Chapter 5: The Secret of Happy Marriage

Books - The Rising Price of Love

Health hazards are one thing, but what about emotional health and emotional pain? This is the age of the "dinkies" (dual income, no kids, easy divorce). In Britain this followed the 1984 Matrimonial and Family Proceedings Act, with 10% of all marriages ending in two years - but is life that simple? Not according to the agony columns which are giving out a lot more than sex advice, helping people cope with relationship pain, the true agony of their situations.

We have seen that the search for love is one of the most fundamental and long-lasting human drives, influencing almost all others and having a dominant effect on sexual behaviour in many people.

I want to look now at what happens when people feel they have found the answer to that search - and then lose it. Bereavement following partner death is often deeply traumatic. By the age of 65, one in five married men have lost their wives through death, and half of all women are widowed. Those at highest risk emotionally are young with several children, a previously happy marriage and now financial difficulties.

However I want to turn to grief caused by partner separation, its long term effects and what we know about predicting long term stability and happiness.

Grieving after separation is complicated by conflicting emotions and the fact that both go on living. Lives may cross and re-cross with shared friends, neighbourhood or places of work. The chances of a "clean break" drop almost to zero if children are involved. Every day a divorced or separated parent looks at his or her children, there are powerful reminders of the previous partner - in their existence and "family likeness".

Women often more dissatisfied than men

Although cohabitation is common, most research on partner happiness has been done on those who get married. We need to look at the results urgently. The divorce statistics are ghastly, with one divorce for every two marriages in Britain in 1992. Three out of four of these divorces are initiated by women and women are generally more dissatisfied by marriage then men. A sex therapist said recently that in his experience a great many women in middle years were bored with the lack of emotional response from their husbands and landed up seeking more support from other women, at a time when their partners might have no idea anything was wrong.

If we were to extend trends from 1971 to 1991 on further to 2011 we might find that divorces had equalled marriages by then.

However this is very unlikely because of the changes already coming. As we have seen, it is still true at the moment that most marriages last for life.

Despite gloomy predictions by the Family Policy Group of a 40% divorce rate for new marriages by the year 2000, there are signs of a flattening out of the massive jump in divorce and plummeting marriage rates.

British divorce rates doubled from around 80,000 per year in 1971 to 157,000 in ten years. However it only rose to 170,000 at the end of another decade, while the marriage rate from 1981 to 1991 hovered around or near the 375,000 mark. The number of divorces per thousand married people has remained almost unchanged since 1986 (around 13).

We have already seen that three times as many UK adults in 1993 wanted divorce to be made harder than wanted the law to be eased. But will that just lock people up in misery?

Meanwhile more couples are looking for professional help. Relate saw only 22,000 people in 1971, but the figure had risen to 70,000 by 1991, and 76,000 two years later.

You cannot have love without grief

Recently I sat on the Bench with a County Court Judge as he deliberated over case after case of partner dispute. Wrangles over housing, property income - and children. Who looks after them, where they live, or go and stay? Can dad take them out for a day? An hour? At all?

You cannot have love without grief. The more the love, the greater the pain of separation - from whatever cause, even if it is caused by death. The only way you can avoid grief if you are happy together is by dying first. The greater the hope, the more acute the disappointment. The greater the investment, the greater the loss. Experience of those in the hospice movement over the years is that grief is made harder by relationship conflict. For these reasons we might expect divorce in those married for some time to be particularly likely to be devastating.

In addition, at such a time of great loss there is often isolation. A study of divorced women in America found they often lost a wide circle of friends although closest family and friends kept in touch. Families tended to rally round divorced mothers with pre-school children but they often had unmet needs ranging from emotional support to financial difficulties, need for a boyfriend, partner or spouse, time for themselves and for child care.

Single parent mothers on low incomes are most likely to be sad and unhappy. Six out of ten in a study of 225 women were found to be very depressed, affecting not only their own emotional health, but also their attitudes to their children and in turn child behaviour.

As we have seen, a Norwegian study found divorced or separated people have a four times greater chance of needing admission to a psychiatric ward compared to those married.

A particularly vulnerable time can be when children grow up and leave home. This is a big adjustment for all parents but at least parents together have each other. Coping with the empty nest can be far more difficult on your own, especially when older teenagers have been providing a substitute for a partner's company.

Divorce increases poverty

A new female underclass is being created by marital breakdown, according to Dr Angela Dale, deputy director of the Social Science Research unit at City University, London. She looked at 11,500 men and women aged 33 in 1991 and found single mothers were often "hard up, having lost their hold on the job market, and faced every prospect of an impoverished old age dependent solely on state pensions. They were trapped in a downward economic spiral in which the demands of bringing up a child single-handedly cut income."

If divorce is so destructive then we need to look at ways to prevent it. Attitude towards a relationship by both people is a vital key to its future. Cynicism is likely to wreck it before it starts. The trouble is that previous hurts or parental unhappiness can make people feel very cautious about how much they trust or are willing to invest. Trauma in one generation can lead to cynicism in another and a cycle of unhappiness may repeat itself, as research has shown.

One response has been to take out insurance against divorce, or pre-marriage settlements. You go to a solicitor before you get married to agree divorce terms in advance just in case. Such arrangements are unlikely to lead to happier or more stable marriages. Research suggests we will find the opposite because anything that undermines the strength of long term commitment to work things out is likely to make a split more likely.

And how will insurance help a marriage work well?

An easier exit may make life harder

I remember a female medical student I trained with who got married and announced she was keeping her maiden name. That is a valid decision for many reasons, for example equal recognition of women rather than negating female identity and lineage in male paternalism. However she said her motivation was insecurity because her own parents had split up and she had little confidence in her own future.

She did not want the hassle of changing her professional name if she divorced. You may feel women changing their names after marriage is oppressive. Why should women bear yet another unequal cost of divorce? She was the only woman in the year who took such a step. She was separated in less than twelve months and divorced within two years.

I am not saying the marriage would have worked better if both had agreed the same name. What I am saying is that research shows that you tend to get out what you put in. Attitudes count: they shape our responses to each other, communication and even sex life.

Feeling secure is very important in long term, happy relationships, where each person feels able to rely on the other and partners are "psychologically available", around and listening well. The feeling of mutual dependence in a satisfying and close relationship is one of the most deeply rewarding human experiences - far more likely to sustain a lifetime marriage than sex alone. Security means couples can laugh at themselves, rather than take everything too seriously, keeping a sense of proportion at times of tension.

So why do people get into relationships that are likely to destroy them, their partners and possibly their children? Is love so blind? How can we help people see trouble ahead before they get married rather than eight weeks after?

We want to learn from other's mistakes

Perhaps every couple preparing to get married tends to look around for a role model: a relationship that is happy and fulfilling, where both people treat each other well and are finding their full potential. We all have our own explanations and theories as to why the so and so's broke up, why he and she are so happy, why you reckon him and her will split within a year.

We apply these anecdotal experiences to our own lives and the lives of our children. Sheila and I certainly did. This person is someone I could see myself married to happily. That person is amazingly attractive but if we lived together I reckon we'd row all the time. I like so and so, but I'd hate him or her to bring up my kids.

We started with a hope for marriage as a happy lifelong commitment, seeing divorce as a personal disaster. We searched in our experience for role models we liked that were working and were very excited one day to discover that we loved each other, and that both of us felt we could be very happily married - as indeed has turned out.

So what does research show? Firstly, I want to look at long term relationships and at attempts to predict survivors out of those already partnered. Secondly, I want to look at partner selection.

These things are vitally important to the whole future of sexual behaviour. If it becomes clear we now know how to help guarantee a marriage will be happy long term, how to select an ideal partner and how to work it out together, it may lead to a new confidence and belief in stable relationships. As we have seen, when people fall in love most do want to believe it could last forever. But what is the evidence that it can?

New research helps long term happiness

There are few great surprises from all the studies: love, care, affection, unselfishness, agreement, consensus, understanding, similar ways of seeing things, a willingness to listen, be flexible, give, apologise, make adjustments and spend time talking together are all important. Research shows that despite popular fiction spouses do not get more similar to each other with time. Many are similar before they get married.

Verbal or physical abuse, lack of respect for the other, drug or alcohol addiction, unwillingness to invest time and effort in communication or in resolving difficulties, taking the other person for granted, long standing hostility, unwillingness to apologise, rigidity and unwillingness to make adjustments are all factors associated with risk of breakdown. Marriages can also come under pressure when children arrive, partly because of the change from a simple partnership to a family unit. One in three couples in a recent British survey found their relationship declined with increased conflict after birth of their first child. However relationships that survived then had a good foundation for the future.

The answer is for both to be particularly sensitive to the other's needs at that time of change, and to keep talking, making each other continue to feel important and special. The arrival of a child is very often a time of great happiness and celebration for both, further strengthening a lifelong relationship with a new sense of purpose together.

For Sheila and I, having children has been a wonderful experience, a never ending source of enrichment and pleasure - although tiring and emotionally taxing at times, especially when it comes to loss of sleep with a baby, the feeling of utter responsibility for a little baby, and later on the issues of discipline with a clash of wills and personalities.

We waited several years after being married, enjoying being able to pursue two full-time careers without time conflicts, and enjoying the freedom. When children came we were both ready and looking forward to it, something we wanted to do together, an important new development in our relationship.

Incidentally, we got married relatively young, at 21 and 22, and waited until then to begin a sexual relationship, which for each of us was our first. Therefore our wedding day was vitally significant, the start of the whole of the rest of our lives, a celebration of coming together.

"Life after sex" for us has been life after making a public commitment to care for and be faithful to each other. Our entire intimate language of erotic love has been built with each other over years, and every time we enjoy sex, we do so as a powerful, passionate experience of that same declaration, commitment, affection and security.

Predicting divorce

The number of reports predicting long term marriage stability is growing rapidly - a whole new research industry. We know enough now for a bookmaker to be able to offer stakes on the likelihood of an engaged couple still being together for their golden wedding (fifty years).

Since the average length of marriage before separation can be as little as five years, it is obvious that many relationship problems have their roots in the premarital stage. As we have seen, in many cases the process of breaking up has started less than a year after marriage . Therefore the nature of pre-marriage relationships should be a good indicator of what is to come - except in arranged marriages where the indicators are likely to be other equally predictable factors.

Incidentally, I hear many negative comments about arranged marriages, but where the choice has been a good one, with some involvement of the two concerned, the result can often be an affectionate, caring, lifelong relationship. After all, as we have seen, many people when left entirely to themselves make disastrous choices.

We have seen that divorce in one generation makes divorce more likely in the next, although the added risk is relatively small. Teenagers from divorced families go out on dates more often, and are less happy in their pre-marriage relationships than others, particularly if divorce is associated with hostility between parents, conflict between the parents and the child and if the parent retaining custody remains single.

It is well known that teenage marriage is a high risk. However, if you survive the first five years the risk falls towards the average of all marriages. marriage after the age of thirty also carries a higher risk factor, because adjustment gets more difficult with age. So the lowest age risk is for couples getting married in their twenties.

Look before you leap

Longer courtship makes happy marriage more likely, probably because there is increased time for adjustment. However very long courtship, including cohabitation with varying degrees of enthusiasm for getting married, is more likely to end later in divorce.

I can remember someone saying they would be engaged for seven years. If they can wait that long without any urgent feelings to be one, what kind of glue is going to hold them together? If they are going to live together anyway as man and wife beforehand, but with a private commitment to each other, why not do it publicly and celebrate a great start to the most important human relationship in their lives? Some live together because they say they need to save up for this and that. But possessions and income don't make marriages happy. The strongest foundation is found somewhere else.

Other factors making life-long marriage more likely are happiness in parents' marriages, a warm relationship with parents and brothers or sisters, lower childhood conflict with parents and a background of firm parental discipline.

"Tranquillity, frankness and steadiness" in men and "frankness, stability and contentedness" in women are low risk factors for divorce. So are "consideration for others, companiableness, self confidence and emotional dependency on the other, having the same degree of attractiveness, or extraversion or intelligence". Emotional dependency is a positive thing when both partners feel it towards each other because it binds them together. They feel they need each other to be happy in an exclusive, emotionally fulfilling attachment and want to share their lives deeply.

On the other hand constant arguments before marriage , tension and conflict, physical aggression or communication problems are predictors of a likely weak relationship with serious problems two or more years later.

Burgess and Wallin carried out a classic study of 1,000 engaged couples in 1953. Broken engagements were associated with parental disapproval, differences in leisure time preferences or religious faith, lower levels of expressed affection and less confidence in the happiness of their future marriage .

Deception, avoiding talk about the relationship, and conflict all erode relationships in early stages. The trouble is we tend to be less accurate in detecting deception as relationships get longer. The most damaging area of deception is another, secret relationship. It does not even need to be the act of sex. There can be such a thing as emotional adultery, robbing a partner of intimacy and knowledge.

Computer assisted predictions

Attempts have been made to combine all these things into score sheets such as "PREPARE" which measures eleven risk factors to predict relationship survival. It looks at realistic expectations, personality issues, communication, conflict resolution, financial management, leisure activities, sexual relationship, children and marriage , family and friends, equalitarian roles and religious orientation. It is good at predicting who is most likely to be happy or unhappy, divorced or not up to three years after marriage .

So then, there is hope for people who are fed up with relationships that don't work. Choose the person you invest your life into with great care, perhaps taking into account the opinions of good friends and family as people more likely to be objective, develop the relationship slowly in a loving and unselfish way, keep making the relationship a priority for the rest of your lives - and make sure the person you love feels the same way about you and has similar expectations, before you get too involved. You don't have to get divorced. Most people don't. Of course both spouses need to be equally committed to making things work.

So often people start going out with someone they are initially attracted to, without much thought, and land up getting married, then divorced. Can we wind back the video-tape to see what is going wrong? I can hardly remember the times Sheila and I have heard people tell us that they would never consider marrying the person they are going out with "because it would never work. So what were they doing? Just playing at relationships? Even short term relationship break up is often traumatic, especially if they have had sex together.

We have seen over and over again how people get more and more drawn into disastrous relationships. They start going out with someone they know could be a big risk long-term but is fun to be with, then begin to fall in love and lose objectivity. "Love at first sight" can be particularly suicidal: an instant and overwhelming infatuation with a near total stranger. Sometimes it works out but often it does not.

The second or third date with someone very attractive may be the last completely objective decision the person makes about a relationship. We need to think carefully from a distance before losing our hearts to an uncertain future - if we want to increase our chances of long term happiness, or we may find ourselves propelled against common sense into long term misery from which the trauma of later divorce comes as a relief.

Compatible or just a good relationship?

Over the last seven decades theories have come and gone about whom we choose as partners and why. Freud told us we tended to marry people who unconsciously reminded us of our opposite-sex parent, related to the "oedipus complex".

Then came "compatibility" theories. If various aspects of our personalities and backgrounds match, then we should get on well. This is the "birds of a feather flock together" folk-lore. At first it looks like research backs this up.

Many studies have found couples tend to be similar in attitudes and values, personality, physical attractiveness, age, sex, religion, race and other things. However part of this could be because we tend to move in certain circles of friends, because of where we are brought up - and this may narrow our choices.. Similarity does not predict who stays together and who breaks up. Another version of "compatibility" theory is that "opposites attract": we choose people who will complement who we are. This is widely believed but again there is little science to back it up.

Most work on relationships has turned away from these simplistic explanations of background or personality to look at how people relate to each other. What happens when two people spend time together? How do they communicate? How do they behave? Do they have positive attitudes to each other? What is the quality of the relationship? Is there any commitment to work things out? Do they love each other? Of course, similarity can help these things, for example if interests are shared, or two people have a similar educational background, or come from similar family culture.

These courtship studies are fascinating and once the media wakes up to them I believe we will begin to see a profound effect on partner choice and behaviour, with improved relationship stability. After all who wants to be miserable when you can be happy for life?

This information makes it more likely that those who want to will be able to build long term relationships with a realistic expectation based on the positive and negative experience of tens of thousands of others. With care and attention they know their relationships are likely to bring lasting pleasure and be a deeply enriching experience.

The alternatives are not glamorous, they are bleak. Flitting around from one person to another may be acceptable to many twenty year olds, but when you are in your late thirties or early forties, questions about whether you will ever have a family can start to grow, especially for women, or doubts about whether you want your current partner as a future co-parent.

Painful reality of approaching middle age

Sheila recently went to an old school reunion. Some people were single and very happy and fulfilled to be so. Many others were married and had "settled down", often with a number of children who were fast growing up. Others were in various kinds of sexual relationships.

One former class-mate said she now had a "live-in weekend partner", a relationship of temporary companionship and convenience. However, the painful reality is that at the age of thirty eight her fertility is now falling rapidly and the possible medical complications of pregnancy and birth are increasing by the day. If she is ever going to have children of her own, time is fast running out.

Many men who want children have "settled down" by the age of forty, while others may have no desire for long term ties. A divorced man may have children of his own already. Does she want a "second hand" husband, or to be mother to someone else's children when she is unlikely to have more than one of her own?

A decade later the philosophy of transience becomes even harder to cope with: a forty eight year old woman married at the age of twenty, now divorced with two teenage children. A fifty year old man living alone in a bedsit, paying maintenance to keep his ex-wife and three children in the family home - just one of 25% of British households, a threefold increase in single living from 1961 to 1992.

Or a man who has had five relationships each lasting several years, now alone again at forty eight wondering what will happen when he is sixty. This is the dry, harsh reality. The debris of youthful hopes, years and shattered dreams.

What life can be like after sex

A forty six year old woman has two children from different fathers who do not get on. Her male lodger has become a sexual partner, resented by the seventeen year old who is moving out. The eight year old cries every night for his dad. He is withdrawn and his teacher is concerned. He is scared of the lodger. His own dad has another woman now. His new step-mum is twenty four and has just had a baby - no time for him. You will find similar situations in any school or in the law courts. Children may need protecting.

Transience becomes more and more costly as the years pass. A man in his sixties starts another relationship with a married woman and tries to persuade her to leave her husband. The relationship is discovered and the wife leaves to live with the man but finds him difficult. She separates, now facing thirty years of decline to old age on her own. Her children have never forgiven her.

Such things make powerful subjects for plays, films and books, but can be hell to live through and the end result is more and more in question.

A generation to judge

The trouble with social experiments is that they usually take a generation or two to assess. What happens to a nation pulverised by the biggest divorce rate in history and the biggest rate of cohabitation and births outside marriage ? No one knows but the impact is likely to be almost immeasurably huge on every aspect of life well into the middle of the next century. Will there be a reaction when we count the cost? Of course there will - there is already.

All is not lost if people hit problems. Marital therapy is a boom industry offering hope in distress, whether through agencies like Relate, psychotherapy based models or other sources. Relate's income in 1992/3 was almost £11 million. Why the boom? Because so many people are facing the collapse of their relationships and realise how much trauma it will involve to separate. They hope deep down there is a better way forward. They want to believe there can be hope.

So what approaches are being taken? These hardly fill newspaper or magazine pages yet, but are a mark of a trend to come. This is important because every new understanding we have of how to make relationships in difficulties go on to work long term, brings nearer the romantic ideal for more people.

Preventing marital distress

It is possible to categorise behaviour of couples into five main kinds of relationship patterns, depending on how they tend to resolve conflicts, avoid them, or escalate them. Two of these have a high risk of divorce.

Researchers at the University of Denver in Colorado have been following up couples over five years of therapy designed to teach them how to improve communication and work through conflict. After five years, communication in many had improved significantly and levels of violence were down. So marital therapy helps prevent divorce and conflict.

Violence by husbands is a common problem. You can predict in advance marriages where it is more likely to happen. Domestic violence is more likely in relationships where the husband is subordinate, with less earning power, less decision-making power and poorer communication skills.

It has been suggested (without wanting to try and justify violent behaviour in any form) that violence by husbands may sometimes be compensatory behaviour to make up for perceived lack of power in other areas of the marriage . Marital therapy can then be directed amongst other things at helping to restore a man's self image as well as directly encouraging self control and conflict resolution in non-violent ways.

Some models of family therapy do tend to play down the seriousness of violence by emphasising shared responsibility for whatever happens. A worrying survey of 362 therapists in the US found very few took much notice of violence and the need for protection of wives.

In a world that is still strongly male dominated and paternalistic, some marriages get into added difficulties when roles are altered. For example, a woman going out to work for the first time after years of marriage may enjoy extra income, financial independence and less domestic chores, with husbands expected to take a more equal share.

A study in New Jersey suggests that these changes may be beneficial for women but mental health of some husbands can be affected by the stress of the adjustment. We need to see marriage in the context of the whole of life, helping partners to release each other to their full potential, adjusting to change without feeling trapped or threatened.

Many couples get "stuck" in conflict, expecting the other to make the first move, the first apology. "If my partner refuses to change first, I am helpless to do anything about the situation." There are practical ways through this, turning helplessness into empowered creative action.

My experience is that when you think an apology is due but not forthcoming, look in your own heart for something you can apologise for yourself and take the initiative to apologise first. As that happens, it often triggers a corrsponding response, helping break down the wall of mutual hostility and resentment. If that fails and there is "lock-up" in the relationship, then outside help may be needed, even if from a mutual trusted friend, or later from professional counsellors.

marriage " class="gcbasicbold">Alcohol abuse and marriage

Alcohol abuse is a common cause of marital distress and urgent attention needs to be given to combating this problem at individual, local and government levels. An existing alcohol problem can also be made worse by unhappy marriage .

Parental alcohol abuse affects children in many ways. A study of 16,795 US adults between the ages of eighteen and thirty nine found white adults were 50% more likely to get married early if a parent abused alcohol, which may help explain why so many of the marriages of children from "alcoholic" homes break up - youth is a big risk factor. These marriages may happen early because older teenagers are trying to escape alcohol related problems at home, or because they have a greater need than others for love and affection.

Sometimes marriages can hit problems just when pressures seem to be easing. A large number of couples seek professional help during midlife changes. Some have long standing problems, but others have marriages that seem at first sight to be highly successful. They are more financially secure, more established professionally and socially, less controlled by the demands of young children, yet in deep trouble.

Lifelong marriage can only survive by constant adaptation to changes within each person - but on the other hand those same changes can help keep a relationship fresh and interesting. Change is obvious with the birth of a child or a new job, yet change happens continually. People who hope just to "live happily ever after" are likely to find years later they are married to a stranger, if still married at all.

Which couples respond best to help?

Can you predict who will be helped most by marital therapy or marriage guidance counselling? An important report from the Department of Psychology at Texas University suggests that you can. Three psychologists looked back at how fifty five couples had progressed over four years.

Couples most likely to be divorced or still very unhappy were ones where at the start one partner was very depressed, where there were poor problem solving or communication skills, and where one or both were unskilled workers. You need a certain level of intelligence and emotional commitment to get the best out of some of these approaches.

Many difficulties can be caused or made worse by health problems. Doctors and nurses are often very slow to recognise this and discuss it - for example with sex and heart problems, gynaecological cancers or Alzheimer's disease.

On the other hand, helping people's marriages can improve their health, or their ability to live with illness. For example, marital therapy has often been used for couples where one or other has severe chronic low back pain. In Finland, sixty three couples were found where chronic back pain was a problem. Half were given marital therapy. After five monthly sessions with two therapists they were all followed up a year later. It was found communication improved in the treated group, and worsened in the control group (no therapy). Levels of psychological distress were less with treatment, although the actual disability remained the same.

Helping couples resolve conflict may reduce blood pressure in men which can shoot up when they try to influence or control their wives, and depression or suicide rates among women - because suicide is not unusual in severe cases of marital distress in the absence of professional help. Marital therapy can be a very effective way to treat some people with depression, by dealing with the main cause of distress.

Family doctors are well placed to help couples with relationship or sexual difficulties. They may have known partners and children for years and built trust. This "therapeutic alliance" is vital for success in supporting a couple through painful adjustment. With training many doctors can more easily help identify couples heading for a crisis and offer support.

Sex problems can emerge in long term relationships

As we have seen, sexual dissatisfaction or dysfunction is very common, affecting perhaps one in five of all adults at any time, including the elderly. We have already seen how our culture creates sexual dissatisfaction even where there was none before, part of hyping the impossible sexual ideal of pornography.

"Sensation seeking" does not guarantee fulfilment. Indeed the opposite may be true. One study found that female "sensation seekers" had greater sexual desire, greater sexual arousal and more positive attitudes towards sex but the same frequency of

sexual intercourse and greater marital or sexual dissatisfaction.

When people think of sex problems they often think of impotence, premature ejaculation or lack of orgasm in women. While great progress has been made in treating impotence with medication, and premature ejaculation with stop-start techniques, most sexual difficulties such as impotence or lack of orgasm are caused by psychological and emotional factors as well as physical ones such as poor technique.

Dr Paul Brown is a psychiatrist who set up one of Britain's first government funded sex clinics. In four out of five cases it is women who seek him out, hoping their partners will follow. He often asks couples how they make "intimate time" for one another. "In so many marriages, sex stops being something for which time is created. It's a kind of quick relief function. Who would do anything for REAL pleasure in the last fifteen minutes before falling asleep?"

Sex therapy growing

As with marital therapy, there are many different sex therapy approaches. All appear to help some people, but others are not helped and it is hard to choose one method on the basis of results.

A deciding factor will be cultural. For example, different strands of Asian traditions can be used in sexual counselling of people from a Hindu or Buddhist background in a way totally different from an approach for devout Muslims or Christians. An approach to a couple from an ethnic minority in Britain might be very different from a couple in India, Malawi or Thailand.

Common reasons for sexual difficulties are negative, confusing, guilt inducing or traumatic sexual experiences. While sexual abuse has been increasing, so have the casualties. One successful approach has been to help the person to be a "survivor" rather than a "victim", helping a couple develop a fulfilling sex life because living well stops the abuse from controlling the present and future as well as the past.

The aim of therapy is not just to restore sex life, but to create a "style" of sexual behaviour together that draws the relationship closer, strengthening, enriching and energising it in every way.

After initial meetings with a therapist, best results are obtained if couples return for follow up every six months. They usually need to find regular time together to enjoy giving each other intimate, physical pleasure without all the pressures of intercourse, having agreed to set themselves realistic goals.

Attempts have been made to try and combine marital and sex therapy sessions in group sessions, or with just a couple on their own. Clearly the nature of the relationship affects sexual intimacy. We are whole people. Medical and psychological factors, sexual knowledge or lack of it, communication between partners, marital harmony, sexual anxiety and worries about performance all affect sex life - for example, preventing a woman from being able to enjoy orgasm.

A hundred and thirty five couples were given individual counselling, sessions together or with groups of others. The most popular were couple sessions. These were times of counselling. Couples' therapy may not work if one partner has a big agenda of his or her own, when it is often necessary to meet with each partner separately at first.

So then we have seen the terrible emotional price that many are paying today for the sexual revolution yesterday. Sexual chaos, relational chaos, fragmented experiences with different people, trauma of breaking up after years, loneliness and childlessness in middle life and a big rethink about the future.

We have seen that it is very possible for people to enjoy long term, happy, loving relationships which are deeply fulfilling, research has helped us understand how to make this more likely and where relationships are struggling we are finding many practical ways to help.

The writing is there on the wall: the revolution in sexual relationships not only makes many ill or kills them with sex diseases like AIDS, but also wrecks emotionally, often scarring people for life. What is more, it is all so unnecessary. But if that is what has happened to so many adults, what about the children?

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