual satisfaction and the role of marital quality as a mediator. The study supports traditional assumptions about the direct relationship between family of origin and sexual satisfaction but offers a potentially more accurate representation of the relationship by considering marital quality as a mediator. Further research is needed to examine the subtleties of attachment continuity and the specific factors from childhood influencing marital quality and sexual satisfaction in mar- riage. Finally, clinicians’ and educators’ conceptualizations should include family of origin as a key factor in marital quality and both

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family of origin and marital quality as key factors in the sexual rela- tionship of married couples.

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SOCW 6456: Social Work Practice With Couples and Family Systems

Treatment Plan Template

Instructions and Template for Treatment Plan

Use the following treatment plan template for the treatment plans you design for the Discussions and Assignments in this course.

Identified strengthsIncludes strengths that will help client achieve long-term goal(s) (e.g., supportive family). Client should help identify. Initially, it may be difficult to help client identify more than one or two strengths, but as the course of treatment continues, more should become evident.

Identified problems/deficits Includes factors in client’s life that may impede successful recovery.

 

Long-Term Goal(s): Short-Term Goals Objectives Strategies Expected Outcome

(With Time Frame)

Stated as broad desirable outcome that will be broken down into short-term goals and objectives; usually, one long-term goal will be adequate for first year. Series of time-limited goals that will lead to achievement of long-term goal

 

Statements of what client will do to achieve short-term goal. Stated in measurable, behavioral terms How objective will be carried out or accomplished Objective, measurable desirable outcome with timeframe
Long-Term Goal(s): Short-Term Goals Objectives Strategies Expected Outcome

(With Time Frame)

Example:

1. John will remain abstinent from use of heroin and all other mood-altering substances and behaviors for 1 year, as demonstrated by negative random drug screens and self-report.

Example:

1. John will successfully complete residential treatment.

Example:

1. John will attend and actively participate in all individual and group counseling sessions.

2. John will admit he has an addiction problem.

Example:

1. Schedule one individual counseling session and five group counseling sessions weekly.

2. John will complete Step One of the Twelve Steps.

Example:

1. Staff and self-report of regular attendance and active participation in individual and group counseling sessions (30 days).

2. Self-report to counselor and members of group sessions (30 days).

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