Volume 28, Issue 2 (5-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(2): 83-92 | Back to browse issues page

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Farhadi A, Salehin S, Aghayan S, Keramat A, Talebi S. The Effectiveness of Reality Therapy Based on Choice Theory on Marital Intimacy and Sexual Satisfaction of Newly Married Women. Avicenna J Nurs Midwifery Care 2020; 28 (2) :83-92
URL: http://nmj.umsha.ac.ir/article-1-2152-en.html
1- Student Resaerch Committee, MSc Student of Midwifery Counseling, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
2- Assistant Professor, Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran , drbsalehin@gmail.com
3- Assistant Professor, Behavioral and Social Sciences Research Center in Health, Shahroud University of Medical Sciences, Shahroud, Iran
4- Professor, Department of Reproductive Health, Center for Research on Women's Health and Fertility, Shahroud University of Medical Sciences, Shahroud, Iran
5- Assistant Professor, Department of Epidemiology, School of Health, Shahroud University of Medical Sciences, Shahroud, Iran
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✅ Therefore, according to the findings of this study and its comparison with the existing research literature in this field, it can be concluded that the theory of selection theory helps newlyweds by improving the relationship between couples and increasing the infertility of couples so that they can be real without feeling controlled and controlled.
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Marriage as the most important and highest social tradition has always been emphasized in order to meet the emotional needs of individuals. Marital intimacy is one of the necessities of married life and at the same time it is a prominent feature of a successful and happy couple. The depth of intimacy that people create in their relationship depends to a large extent on their ability to communicate accurately, effectively, and clearly with their thoughts, feelings, needs, wants, and desires; thus, learning how to communicate effectively is the first step in the process of establishing or increasing intimacy in any relationship. It increases conflicts and reduces intimacy in marital relationships and causes emotional and psychological problems; thus, having marital intimacy between married couples is an important factor in creating a lasting marriage [3].
In addition to marital intimacy, one of the most important behaviors between couples is sex. The percentage of many divorces is due to the inability to quantity and quality of sexual intercourse between couples. In fact, sex is the most important source of pleasure, comfort, and intimacy. Experts have defined sexual satisfaction as an emotional response arising from a person's mental evaluation of the positive and negative aspects of having sex with another person [6]. One of the approaches of couples therapy in recent decades is the reality of the treatment that Glaser has developed. This approach trusts clients' ability to meet their needs through a logical or realistic process. This treatment emphasizes the need to face reality, take responsibility, and evaluate correct and incorrect behaviors [9]. The overall goal of reality-therapy is to help people satisfy their psychological need for responsibility, power, freedom, and fun responsibly and satisfactorily. The counselor, with the help of the client, measures the level of satisfaction of their needs and determines what changes should be made to satisfy these needs. Therefore, this study was conducted to evaluate the effectiveness of reality therapy based on the theory of choice on marital intimacy and sexual satisfaction of newly married women.


Materials and Methods

This study was a clinical trial that was conducted in 2019 in Ardabil. Patients were randomly selected. Then, the two questionnaires of marital intimacy and sexual satisfaction were given to the visiting women who were eligible for sampling at the selected health center. After planning and introducing the members of the intervention group to the present plan, group reality therapy were held in 8 sessions twice a week for each of these blocks on even and odd days. For this purpose, blocks 1 to 3 on even days (Monday and Wednesday) were trained in three 90-minute periods at Shahid Ghannadi Health Center, and blocks 4 to 6 were trained at the same center and on odd days (Tuesday and Thursday) under reality therapy. Finally, one week and one month after the end of the sessions, based on previous coordination with the participants, the sex satisfaction and marital intimacy questionnaires were re-completed by the participants in the pre-determined time and place. In the next step, based on the researcher's commitment and in order to observe ethical issues and thank the control group, a 3-session of training for child sexual education was held for this group. During the training process, a total of 4 members of the training group withdrew from attending the meetings, which was prevented by the appropriate allocation of members in each block. The experimental group also received the intervention, but the control group did not. To analyze the data of the present research in the descriptive statistics section, many forms, tables, means and standard deviations were used, and at the inferential statistics level, the repeated analysis of variance test was used to test the research hypotheses. The tools used in the present study were the Thompson & Walker intimacy scale and the Hudson et al. Sexual satisfaction questionnaire.
The content of the sessions was based on a reality-based educational package for couples based on the Glaser-approved standard.
Pre-test, post-test, and follow-up data were analyzed for both groups, and the data collected in this study were analyzed using SPSS 22 (SPSS Inc., Chicago, Ill., USA). In this study, ethical considerations such as obtaining informed consent of the participants in the study were observed by stating the objectives of the research and confidentiality of the participants' specifications in the research.



Results of the repeated measures analysis of variance demonstrated that there was no significant difference between experimental and control groups in sexual satisfaction and marital intimacy in pre-test stage. In post-test and follow-up stages, there was a significant difference between the two groups in sexual satisfaction and marital intimacy (P<0.001).

Table 1. Mean and standard deviation of pre-, post-test and follow-up scores of the experimental and control group
Variable Time Test Group Control Group
Marital intimacy Pre-test 52.45 4.13 49.44 5.41
Post-test ( a week after intervention) 71.81 5.06 48.96 5.55
Follow-up (a month after intervention 74.16 6.74 48.41 5.33
Sexual satisfaction Pre-test 64.36 7.56 62.22 7.79
Post-test ( a week after intervention) 83.63 8.04 61.44 8.70
Follow-up (a month after intervention 84.27 8.94 60.33 8.02
Table 2. Results of variance analysis
  The amount F df theory df error Sig
The effect of test steps Lambda Wickles 0.187 1.27 2.000 59.000 0.001
Interaction effect (group * steps) Lambda Wickles 0.157 1.58 2.000 59.000 0.001
Table 3. Variation analysis of repeated measurements to investigate the effect of intervention on marital intimacy
Source Total square footage Level of freedom Average squares F Significance
The effect of intragroup steps 3252.07 1.31 2158.21 196.43 0.001
Interaction effect (group * steps) 4826.14 1.31 3676.40 253.31 0.001


The aim of this study was to investigate the effectiveness of reality therapy theory based on the theory of choice on marital intimacy and sexual satisfaction of newly married women. The findings of the analysis of the data obtained from the present study confirmed the hypothesis that the average marital intimacy score of newly married women in the control and experimental group before and after the intervention is different. In other words, the results of the present study showed that newly married women who were trained in the reality of treatment-based reality therapy received higher marital intimacy scores after the test than the control group. This finding is consistent with the results of similar research in this field, such as the study of Fathollahzadeh et al. They concluded that intervening to enrich married life based on the theory of choice by correcting and increasing interactions between couples increases intimacy and improves the quality of their marital relationships. In another similar study, Namney et al. [16] found out that the reality therapy approach effectively reduced marital conflicts compared to the control group in women In addition, Zarei, Sadeghifar, and Ghiasi [14] in another study, concluded that group counseling based on choice theory leads to increased marital intimacy and marital satisfaction and reduced marital conflict in married women.
The results of repeated measurement analysis of variance showed that the reality of choice-based therapy has increased sexual satisfaction scores in the experimental group compared to the control group. The result is consistent with the results of similar studies such as Beebe et al.'s study, which concluded that the reality-couple therapy program has a positive effect on the couple's internal control, self-esteem, and marital satisfaction [19].



Teaching choice theory to newlyweds helps them improve their relationship by improving the couple's relationship and increasing the couple's intimacy so that they can be real without feeling controlled and controlling. As a result, by increasing the couple's trust in each other, they express their desires and needs without fear of judgment and rejection, which makes them respect each other and at the same time be able to enjoy being together. This is done in the light of the theory of choice, which increases intimacy between couples and thus enhances their sexual and marital satisfaction; therefore, the use of this theory in preventive and family intervention programs can be a factor in increasing the stability of married life.



Researchers need to express their gratitude for the cooperation of Ardabil Health Centers, all the participants in the research, and other people who helped us to do this research in the best possible way. The present article is a part of the dissertation with the code of ethics IRSHMU.REC. 1398. 028 which has been done with the financial support of the Vice Chancellor for Research and Technology of Shahroud University of Medical Sciences.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Original Research | Subject: Midwifery
Received: 2020/02/18 | Accepted: 2020/03/9 | Published: 2020/03/25

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