Behavioural Therapy and Exercises

 Behavioural Therapy and Exercises

Behavioural Therapy and Exercises

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Running head: LITERATURE REVIEW 1

Running head: REVIEW 1

Literature Review on Improving Intimacy Issues in Couples After Childbirth Through the Implementation of Cognitive Behavioural Therapy and Caressing Exercises

Mississippi College

Patricia Busby-Robinson

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Literature Review on Improving Intimacy Issues in Couples After Childbirth Through the Implementation of Cognitive Behavioral Therapy and Caressing Exercises

Woolhouse, McDonald, and Brown (2012) conducted a study with 77 women, 29-47 years of age regarding intimacy after childbirth and the most reported reason for a decrease in sexual activity was tiredness and exhaustion, especially in the early months following childbirth (Woolhouse, McDonald, & Brown, 2012). The change in lifestyle and gender roles were also reported, most of the women reported the loss of freedom, spontaneity, time for self and time for togetherness as a couple (Woolhouse, McDonald & Brown, 2012). Gender roles became clearly defined even if before the baby was born and the domestic responsibilities were shared the women reported that domestic responsibilities changed once the child was born and gender roles became more stereotypical (Woolhouse, McDonald, & Brown, 2012). The women reported an intense emotional connection to the child which resulted in intimacy and sex not being a priority which caused negative issues in their intimate adult relationships (Woolhouse, McDonald & Brown, 2012). Body image was not an issue for all the women within the study. Some of the women reported a drop-in libido yet they gave physical explanations such as tiredness, hormonal changes and breastfeeding for their reasons and psychosocial explanations such as adjusting to parenthood, resentment due to role changes and an emotional connection to the new baby (Woolhouse, McDonald, & Brown, 2012). Despite their drop-in libido the women reported that they had high expectations of themselves to engage in sex, which some reported that it was self-imposed expectations while other reported pressure from their partner (Woolhouse, McDonald & Brown, 2012). The women also reported that there was a relationship between emotional intimacy and sex and physical and emotional intimacy decreased in their relationship due to sexual problems (Woolhouse, McDonald, & Brown, 2012). The women also viewed their sexuality differently once they became a mother stating that they did not view themselves as sexy (Woolhouse, McDonald, & Brown, 2012). The women reported that they didn’t believe their partners viewed them differently but the way they viewed themselves changed (Woolhouse, McDonald, & Brown, 2012). Comment by Dawn Ellison: This whole section is a summary of one article (and it is too old). You need to review multiple articles and integrate the information into a cohesive narrative.

Intimacy Issues After Childbirth Among Couples

Woolhouse, McDonald and Brown (2014) conducted another study that revealed that women desired more information from their primary health care providers about the changes that should be expected in intimate relationships during the postnatal period, especially what is considered normal. Participants reported that physical pleasure increased gradually over the first 12 months postpartum, but dropped again by 4.5 years postpartum (Woolhouse, McDonald, & Brown, 2014). Data suggested that most of the women were not asked about their sexual health or intimate relationships by their health professionals, providing antenatal and postnatal care (Woolhouse, McDonald, & Brown, 2014). Comment by Dawn Ellison: Again, another summary of one article. A literature review is a compilation of information from multiple sources

Woolhouse, McDonald, and Brown (2014) reports that women view their relationships with their intimate partner as important and their relationship with their intimate partners were affected significantly by childbirth. Participants expressed that intimate relationships and sexual health were not addressed by their primary health care practitioners (Woolhouse, McDonald, & Brown, 2014). Participants reported that after childbirth, the postnatal period, the focus changes from mother’s health to the baby’s health (Woolhouse, McDonald, & Brown, 2014). Due to this shift, participants felt that their own health needs were neglected (Woolhouse, McDonald, & Brown, 2014).

Participants felt that having more knowledge about the possible changes they may experience in their intimate relationships, during the postnatal period, would have helped with transitioning, with a new baby much smoother (Woolhouse, McDonald, & Brown, 2014). The participants stated that they would have wanted to know if what they were experiencing was normal and that they were not alone (Woolhouse, McDonald, & Brown, 2014). Talking to intimate partners and friends about sex and sexuality was difficult and could result in conflict with partners, so participants desired to discuss those issues with trusted external sources of support, discussing their experiences of sex and sexuality after childbirth (Woolhouse, McDonalds, & Brown, 2014).

Participants also shared that the 6-week postnatal check-up gave a false idea that everything was going to be back to normal by 6-weeks postpartum and because thing weren’t back to normal, that left the participants feeling confused and concerned (Woolhouse, McDonald, & Brown, 2014).

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There were things that the women stated that they did with their partners that made the transition into parenthood go more smoothly, such as teamwork between partners which helped to maintain an intimate relationship after birth, taking on challenges together and shared responsibilities (Woolhouse, McDonald, & Brown, 2012). Time together as a couple was another way to maintain intimacy though some of the women reported that childcare was challenging and prioritizing as a couple (Woolhouse, McDonald, & Brown, 2012). Communication was another way in which couples could stay connected (Woolhouse, McDonald, & Brown, 2012).

What is Intimacy?

Intimate relationships are different from other close interpersonal relationships due to the potential, desired or actual physical closeness and sex (Papp, Goeke-Morey & Cummings, 2013). Papp, Goeke-Morey (2013) examined the occurrence of intimacy-related martial conflict within the home environment, such as those considered as disagreements dealing with sex, verbal and physical displays of affection and closeness (Papp, Goeke-Morey & Cummings, 2013). Both woman and men report that sexual gratification and intimacy is among the most significant rewards from a romantic relationship (Papp, Goeke-Morey & Cummings, 2013). Comment by Dawn Ellison: Not APA Comment by Dawn Ellison: Not APA Comment by Dawn Ellison: Not APA

Interventions

Cognitive-Behavioral Therapy

Baucom and Epstein (1991) reconceptualized what Synder and Jacobson concluded in terms of cognitive, behavioral, and affective factors which are focal to cognitive-behavioral marital therapy. According to Beucom and Epstein (1991) data has indicated that changing certain behaviors may have little impact on spouses’ marital satisfaction if some affective and cognitive factors are not considered. Comment by Dawn Ellison: Summary of one article Comment by Dawn Ellison: This is too old

Focusing on cognitive factors in behavioral marital therapy (BMT) was based on clinical observations that showed that spouses’ negotiations and satisfaction with behavioral changes was influenced by their idiosyncratic appraisal of each other’s behavior, (Beucom & Epstein, 1991). There is also a growing number of empirical findings that support that marital distress is influenced by spouses’ cognitions about each other’s behavior and it is because of these findings that BMT should be broaden, to include approaches that focus on the cognitive and affective aspects of the relationship, (Beucom & Epstein, 1991).

Beucom and Epstein (1991) noted that when a spouse comes to accept a partner that can be largely because of several cognitive and emotional changes and encouraging a spouse to accept their partner is often a difficult task that requires that person to make significant cognitive and affective changes.

When a counselor is working with a couple it is important to utilize interventions that will create a cognitive or cognitive -emotional shift for one spouse or the couple (Baucum & Epstein, 1991). Insight and acceptance can be promoted through specific cognitive and behavioral interventions initiated by the counselor (Baucom & Epstein, 1991). Communication is also encouraged; couples are taught to communicate for purposes other than trying to solve a problem, rather than focusing on behavior communication is encouraged because it also enhances cognitive changes, (Baucom & Epstein, 1991). In fact, couples are encouraged to communicate clearly with each other about specific cognitive variables that has been identified as important to their relationship, (Baucom & Epstein, 1991).

Caressing Exercises

The Beginning: Master’s and Johnson’s Sensate Focus

Weiner and Avery-Clark (2014) discuss Sensate Focus focus that was developed by Masters and Johnson as a diagnostic and therapeutic tool, identifying psychological and relationship factors that contributes to sexual difficulties; and to teach new skills to overcome these problems and to foster more meaningful sexual intimacy (Weiner & Avery-Clark, 2014). Sensate focus is considered the centerpiece of Masters and Johnson’s therapeutic work and continues to be utilized by sex therapists (Weiner & Avery-Clark, 2014). The aim of Sensate Focus focus is that participants must touch for themselves, explore their partners body for their own self, own interest, focusing on what’s going on with themselves; the initial part of Sensate sensate Focus focus promotes a psychological attitude rather than a specific behavior then in later phases information about pleasure is shared between both partners (Weiner & Avery-Clark, 2014). Sensate Focus focus shifts from non-demand partner pleasuring to non-demand touch for self (Weiner & Avery-Clark, 2014).

Strategies and Techniques

McCarthy and Wald (2015) shared various techniques that clinicians can use when working with couples that have sexual desire problems. McCarthy and Wald (2015) note the core contributions to the field of sex therapy as Masters and Johnson’s development of sensate focus exercises. Yet it is imperative to note that sexual desire is a challenging clinical and research issue and what may work for one couple may not work for another couple (McCarthy & Wald, 2015). McCarthy and Wald (2015) states that sexual desire can be rekindles and reinforced; psychological, biological and relational factors would need to be reinforced to promote strong, resilient sexual desire and couples would need to address and challenge any factors that can undermine sexual desire.

When utilizing techniques involving touch, it is imperative that the counselor is aware of the many perceptions and multiple interpretations that touch can have (DeVillers, 2014).

Limitations

Though Baucom and Epstein (1991) supports cognitive-behavioral marital therapy it is suggested that counselors examine their interventions and how they alter the cognitive, affective, and behavioral components spouses may experience in their marriages because couples vary in their cognitive, behavioral, and emotional factors influencing their marital problems and interventions should be tailored to those couples’ specific needs. There is also not a lot of research pertaining to intimacy issues in couples after childbirth, implementing caressing exercises. Comment by Dawn Ellison: Too old and your limitations are regarding one article

Conclusions

The implantation of caressing exercises appears to be effective in working with couples dealing with intimacy issues. However, counselors need to understand that caressing exercises are not a stand-alone approach to resolving sexual difficulties and sometimes serve primarily as an exploratory device; counselors should also know that any touch exercise must be explained in detail to the clients, written instructions is preferred; counselors should also understand that caressing exercises are not restricted to heterosexual couples only (DeVillers, 2014). There are guidelines that counselors can follow when introducing and explaining caressing exercises that counselors can tailor for their use (DeVillers, 2014). Yet when a counselor is working with a couple it is important to utilize interventions that will create a cognitive or cognitive -emotional shift for one spouse or the couple (Baucum & Epstein, 1991) and combined with caressing exercises I hypothesis that the treatment will be effective.

References

Baucom, D. M. & Epstein, N. (1991). Will the real cognitive behavioral marital therapy please

stand up? Journal of Family Psychology, 4(4), 394-401. https://doi.org/10.1037/0893-

3200.4.4.394

De Villers, L. (2014). Getting in touch with touch: A use of caressing exercises to enrich sensual

connection and evoke ecstatic experience in couples. Sexual and Relationship Therapy,

29 (1), 87–97. https://doi.org/10.1080/14681994.2013.870336

McCarthy, B., & Wald, L. M. (2015). Strategies and techniques to directly address sexual desire

Problems. Journal of Family Psychotherapy, 26(4), 286–298. http://doi.org/10.1080/08975353.2015.1097282

Papp, L. M., Goeke-Morey, M. C., & Cummings, E. M. (2013). Let’s talk about sex: A diary

investigation of couples’ intimacy conflicts in the home. Couple and Family Psychology:

Research and Practice, 2(1), 60–72. https://doi.org/10.1037/a0031465Reference

Weiner, L., & Avery-Clark, C. (2014). Sensate focus: Clarifying the Masters and Johnson’s

model. Sexual and Relationship Therapy, 29(3), 307–319. http://doi.org/10.1080/14681994.2014.892920

Woolhouse, H., McDonald, E., & Brown, S. (2012). Women’s experiences of sex and intimacy

after childbirth: Making the adjustment to motherhood. Journal of Psychosomatic

Obstetrics and Gynecology, 33(4), 185-190. Retrieved from

http://doi.org/10.3109/0167482X.2012.720314

Woolhouse, H., McDonald, E., & Brown, S. (2014). Changes to sexual and intimate relationships

in the postnatal period: Women’s experiences with health professionals. Australian

Journal of Primary Health, 20, 298-304. Retrieved from

http://dx.doi.org/10.1071/PY13001

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