Comparison of the Effectiveness of Transactional Analysis Therapy and Narrative Therapy on Fear of Intimacy in Women Affected by Marital Infidelity

Introduction

Marital infidelity is a distressing issue for spouses and families and is a common phenomenon for marriage and family therapists (Fincham & May, 2017). Marital infidelity is one of the primary reasons couples seek divorce and attend family counseling clinics. After the disclosure of a spouse's infidelity, the sense of security derived from interpersonal trust in marital relationships is destroyed (Van Zyl, 2020). Consequently, the established trust in the relationship can easily lead to the destruction of shared assumptions, beliefs, and expectations (Yuan & Weiser, 2019). The issue of marital infidelity is also a concern in Iranian society and is associated with instability in relationships and a high divorce rate. Unfortunately, there are no precise statistics in Iran; however, marital infidelity was reported as one of the main causes of divorce in 2016 and 2019, indicating a high prevalence of infidelity in Iran (Choupani et al., 2019).

Studies have shown that marital infidelity results in various psychological damages to the affected spouses (Fazel Hamdani & Ghorban Jahromi, 2018). Therefore, both the affected spouse and the unfaithful spouse may withdraw from their relationship and experience recurrent intrusive thoughts about the infidelity and its disclosure, with differing responses to these harms post-disclosure (Sui et al., 2020). Intimacy may also impact marital relationships and infidelity (Selterman et al., 2019). Psychologists describe intimacy as the ability to communicate (without control) with another person and express emotions (without inhibition), considering it a fundamental human right and a natural state (Ebrahimi et al., 2021). When an individual's capacity for intimacy diminishes, fear of intimacy develops (Rose et al., 2019). Fear of intimacy, defined as the restricted ability to share thoughts and feelings with a significant and close person, is one of the factors leading to relationship failures (Beltran-Morillas et al., 2019).

In contemporary psychology, various therapeutic approaches have been discussed for individuals affected by marital infidelity, with some proving effective. Among these therapeutic approaches, transactional analysis therapy is notable for its wide applicability and theoretical depth (Fazel Hamdani & Ghorban Jahromi, 2018). Founded by Eric Berne, transactional analysis therapy is one of the best practical methods of group therapy (Shafiabadi & Naseri, 2011). Transactional analysis therapy is a supportive relationship in which a qualified therapist uses transactional analysis methods to enhance the client's or group's "adult" awareness from a problem-solving perspective. These methods are employed to create change through appropriate, here-and-now techniques, aiming to increase cognitive and emotional awareness of the damaged area, such as relationship problems (Boehn, 2020). Research has shown that transactional analysis therapy improves overall family functioning and domains within couples (Sudani et al., 2012), increases satisfaction, positive emotions, and marital skills (Akbari et al., 2012), and enhances intimacy (Neyri et al., 2014).

Conversely, therapeutic conversations, which include telling, listening, retelling, and re-hearing stories, can help heal the wounds caused by a spouse's infidelity (Monk & Winslade, 2019). Narrative therapy assists individuals in overcoming their problems by engaging in therapeutic dialogues (Payne, 2016). A narrative is a story about a life experience created by an individual or group, encompassing events perceived by the narrator as significant life issues (White, 2000). The primary focus of narrative therapy is on the individual and their problem within the context and discourse, aiming to change the person's narrative (Dastbaz, 2013). Narrative therapy enhances clients' vocabulary to narrate their experiences better, helping them understand who they are and express their goals and desires more clearly. Expressing desires and feelings in marital relationships can reduce the tendency for separation, as couples become emotionally closer and less likely to experience infidelity, reducing the desire for separation (Gonçalves et al., 2009).

Narrative therapy has been effective in increasing intimacy in couples and its dimensions (Khoda Bakhsh et al., 2014; Banker et al., 2010; Frost, 2013) and improving family functioning (Rabiee et al., 2008). Sudani et al. (2015) found that narrative couples therapy improves conflict resolution tactics in women victims of violence, reducing psychological and physical violence and fostering greater emotional intimacy.

Given the explicit and implicit prevalence of extramarital affairs and the complex nature of infidelity and its catastrophic effects on relationships, effective interventions are needed to assist couples facing this issue. Most research on marital infidelity has been descriptive, focusing on individuals' attitudes, consequences, and definitions of infidelity. An overview of the oldest to the latest therapeutic methods for reducing tension and increasing marital commitment and interpersonal motivation reveals that each therapeutic method uses different techniques based on its theoretical stance. The reason for comparing transactional analysis therapy and narrative therapy was the relatively significant differences observed in the effectiveness of these two therapies on the dependent variables of the study, with transactional analysis therapy being more effective due to its reputation as one of the most effective methods for improving intra- and interpersonal communications. The ultimate goal of this approach is to ensure that patients fully regain their independence (Shafiabadi & Naseri, 2021). However, narrative therapy is a new approach that involves buried stories that can be rewritten and applied in individuals' current and future lives, and it is more cost-effective than transactional analysis therapy. A review of previous research emphasizes the greater impact of transactional analysis therapy compared to other approaches, and no comparative study of these two approaches has been conducted in any population. Moreover, according to the researchers of this study, no research has simultaneously examined the effectiveness of transactional analysis therapy and narrative therapy on the fear of intimacy, emotional regulation of women affected by their spouse's infidelity, and the difference between these two therapies, indicating a research gap. Therefore, the present study aimed to compare the effectiveness of transactional analysis therapy and narrative therapy on the fear of intimacy in women affected by their spouse's infidelity.

Methods and Materials

Study Design and Participants

The present study used a quasi-experimental method with a pre-test, post-test design and a control group with a two-month follow-up period. The statistical population included all women affected by their spouse's infidelity who referred to counseling centers in District 4 of Tehran in 2022. The sample size was determined based on the number of groups and variables under study. Accordingly, 45 women were selected from the population after a preliminary interview and based on inclusion and exclusion criteria, and were randomly assigned to experimental and control groups (15 in the transactional analysis therapy group, 15 in the narrative therapy group, and 15 in the control group). Inclusion criteria included informed consent, female gender, affected by spouse's infidelity, personal fidelity, at least 5 years of married life, not participating in other psychotherapy courses simultaneously, not taking psychiatric medications for at least one month before the assessment, minimum literacy level (middle school), age range of 20-50 years, and physical and psychological readiness to answer questions. Exclusion criteria included more than two session absences, unwillingness to continue participating in the study, infidelity (taking revenge), concurrent participation in other counseling or psychotherapy programs, and non-cooperation in completing questionnaires at pre-test, post-test, and follow-up stages. The study was conducted by coordinating with the Baran Counseling Center in District 4 of Tehran, where participants' files were reviewed by the researcher, and preliminary interviews were conducted with women affected by their spouse's infidelity. Based on the inclusion and exclusion criteria, 45 women were selected and randomly assigned to three groups: two experimental and one control. Participants completed the research questionnaire as a pre-test before the intervention. The first experimental group received transactional analysis therapy, and the second experimental group received narrative therapy in 8 group sessions of 90 minutes each, twice a week, conducted in person by the researcher. The control group did not receive any intervention. After the therapy sessions, all three groups completed the research questionnaire at the post-test stage and again 60 days later during the follow-up stage. Ethical considerations in this study included: 1) informing participants about the study's topic and method before it began, 2) ensuring the researcher would protect participants' private information and use data solely for research purposes, 3) offering to interpret the study results for participants upon request, 4) providing necessary guidance in case of any ambiguity, 5) ensuring participation in the study would not incur any financial burden on participants, and 6) ensuring the study aligned with participants' religious and cultural norms.

Measures

Fear of Intimacy

The Fear of Intimacy Scale (IFS), designed by Pollard and colleagues in 1988, was used to assess forgiveness within families. The questionnaire comprises two sections: one concerning the original family (first generation) and the other concerning the nuclear family (couples). The original form consists of 40 statements, with 20 items related to forgiveness within the spouse's family, which were assessed in this study. The items pertain to the status of resentments, grudges, and forgiveness among family members. Each statement is rated on a four-point scale: "almost always true," "often true," "rarely true," and "never true." Pollard et al. (1988) reported internal consistency coefficients with Cronbach's alpha of 0.73 and confirmed the questionnaire's two-factor structure using confirmatory factor analysis. This scale was examined for Iranian families by Seif and Behari in 2000, who calculated convergent validity of 0.67 and divergent validity of 0.73 using correlation tests. The internal consistency coefficient with Cronbach's alpha was reported as 0.89. Content and face validity were confirmed by Seif and Behari (2000) through expert evaluation by 15 psychiatrists, final-year psychiatry residents, and senior psychology experts, all of whom endorsed the scale's content and face validity. The test-retest reliability over a 10-week interval was reported as 0.81. In the present study, Cronbach's alpha for the questionnaire was 0.81.

Interventions

Transactional Analysis Therapy

Transactional Analysis Therapy Protocol Based on the Enrichment Program: For the transactional analysis therapy intervention, participants in the first experimental group were administered the therapy protocol based on the Lou and McKay (2017) model during therapy sessions.

Session 1: Introduction

This session involves introducing the group members to each other, establishing group rules, and conducting the pre-test to assess baseline levels of fear of intimacy and other relevant variables.

Session 2: Communication Skills

This session focuses on defining communication skills, teaching empathetic listening and social skills, enhancing positive behavioral exchanges, and promoting the direct expression of emotions.

Session 3: Advanced Communication Skills

Continuing from the previous session, this session emphasizes clear, accurate, and effective transmission and reception of thoughts, feelings, and needs between partners.

Session 4: Identifying Cognitive Distortions

Participants learn to recognize common cognitive distortions in their interactions. The session includes a review of homework assignments and discussions on how these distortions affect couple dynamics.

Session 5: Understanding Schemas

This session prepares couples for identifying maladaptive schemas by discussing their definitions and impacts on relationships. Couples begin recognizing their own and their partner’s schemas.

Session 6: Schema Reconstruction

Participants work on identifying and reconstructing maladaptive schemas, understanding their influence on thoughts, emotions, and behaviors within the relationship. Techniques such as imaginary dialogues with schemas are introduced.

Session 7: Cognitive-Emotional-Behavioral Techniques

The session introduces cognitive, emotional, and behavioral techniques aligned with transactional analysis. Participants learn to prioritize behaviors and review their effectiveness.

Session 8: Practicing Coping Strategies

Participants are encouraged to abandon maladaptive coping styles and practice effective coping behaviors to satisfy basic emotional needs.

Session 9: Behavioral Pattern Breaking

The session focuses on breaking behavioral patterns associated with maladaptive schemas. Techniques for evaluating communication between healthy aspects of oneself are practiced.

Session 10: Adaptation and Resilience

Couples learn about the importance of resilience in relationships and practice strategies to enhance their adaptability and resilience in their marital relationship.

Session 11: Mindfulness Techniques

Participants are taught mindfulness techniques (NBSR) to enhance enjoyment and insight from the present moment, fostering greater connection and awareness.

Session 12: Review and Post-Test

This final session involves practicing the techniques learned throughout the therapy, reviewing progress, and conducting post-tests to evaluate changes in fear of intimacy and other variables.

Narrative Therapy

In this study, the integrative narrative therapy protocol was implemented in group sessions based on Feldman's (1992) model for the participants in the second experimental group.

Session 1: Building Empathy

This session focuses on creating empathy among couples, familiarizing them with therapy rules, building trust for sharing thoughts and feelings, and understanding the nature of their relationship problems.

Session 2: Exploring Current Relationships

Participants explore their current relationships with their spouse, family of origin, and other significant individuals. Individual sessions are held to delve deeper into each partner’s perspectives.

Session 3: Identifying Dysfunctional Patterns

Couples identify and explore dysfunctional communication patterns, focusing on personal traits and facilitating the expression of feelings about current relationships with significant others.

Session 4: Addressing Resistance

The session addresses resistance and facilitates the expression of hidden feelings and desires about significant others. Emotional venting regarding dysfunctional patterns is encouraged.

Session 5: Exploring Repetitive Patterns

This session focuses on recurring interaction patterns or "dances," identifying defenses and resistances that sustain these patterns, and empathetically confronting discrepancies between hidden feelings and current behaviors.

Session 6: Projections and Identifications

Participants examine projection identifications within their relationship with their spouse, understanding how these projections affect their interactions.

Session 7: Modifying Interaction Patterns

The session involves changing and correcting interaction patterns, anxieties, defenses, and hidden desires based on family of origin identifications and current relationships, intensifying projection identification chains.

Session 8: Addressing Infidelity Anxiety

The session explores methods to change the anxiety stemming from infidelity over time, diagnosing problems resulting from infidelity anxiety, and overcoming them through cognitive coping strategies. Practice and homework are assigned.

Session 9: Communication Styles

Participants become familiar with different communication styles and coping responses, explore family interaction patterns, hypothesize about family hierarchy and power distribution, and practice these concepts in the session.

Session 10: Strengthening Functional Boundaries

This session focuses on strengthening functional boundaries and eliminating dysfunctional ones within the family system. Discussions include familial metaphors, relationships with relatives, and balancing relationships with extended family and friends.

Session 11: Generalizing Therapeutic Relationships

The aim is to generalize the therapeutic relationship to other life relationships, particularly outside of therapy sessions, and resolve existing crises with their spouse.

Session 12: Reviewing Progress and Closure

The final session reviews the relationships developed during the therapy, accepting ownership of their identifications, and preparing couples for the conclusion of therapy.

Data analysis

Data were analyzed using mixed ANOVA and SPSS version 26.

Findings and Results

The demographic information of the participants showed that 45 individuals (15 in the transactional analysis therapy group, 15 in the narrative therapy group, and 15 in the control group) were included, with mean and standard deviation for age being 34.51 (SD = 5.29) for the transactional analysis therapy group, 33.75 (SD = 5.61) for the narrative therapy group, and 33.58 (SD = 5.48) for the control group. All participants were female. The descriptive findings for the research variables are presented below. The mean was used as a measure of central tendency, and the standard deviation was used as a measure of dispersion.

As shown in Table 1, fear of intimacy for the three groups (control, transactional analysis therapy, and narrative therapy) is displayed across three stages (pre-test, post-test, and follow-up). It is observed that in the control group, the mean total score for fear of intimacy shows little change between the post-test and follow-up stages compared to the pre-test. However, in the transactional analysis and narrative therapy groups, there is a significant increase in fear of intimacy in the post-test and follow-up stages compared to the pre-test.

The significance of these changes was examined using mixed ANOVA. Before conducting the mixed ANOVA, the Kolmogorov-Smirnov test was used to check the normality of the distribution of fear of intimacy scores at the three measurement stages (p>0.05). Levene's test was used to assess the homogeneity of variances in fear of intimacy at the three measurement stages: pre-test (F=0.186, p=0.20), post-test (F=1.105, p=0.123), and follow-up (F=1.33, p=0.263). M-Box's test was used to check the homogeneity of the variance-covariance matrix for fear of intimacy (MBOX=29.73, F=1.04, p=0.32), and the results were not significant. Mauchly's test of sphericity indicated that the assumption of sphericity was not met for the variable of fear of intimacy. Therefore, Greenhouse-Geisser correction was used for interpreting the results.

Based on the results of the mixed ANOVA presented in Table 2, there is a significant difference between the groups and over time for the variable of fear of intimacy. Specifically, there is a significant difference between the pre-test, post-test, and follow-up stages across the two therapy groups and the control group. The group effect indicates a significant difference between the transactional analysis therapy, narrative therapy, and control groups regarding fear of intimacy, with the Bonferroni post hoc test results shown in Table 3.

As observed in Table 3, there is a significant difference between the narrative therapy and control groups for fear of intimacy (p<0.05) and between the transactional analysis and control groups for fear of intimacy (p<0.05). Additionally, the results show a significant difference between narrative therapy and transactional analysis therapy at the 0.05 significance level. The difference in means between transactional analysis therapy and narrative therapy for the variable of fear of intimacy in the post-test and follow-up stages is significantly positive, indicating that transactional analysis therapy is more effective in increasing fear of intimacy compared to narrative therapy (p<0.05).

Discussion and Conclusion

The present study aimed to compare the effectiveness of transactional analysis therapy and narrative therapy on the fear of intimacy in women affected by their spouses' infidelity. The findings indicated that transactional analysis therapy effectively reduces the fear of intimacy in women affected by their spouses' infidelity. These findings align with those of Fazel Hamdani and Ghorban Jahromi (2018) and Nejad Karim et al. (2017).

In explaining the effectiveness of transactional analysis therapy on reducing fear of intimacy in women affected by their spouses' infidelity, it can be stated that the women in this study, through understanding ego states, became aware of how these ego states manifest in their spouses and children in various situations. They learned to enhance intimacy by establishing proper relationships, resolving conflicts, and issues, which increases family cohesion and closeness, leading to greater forgiveness and intimacy. By learning transactional analysis, individuals gain self-awareness (Fotouhi Bonab et al., 2021) and become aware of ego states and interactions in relationships, fostering constructive communication within the family that shifts the "You are not OK" stance to "I am OK – You are OK," leading to emotional closeness. When an individual is upset and feels "You are not OK," they may also develop the view "I am not OK" due to the interactions that have occurred. Training in transactional analysis helps change these formed views. When an individual develops the "I am OK" view, they realize that one aspect of being OK is acceptance and forgiveness. Additionally, understanding the ego states, structural damage, and life scripts of the offending person facilitates the shift to "You are OK" more easily. Transactional analysis training on positive and effective strokes, including active listening and avoiding blame and negative strokes, as well as facilitating intimacy by expressing genuine feelings with adult awareness and acceptance of oneself and others, and avoiding psychological games, can all lead to increased intimacy, attraction, interest, and desire among family members.

Furthermore, another finding of the study showed that narrative therapy effectively reduces fear of intimacy in women affected by their spouses' infidelity. This finding is consistent with the research of Priscala (2002) and Andrew et al. (2003). Avoidance of unpleasant emotional states is one of the goals and motivations of fear of intimacy. In relation to the role of narrative therapy as a chosen method for reducing fear of intimacy, studies confirm that narrative therapy is associated with thought control strategies by externalizing the problem. By doing so, individuals re-evaluate their beliefs about themselves, thereby alleviating the emotional burden related to fear of intimacy and experiential avoidance (Klonsky, 2007). Studies show that the life stories of individuals affected by their spouses' infidelity are filled with experiences of sadness, failure, lack of self-respect, hypochondria, and doubt (Ryo, 2005). Psychological research indicates that women affected by their spouses' infidelity often blame themselves when recounting their life stories, making them more susceptible to fear of intimacy and avoidance (Pevesta Gar, 2015). Narrative therapy allows individuals to describe themselves and their relationships based on a new, problem-free perspective, helping them find the realities related to themselves that were not understood when justifications filled with problems were in place (Goldenberg, 2012).

Narrative therapy has a strong capacity for psychological interventions with women affected by their spouses' infidelity, helping them recognize their self-efficacy, values, commitments, and abilities, and change their relationship with the problem (Reamen et al., 2021). Narrative therapy can enhance women's ability to cope with difficult life circumstances, reduce self-blame, and decrease the tendency to blame others (Voe et al., 2021). Negative emotions and the low capacity of women affected by their spouses' infidelity to effectively manage these emotions were key factors leading to insufficient attention and arousal, which narrative therapy helped to improve by increasing control over these emotions and replacing them with positive emotions. The bidirectional effects between emotions and cognition are likely, with emotions helping to organize thoughts and actions and cognitive processes playing a significant role in regulating emotional cognition. Narrative therapy aims to structure individuals' experiences by altering their cognition, making decision-making easier and gradually eliminating disruptive experiences. Numerous studies show that expressing emotional distress in words during narrative therapy enhances mental and physical health.

Finally, the findings of the present study show that transactional analysis therapy has a greater effect on reducing fear of intimacy compared to narrative therapy in women affected by their spouses' infidelity, and this change was maintained at the follow-up stage. It can be explained that women who have experienced their spouses' infidelity desire interpersonal relationships but fear rejection and repeated infidelity. In transactional analysis therapy, the women in this study learned how ego states manifest in their spouses and children in various situations and learned to enhance satisfaction in relationships by establishing proper relationships and resolving conflicts and issues, leading to increased family cohesion and closeness, and forgiveness of others' mistakes. By learning transactional analysis, individuals gain self-awareness (Fotouhi Bonab et al., 2011) and become aware of ego states and interactions in relationships, fostering constructive communication within the family that shifts the "You are not OK" stance to "I am OK – You are OK," leading to emotional closeness. When an individual is upset and feels "You are not OK," they may also develop the view "I am not OK" due to the interactions that have occurred. Training in transactional analysis helps change these formed views. When an individual develops the "I am OK" view, they realize that one aspect of being OK is acceptance and forgiveness. Additionally, understanding the ego states, structural damage, and life scripts of the offending person facilitates the shift to "You are OK" more easily.

Marital infidelity is one of the most destructive problems in a relationship and commonly leads to divorce, defined as a violation of the sexual agreement between a couple. Both the affected and unfaithful spouses may withdraw from their relationship and experience recurrent intrusive thoughts about the infidelity and its disclosure, often seeking revenge, which reduces fear of intimacy. This study aimed to compare the effectiveness of an enrichment-based transactional analysis program and integrative narrative therapy on reducing fear of intimacy in women affected by their spouses' infidelity. It was concluded that both interventions positively impact reducing fear of intimacy in these women, but transactional analysis therapy is more effective than narrative therapy. These results support the effectiveness of both interventions, emphasizing the importance of these therapeutic methods for women affected by their spouses' infidelity. Thus, the findings of this study can pave the way for interventions to assist women affected by their spouses' infidelity.

Limitations & Suggestions

One limitation of this study was the purposive sampling of women affected by their spouses' infidelity from a specific area in Tehran, which reduced the external validity of the research. Additionally, some psychological variables (such as psychological mindset, insight of the clients, clients' motivation, concurrent events, and stressors during the research) were not considered, which could threaten internal validity. Future research should aim to reduce potential biases and control confounding variables by sampling from various cities and groups with larger sample sizes to generalize the results with greater confidence.

Acknowledgments

We would like to express our appreciation and gratitude to all those who cooperated in carrying out this study.

Declaration of Interest

The authors of this article declared no conflict of interest.

Ethical Considerations

The study protocol adhered to the principles outlined in the Helsinki Declaration, which provides guidelines for ethical research involving human participants.

Transparency of Data

In accordance with the principles of transparency and open research, we declare that all data and materials used in this study are available upon request.

Funding

This research was carried out independently with personal funding and without the financial support of any governmental or private institution or organization.

Authors’ Contributions

All authors equally contributed in this article.