The Eectiveness of Solution-Focused Brief
Counseling on Marital Intimacy in Mothers of
Children with Down Syndrome: A Randomized
Clinical Trial
Mahshid Bokaie¹, Naeimeh Mirshafieian², Mir Saeid Jafari3
¹ Research Center for Nursing and Midwifery Care, Non-communicable Diseases Research Institute, Department of Midwifery/
Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
² International Campus of Shahid Sadoughi University of Medical Science, Yazd, Iran
³ Department of Psychology, Islamic Azad University, Tehran South Branch, Tehran, Iran
GMJ.2023;12:e2747
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Correspondence to:
Naeimeh Mirshaeian, Safaieh, Timsar Fallahi St.,
Bouali Sina Alley, School of Midwifery and Nursing,
Yazd, Iran.
Telephone Number: +98 35 3824 1751
Email Address: naeime.mir61@gmail.com
Received 2022-11-12
Revised 2023-01-02
Accepted 2023-07-01
Abstract
Background: Parents of children with intelligence and motor problems, including
Down syndrome have to spend more time babysitting resulting in less intimacy with
their mates. Solution-focused brief therapy is one of the treatments presented in the eld
of marital intimacy. This study aimed to investigate the eectiveness of solution-fo-
cused counseling on marital intimacy in mothers of children with Down syndrome.
Materials and Methods: In this randomized clinical trial study, 72 couples were selected
among members of the Asemannili Society (Isfahan-Iran) from 19/01/2021 to 20/04/2021.
The control group received an educational pamphlet for four sessions (without homework)
every other week while the intervention group attended eight 90-minute online counseling pro-
grams once a week. Bagarozi Marital Intimacy Questionnaire was completed at baseline, after
intervention (8th week), and follow-up period (12th week) by the women and their spouses.
Results: The mean scores of marital intimacy between the two groups at baseline (online:
313.23 ± 70.86, pamphlet: 315.92 ± 41.45) compared to the 12th week (online: 370.13 ±
44.63, pamphlet: 332.42 ± 30.39) were signicantly dierent. The analysis of the vari-
ance test with repeated observations showed that the eect of group, and time on the total
score of marital intimacy and its other dimensions, were signicant (P<0.05) for women.
Conclusion: Both online and pamphlet counseling can improve marital intimacy in moth-
ers of children with Down syndrome, but online counseling appears to be more eective.
Thus, this method is recommended for improving the marital intimacy of these women.
[GMJ.2023;12:e2747] DOI:10.31661/gmj.v12i0.2747
Keywords: Marital Intimacy; Solution-focused Brief Therapy; Down Syndrome; Internet-based
Intervention; Counseling
Introduction
One of the basic human needs is the de-
sire to establish intimate relationships
and strive for belonging. To develop intimacy,
marriage oers a unique opportunity that goes
beyond intimate relationships with friends and
relatives [1]. Dissatisfaction with intimacy
may increase disagreements, reduces marital
satisfaction, and cause emotional-psychologi-
cal problems [2]. To address the challenges in
marital relationships, establishing an intimate
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Bokaie M, et al. Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome
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relationship, transferring feelings- thoughts,
and talking about one’s needs have been pro-
posed. Such mutual communication and co-
operation require personal growth [3]. A large
number of couples who refer to counseling
and psychotherapy center have failed to ob-
tain a satisfactory level of intimacy [4].
The solution-based treatment is based on
solution-making strategies, not problem-solv-
ing skills. The underlying assumption of solu-
tion-based therapy indicates that investigating
the basic problem is not needed in leading the
counseling discussion because the cause of
each problem is not necessarily related to its
solution. In other terms, this therapy presup-
poses that all individuals are equipped with
the necessary resources to make a change
[5]. This approach leads clients to create the
desired future vision in their daily lives via
cooperation in outlining prospects based on
their past successes, strengths, and resources
[6]. Multiple evidence conrms that parents
of children with intelligence problems are
more probable to encounter social, economic,
and emotional problems that are often limit-
ed, destructive, and pervasive [7]. In such a
situation, although all family members are
harmed and their functions are disturbed [8],
mothers are the most vulnerable group due to
their traditional role as caregivers. As a result,
mothers of children with intellectual prob-
lems face numerous psychological and mental
health challenges, including problems caused
by taking care of children with specic needs
[9]. Compared to mothers of children with
no medical problems, mothers of children
with mental disabilities have higher levels of
anxiety [10] and more feelings of shame and
embarrassment, but lower levels of general
health and psychological well-being [11].
A study conducted in Iran found that the solu-
tion-focused counseling approach increased
marital intimacy in the intervention compared
to the control group [12]. Another research
concluded that the solution-based intervention
was eective in enhancing the resilience of
mothers of mentally retarded children in Arak
City, Iran [13]. Based on the results of stud-
ies conducted in Iran, group, sexual counsel-
ing sessions can improve sexual satisfaction
among Iranian women [14, 15]. Considering
the current Coronavirus pandemic, this study
was conducted through online platforms. Giv-
en the scarcity of studies on parents of chil-
dren with Down syndrome, this study aimed
to investigate the eect of solution-focused
online counseling on marital intimacy in
mothers with Down syndrome children.
Materials and Methods
Subjects and Randomization
This randomized clinical trial was conducted
at the Asemannili Society of Isfahan/IRAN,
which is a center for patients with Down
syndrome (From January to April 2021).
This study was approved by the Ethics Com-
mittee of Shahid Sadoughi University of
Medical Sciences (approval code: IR.SSU.
REC.1399.152) and registered in the Irani-
an Clinical Trial Registration System (code:
IRCT20200620047846N1). Also, all partici-
pants signed the informed consent before the
study. The intervention group received eight
online sessions of marital intimacy counsel-
ing (90 minutes per week) conducted based
on the solution-focused approach. The control
group was provided with some educational
pamphlets in four sessions every week. The
educational contents covered through the in-
tervention period were designed based on a
review of the literature and opinions of the
research team (supplement 1). Blinding was
not possible due to the specic type of inter-
vention method.
Sample Size Calculation
Convenient sampling was utilized to conduct
this study, and participants were randomly as-
signed to both intervention and control groups.
The sample size was initially calculated as 36
in each group (Formula 1), which increased to
36 after considering the 10% probable drop-
outs.
Formula1.
Where, z1 for 95% condence interval=1.96,
Z2 for 80% test power=0.84, s=the mean stan-
dard deviation of intimacy scores in the two
groups, d=the minimum dierence between
mean scores of intimacies between the two
Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome Bokaie M, et al.
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3
groups, which showed a signicant dierence
and was considered as P<0.05.
Participants
The study population included 250 couples
who were members of the Isfahan Asemannili
Society. Of these couples, 118 did not meet
the inclusion criteria and 60 were unwilling to
participate in the study. So, the remaining cou-
ples (n=72) were asked to enter the study after
completing the online informed consent form.
The study participants included 72 mothers of
children with Down syndrome who were ran-
domly assigned to the intervention and con-
trol groups. The intervention group received
online counseling based on the solution-fo-
cused approach (n=36) and the control group
members obtained related pamphlets (n=36).
Randomization was performed via the web-
site of random allocation http://www.random-
ization.com.
Inclusion Criteria
Participants with the following criteria en-
tered the study: willing to participate in the
study, having a smartphone, being Iranian, be-
ing a resident in Isfahan, having the ability to
read and write, being married, being the only
partner, having a child ≥2 years of age with
Down syndrome, and being a member of Isfa-
han Asemannili Society.
Exclusion Criteria
Alcohol or drug consumption, taking medi-
cines aecting sexual function, such as psy-
chiatric drugs, suering from diseases aect-
ing sexual function, such as diabetes, appli-
cants for other support such as psychological
services or participating in other counseling
programs.
Data Collection
Demographic data and the Marital Intimacy
Questionnaire were collected through an elec-
tronic link in the online and pamphlet groups.
Questions about demographic characteristics
include age, employment status, level of edu-
cation, history of pregnancy, number of births,
how many years have passed since their mar-
riage, the age of the child with Down syn-
drome, the birth rank in the family, the age of
the woman at the time of this child’s pregnan-
cy, marriage with rst degree relatives. Also,
the Marital Intimacy Needs Questionnaire
(MINQ) was used for the assessment of the
marital intimacy of spouses at baseline, end of
8th and 12th weeks.
Bagarozzi Marital Intimacy Questionnaire
This 44-item questionnaire, designed by Baga-
rozzi (2001) [16], measures nine dimensions
of marital intimacy, including emotional, in-
tellectual, physical, social and recreational,
aesthetic, sexual, spiritual, psychological,
and temporal intimacy. The questions should
be answered on a 10-point Lickert scale. All
subscales, except for the subscale of spiritual
intimacy, have ve questions that should be
answered on a 5-point scale ranging from 1
(this need does not exist in me at all) to 10
(this need is strong in me). The minimum and
maximum attainable total scores in these sub-
scales are 5 and 50, respectively. The spiritual
intimacy includes six questions and its attain-
able scores are within the range of 1-10. The
minimum and maximum attainable scores of
this subscale are 6 and 60, respectively. Final-
ly, the subscale of intimacy in spending time
is scored qualitatively, in such a way that all
three questions of this subscale are calculat-
ed based on the average answers of people
to other subscales. The maximum attainable
score in this questionnaire is 440. The Cron-
bach alpha coecient was calculated as 0.95
for the original version and 0.93 for the Per-
sian version which was assessed by Etamadi
(1385) [17, 18].
Intervention
Participants were randomly assigned to two
groups. The intervention group received eight
solution-focused counseling sessions online
and the control group received pamphlets
with the same content. The online counseling
sessions were conducted by a master’s student
of midwifery counseling, who had acquired
the necessary skills in this eld. Counseling
took place under the supervision of a super-
visor and a counselor who specializes in solu-
tion-focused and couple therapy [19, 20]. A
reminder SMS was sent to the participants
before each session. At rst, both groups were
created on WhatsApp titled “Online Counsel-
ing Group” and “Pamphlets Group”, and then
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Bokaie M, et al. Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome
the WhatsApp phone number of each person
was received to add them to the groups. The
participants of the online counseling group
were provided with one-month free internet
packages. The online counseling session was
held in Skyroom virtual spaces and groups. At
the beginning of the meeting, the subject of
the project and its goals were presented to the
two groups of participants.
Following the method of the study, the control
group received the intervention in the form of
Word formatted pamphlets during four ses-
sions, every other week. Unlike the test group,
the control group members were not sup-
posed to do any homework and send it to the
WhatsApp group. Eight 90-minute sessions
were held one day a week for the participants
of the intervention group. At each stage of the
research, the subjects’ permission to leave
the project was explained. In each session, in
addition to a review of the assignments giv-
en to the participants in the previous session,
they were asked about the eectiveness of the
counseling and their progress. They were also
asked to talk about the changes they experi-
enced in their marital intimacy based on the
content of the sessions. The interventions last-
ed from 2021-01-19 to 2021-04-20.
Data Analysis
Data extracted from the questionnaire were
analyzed using SPSS software version 22
(Statistical Package for the Social Scienc-
es, version 22, SPSS Inc, Chicago, Illinois,
USA). The descriptive-inferential statistics
were employed to analyze the data. The col-
Figure 1. CONSORT owchart
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Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome Bokaie M, et al.
lected data are displayed in Table-3 and -4.
Inferential statistics consisted of independent
t-test (quantitative variables, including age,
number of delivery, and so forth.), Chi-square
(qualitative-nominal variables, including hus-
band’s job, and so forth.), and Mann-Whitney
(qualitative rank-order variables, including
education level, and so forth.). The repetitive
measures analysis of variance was also ad-
ministered. Descriptive statistics, including
frequency, percentage, mean, and standard
deviation of qualitative variables were ap-
plied to present and describe the information,
prepare tables, and calculate the percentage,
mean, and standard deviation of the data,
while inferential statistics were performed to
analyze the dierences in mean scores. The
signicance level (P<0.05) was considered.
Results
Totally 250 eligible women for the study were
assessed and nally, 72 of them were enrolled.
One person from the online counseling group
dropped out in the rst week of the interven-
tion due to her unwillingness to continue par-
ticipating in the study, and one person dropped
out in the second week because she did not
have time to attend the sessions (employed).
And three others dropped out from the study
in the third week, one due to coronavirus
infection and being in quarantine, and the
other two due to the spouse’s unwillingness
and uncooperativeness for completion of the
homework, and nal analyses were performed
on 31 couples in online intervention and 36
couples who received pamphlet (see Figure-1:
CONSORT owchart).
The mean age of women was 38.47 ± 7.05
years in the online counseling group and 40.64
± 9.76 in the pamphlet-receiving groups, re-
spectively. Meanwhile, the mean age of the
participants’ spouses was 42.17 ± 6.68 years
in the online counseling group and 43.86 ±
8.86 years in the control group who received
the educational pamphlets, respectively. Ac-
cording to the independent t-test, the mean
age of women, the mean age of their spouses,
the duration of the marriage, the number of
pregnancies, the number of deliveries, the age
of a child with Down syndrome, and the age
of the mother at the time of pregnancy had no
signicant dierence between the two groups
(P>0.05, Table-1).
Comparing the frequency distribution of
women’s jobs, spouses’ jobs, and marriage
with 1st degree relatives between the two
groups is presented in Table-2. Most women
and their husbands in both groups had aca-
demic education. The majority of children
with Down syndrome in both groups were the
rst child of their families. The Mann-Whit-
ney test showed no signicant dierence be-
tween the two groups regarding the parents’
level of education and birth order of a child
with Down syndrome (P>0.05, Table-3). Ac-
Table 1. Comparison of the Demographic Characteristics of the Two Groups
Variables
Online group
(n=31)
Pamphlet group
(n=36)
Mean SD Mean SD t df *P
Women’s age (years) 38.47 7.05 40.64 9.76 1.02 64 0.31
Age of spouses (years) 42.17 6.68 43.86 8.86 0.36 64 0.39
Length of marriage (years) 14.32 6.46 17.47 8.57 1.22 65 0.1
Number of pregnancies 2.10 0.7 2.08 0.73 0.27 65 0.94
Number of births 1.84 0.58 1.78 0.59 0.63 65 0.67
Age of a child with Down
syndrome (years) 9.11 5.95 9.75 7.7 0.07 62 0.72
Age of the woman at the time
of conception of the child with
Down syndrome (years)
28.55 5.75 29.81 6.6 0.59 65 0.41
SD: Standard deviation; *: Independent t-test
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Bokaie M, et al. Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome
cording to the repeated measures analysis of
variance, the passage of time had a signicant
impact on marital intimacy scores of women
in sexual, spiritual, social and recreational,
and temporal domains (P<0.001) but group
membership did not have a signicant eect
on these domains (P>0.05). So, the mean
scores of marital intimacy increased over time
in the domains of sexual, spiritual, social and
recreational, and temporal but the dierence
between the two groups was not signicant.
In general, group membership and time had
signicant impacts on the total score of mari-
tal intimacy and its domains. The mean score
of overall marital intimacy and its domains,
except for the social and recreational dimen-
sion, increased over time, but this increase
was signicantly higher in the online coun-
seling group than in the pamphlet-receiving
group. Based on the repeated measures anal-
ysis of variance, time and group membership
had a signicant impact on the total score of
marital intimacy and all its domains (P<0.05).
The mean score of marital intimacy and all its
domains increased over time and this increase
was signicantly higher in the online counsel-
ing group compared to the pamphlet-receiv-
ing group (Figure-2). Based on the repeated
measures analysis of variance, time and group
membership had a signicant impact on the
total score of marital intimacy and all its do-
mains (P<0.05) in spouses. The mean score of
marital intimacy and all its domains increased
over time and this increase was signicantly
higher in the online counseling group than in
the pamphlet-receiving group in their spous-
es (Table-4). Based on the repeated measures
analysis of variance, time and group mem-
bership had a signicant impact on the total
score of marital intimacy and all its domains
(P<0.05). The mean score of marital intima-
cy and all its domains increased over time
and this increase was signicantly higher in
the online counseling group compared to the
pamphlet-receiving group in their spouses Ta-
ble-5 and Figure-3.
Discussion
The present study aimed to examine the ef-
fect of solution-focused counseling on marital
intimacy in mothers of children with Down
syndrome. Based on the ndings, the total
score of marital intimacy and its subscales in-
creased signicantly after eight and 12 weeks
from the study compared to the prestudy. This
nding was supported by Hosseini’s study
[21]. The results of the mentioned study in-
dicated that the solution approach focused on
increasing the overall marital intimacy of the
participating members in the dimensions of
emotional, psychological, and sexual intima-
cy was spending time and in other dimensions
of marital intimacy including intellectual,
physical, spiritual, aesthetic and social-recre-
ational no signicant dierence was observed
Table 2. Comparing the Frequency Distribution of Women’s Jobs, Spouses’ Jobs and Marriage with 1st
Degree Relatives between the Two Groups
Variables
Online group
31 couple
Pamphlet group
36 couple
Number Percentage Number Percentage x2df P*
Occupational
status (women’s)
Housewife 27 87.1 32 88.9 - - 0.82
Employed 4# 12.9 4# 11.1
Spouse’s job
Worker 8 25.8 10 27.8
0.37 30.95
Employee 12 38.7 12 33.3
Self-
employment 10 32.3 12 33.3
Unemployed 1# 3.2 2# 5.6
Marriage with
relatives
No 28 90.3 31 86.1 - - 0.59
Yes 3# 9.7 5 13.9
*: Chi-Square test; #: Fisher's exact test
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Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome Bokaie M, et al.
between the two groups [12]. Our study was
not consistent with Hosseini’s study in the
variations in the intervention’s type, duration,
method, and contents.
Kamali et al. (2019) also noted the eective
factors in increasing marital intimacy included
family, time spent together/length of marital
relationship, dedication and mutual forgive-
ness, gratitude, new shared activity, parent-
ing, shared social networks, and religion [7].
In this vein, Ahmadi Khoei et al. reported that
divorce prevention training increased the inti-
macy and quality of communication between
couples [8]. Nazari et al. (2019) found that
training communication skills via enriching
couples’ relationships through the Olson ap-
proach could be eective in promoting mar-
ital intimacy [9] since communication skills
have been conrmed as one of the predictors
of marital intimacy explaining and predicting
46% of marital intimacy [10]. In explaining
these cases, it can be said that sexual health
counseling and training communication skills
improve the marital intimacy of couples and
encourage them to express their thoughts and
feelings in the eld of couple relationships.
All recent studies were consistent with our
study, although the studied couples were dif-
ferent.
Burke et al. (2008) noted that since mothers of
children with Down syndrome were at lower
levels of mental health, they may need more
support and health services to improve their
behavioral-management skills, which in turn
improves the family’s mental well-being. Pol-
icy-makers and authorities are recommended
to employ these ndings to hold educational
courses for caregivers of people with intellec-
tual disabilities and identify specic strategies
to improve the child’s behavior and mother’s
management skills and mental well-being [22].
In our study, women of children with Down
syndrome wanted to continue sexual counsel-
ing. One of the most highlighted ndings of
this study was signicantly higher marital in-
timacy and total scores in all domains at 8 and
12 weeks after the study compared to baseline
scores. A possible reason for this nding may
be attributed to the fact that women participat-
ing in a solution-based approach training pro-
gram can inuence the domain of intimacy in
men. Based on the literature, no studies have
yet investigated the impact of this approach on
marital intimacy in men. The solution-focused
approach was found to enhance the vitality
and resilience of physically disabled students
[23] as well as the happiness and emotion
regulation of couples [24]. Solution-focused
Table 3. Comparison of Frequency Distribution of Women’s Education Level, Spouse’s Education Level
and the Birth Rate of the Child with Down Syndrome between the Two Groups
Variables
Online group
31 couple
Pamphlet group
36 couple
Number Percentage Number Percentage Z*P
Education level
of women
Under
diploma 39.7 4 11.1
0.33 0.73Diploma 7 22.6 9 25
Above
diploma 21 67.7 23 63.9
Education level
of spouses
Under
diploma 7 22.6 13 36.1
1.87 0.06
Diploma 6 19.4 11 30.6
Above
diploma 18 58.1 12 33.3
The birth rank
of the child with
Down syndrome
First 20 64.5 22 61.1
0.34 0.73
Second 10 32.3 12 33.3
Third 1 3.2 2 5.6
*: Mann-Whitney test
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Bokaie M, et al. Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome
brief therapy reduced depression, increased
marital satisfaction in married women [25],
and could enhance marital satisfaction in
mothers of students with intellectual disabil-
ities [26]. Youse et al. (2018) compared the
eectiveness of acceptance-commitment and
solution-focused group counseling approach-
es on the performance of couples on the verge
of divorce. Zakhirehdari et al. showed the
eectiveness of cognitive-behavioral couple
therapy in improving marriage performance
and marital intimacy of couples. Tavaloli et
al. showed the eectiveness of marriage en-
richment training of TIME plan on improving
marital intimacy and psychological securi-
ty of women [27-29]. These studies showed
that counseling approaches can be associated
with improving the performance and marital
intimacy of women in some of the studied
couples. As they mentioned, all approaches of
group counseling were signicantly eective
in marital satisfaction. In the present study,
the solution-focused brief approach was more
eective in increasing marital intimacy in
mothers of children with Down syndrome.
In the post-test to follow-up phases, time did
not aect on reducing the eectiveness of
this treatment. Our ndings showed that solu-
tion-focused training increased marital inti-
macy in the intervention group compared to
Figure 2. The average score of total marital intimacy of women at dierent times in the two groups
Figure 3. The mean score of the total marital intimacy of spouses at dierent times in the two groups
Table 4. Mean Score of Total Marital Intimacy and its Domains at Dierent Times in Two Groups (Women)
Dimensions
of marital
intimacy
Time
Online group Pamphlet
group *P-value *P-value
(N=31) (N=36) (Time
eect)
(Group
eect)
Mean SD Mean SD
Emoonal
Base Line 35.65 7.9 35.11 4.96
<0.001 0.008
After
intervention 42 5.39 37.61 3.59
Follow-up 43 4.96 38.11 3.65
Psychological
Base Line 35.64 8.65 35.53 5.31
<0.001 0.04
After
intervention 41.13 5.5 37.39 4.07
Follow-up 42.06 5.25 37.72 4.12
Raonal
Base Line 58.35 46.8 86.35 10.5
<0.001 0.03
After
intervention 41.39 5.48 37.17 4.29
Follow-up 42.03 5.04 37.39 4.19
Sexual
Base Line 35.68 9.24 36.94 5.85
<0.001 0.239
After
intervention 41.39 6.53 38.31 4.59
Follow-up 42 6.29 38.58 4.40
Physical
Base Line 36.52 8.33 36.56 4.75
<0.001 0.023
After
intervention 42.06 5.38 38.03 3.95
Follow-up 42.74 5.25 38.06 3.91
Spiritual
Base Line 42.81 11.49 43.22 8.17
<0.001 0.112
After
intervention 49.42 7.9 45.03 6.25
Follow-up 50.39 7.25 45.33 6.03
Aesthec
Base Line 34.61 10.11 33.83 6.06
<0.001 0.022
After
intervention 40.03 6.91 35.11 5.25
Follow-up 40.71 6.39 35.25 5.16
Recreaonal and
social
Base Line 33.71 10.46 34.89 7.6
<0.001 0.836
After
intervention 39.84 7.27 41.00 5.68
Follow-up 40.71 7.04 37.31 5.19
Temporal
Base Line 23 5.35 23.97 2.83
<0.001 0.33
After
intervention 26 3.28 24.67 2.4
Follow-up 26.48 3.19 24.67 2.4
Total score of
marital inmacy
Base Line 313.23 70.86 315.92 41.45
<0.001 0.047
After
intervention 363.32 47.05 334.31 31.38
Follow-up 370.13 44.63 332.42 30.39
SD: Standard deviation; *: Repeated Measures
Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome Bokaie M, et al.
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Table 5.Mean Score of Total Marital Intimacy and its Domains at Dierent Times in Two Groups (Spouses )
Dimensions
of marital
intimacy
Time
Online group
(N=31)
Pamphlet group
(N=36) *P-value *P-value
Mean SD
(Time
eect)
(Group
eect)
Mean SD
Emoonal
Base Line 31.42 6.83 32.51 4.68
>0.001
0.002
After
intervention 41.03 5.69 35.52 3.82
Follow-up 43.42 4.54 36.85 3.54
Psychological
Base Line 32.26 7.72 33.03 4.36
>0.001
<0.001
After
intervention 40.81 5.9 35.3 3.9
Follow-up 43.03 4.55 35.67 3.76
Raonal
Base Line 32.68 7.36 34.03 4.25
>0.001
<0.006
After
intervention 41.19 5.81 9.36 4.01
Follow-up 42.81 4.42 36.48 3.9
Sexual
Base Line 32.35 8.09 34.18 4.79
>0.001
0.016
After
intervention 41.03 6.38 36.18 3.75
Follow-up 43.39 5.38 36.88 3.65
Physical
Base Line 32.74 7.67 34 4.09
>0.001
0.002
After
intervention 41.45 5.69 36.24 3.82
Follow-up 43.90 4.53 36.94 3.64
Spiritual
Base Line 38.74 9.94 40.42 7.07
>0.001 0.023
After
intervention 48.84 7.51 43.33 5.44
Follow-up 51.42 5.69 43.82 5.45
Aesthec
Base Line 31.48 8.63 32.45 4.99
>0.001 0.004
After
intervention 39.84 7.14 33.91 4.3
Follow-up 41.9 5.49 34.30 4.38
Recreaonal
and social
Base Line 30.87 9.01 31.85 6.09
>0.001 0.02
After
intervention 39.55 7.77 34.61 4.59
Follow-up 42.1 6.06 35.21 4.19
Temporal
Base Line 20.52 4.8 21.91 2.49
>0.001 .035
After
intervention 25.55 3.66 23.18 2.4
Follow-up 27.03 2.71 23.39 2.34
Total score
of marital
intimacy
Base Line 6.283 62.2 294.45 34.95
>0.001
0.002
After
intervention 359.32 50.51 314.36 29
Follow-up 379 37.25 319.55 28.4
SD: Standard deviation; *: Repeated measures
Bokaie M, et al. Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome
10 GMJ.2023;12:e2747
www.gmj.ir
the control group. These results were in line
with some studies investigating the eective-
ness of solution-focused brief couple therapy
on couples’ happiness and emotion regulation
[24].
The solution-focused brief therapy is a useful
approach [30-32], the solution-focused brief
therapy reduced marital stress among dier-
ent populations and in a variety of settings,
including couple therapy, family therapy,
treatment of patients with intellectual de-
cits, treatment of sexual abuse, and major de-
pressive disorder [33-37]. Couples who were
inuenced by short-term family training had
signicant progress in their marital adaptation
and satisfaction [38]. Similarly, solution-fo-
cused group couple therapy increased marital
consensus and satisfaction of couples [39].
In congruence with these ndings, an inves-
tigation of the eciency of solution-focused
group therapy for couples indicated a signif-
icant improvement in the marital satisfaction
level at the end of the intervention [21, 40].
This treatment method had an enhancing ef-
fect on marital satisfaction, marital adjust-
ment, quality of marital relationships, intima-
cy, and aection expression, which reduced
the rates of divorce and resolved many marital
conicts.
To shed more light on these ndings, one
may notice that the solution-based approach
emphasizes the present and future instead of
drowning clients in the past and rooting out
the causes of the problem [41]. The solu-
tion-focused brief approach is interested in
family change but does not take into account
why the problems emerge in the family and is
mainly focused on the solutions. While ther-
apists and their clients gradually talk more
about the solutions, they develop a belief in
the truth and reality of what they are talking
about. This treatment has dierent compo-
nents, including developing positive view-
points, avoiding labeling, and believing in
the ability of clients. Our ndings indicated
that solution-focused brief counseling signi-
cantly increased marital intimacy and all its
dimensions compared to the pre-intervention
status. Furthermore, the online counseling
group outperformed the pamphlet-receiving
group signicantly. Another noteworthy point
was that counseling in women was indirect-
ly associated with improvement in their part-
ner’s sexual intimacy.
Conclusion
Although solution-focused brief counseling,
whether in the form of online education or
pamphlets, could improve marital intimacy
and its (emotional, psychological, intellectu-
al, sexual, physical, spiritual, aesthetic, so-
cial-recreational, and temporal intimacy di-
mensions) in mothers of children with Down
syndrome, the eect of online counseling
was signicantly higher than that of receiv-
ing pamphlet. This nding can be justied by
referring to specic characteristics of online
counseling, including employing electron-
ic facilities, representing content in the form
of video chat, and providing the possibility
of reviewing the educational content as fre-
quently as required by the participants and
their spouses. Consequently, members of the
online counseling groups could learn the com-
ponents of intimacy, acquire communication
skills to associate among various components
of intimacy and develop a realistic view of
Down syndrome by correcting inecient be-
liefs about marital intimacy after encounter-
ing a child with Down syndrome. In this vein,
participants of the present study learned to use
the methods of establishing intimate marital
relationships during the COVID-19 pandemic
eciently for improving their marital intima-
cy. We oer couples therapy counseling for
these couples.
Acknowledgments
We are grateful to the Vice Chancellor for Re-
search and Technology of Shahid Sadoughi
University of Medical Sciences for their
supportand all participants in this study.
Also, this study was extracted from the thesis
(grant number: 8077 of Naeimeh Mirshaeian
for the MSc degree in Counseling in Midwife-
ry.
Conict of Interest
No potential conict of interest has been re-
ported by the authors.
Solution-focused Counseling on Marital Intimacy in Mothers of Children with Down Syndrome Bokaie M, et al.
GMJ.2023;12:e2747
www.gmj.ir
11
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