Social Behavior Research and Practice

Open journal

ISSN 2474-8927

Impact of Emotional Unavailability on the Happiness Level of Indian Couples and the Happiness Pie Chart as a Tool Towards Resolution: Qualitative Analysis of Case Studies

Nisha Khanna*

Nisha Khanna, PhD

Founder and MD, Bye Tense 1, F.F., 34, Millennium Business Centre, Corner Market Malviya Nagar, New Delhi 110017, India; E-mail:


Emotions are a vital component of existence and have a significant impact on how we live our daily lives. Our emotions are greatly influenced by our social encounters. A lack of emotions might psychologically prevent communication and result in a lack of purpose.

Emotional Unavailability

 In simple terms, the inability to recognize, categorize, and be conscious of one’s feelings frequently prevents expression and the growth of a strong emotional bond. In this phenomenon, emotional unavailability is referred to.

When one spouse is reluctant or unable to express their emotions, a pair may label the other as emotionally unavailable. It makes it challenging to identify, express, or differentiate feelings, which degrades the quality of marriage and prevents the couple from developing a stronger tie. It has been seen as a crucial aspect in defining psychological and mental health in close partnerships, such as marriage.1,2,3,4

A lack of emotional literacy frequently leads to emotional unavailability. It may have a strong foundation in distinct cognitive patterns that frequently stand in the way of personal pleasure and fulfilment outside of marriage. Additionally, having poor emotional expressivity in marriage correlates with marital displeasure, and being emotionally unavailable causes this. High degrees of emotional expressivity toward one’s spouse has repeatedly been linked to higher marital happiness.5,6,7,8,9,10 Additionally, studies show a correlation between higher-levels of perceived marital happiness in women and higher-levels of positive emotional expressivity.7

When a couple struggles to understand one another’s emotions and has difficulties controlling their own, it is clear who is emotionally unavailable. Most of the time, the partner is uncomfortable and is not used to recognising or expressing emotions. Intimacy in marriage is thus hindered by emotional unavailability on both a mental and physical level. To lead a happy married life, it is necessary to understand how to control your emotions. The majority of worries about being emotionally unavailable are caused by a fear of intimacy, which most couples are unaware of. The issue of being emotionally unavailable may typically be seen in two situations: 1) when a partner is not emotionally expressive towards the partner; and 2) when a partner is not emotionally open with the spouse but is able to convey their feelings to others.11

In this situation, a relationship’s mismatch may be to blame. Another cause for the emotional distance between incompatible partners is that they may feel awkward discussing their feelings out of insecurity and fear of rejection. An individual could want to avoid emotional intimacy due to childhood events.12

Occasionally, people use emotional inaccessibility as a protection technique to keep themselves from suffering further harm. There is no question that open communication of feelings is a necessary component of the quality of married life and that no relationship can develop healthily and firmly without it.13,14,15,16,17 It is challenging for a spouse to be more emotionally aware and expressive when they are emotionally unavailable.18 It suggests that a person’s early attachment patterns may have an effect on the kinds of relationships they have as adults. Numerous studies have shown a connection between emotional openness and early attachment patterns.19 Childhood experiences play a big role in a partner’s emotional availability. According to a number of thinkers, adverse early experiences and issues with the mother-infant bond cause someone to be emotionally unavailable and low in emotional regulation.19,20,21 There is a significant link between emotional expression and relationship happiness, according to research on emotions, romantic relationships, and attachment.21

Marital Satisfaction

Marriage is a crucial element of a person’s personal life. Although there is no question that a number of variables contribute to a happy marriage and can result in it, the key component is the capacity to emotionally connect with another person.22,23 Emotional regulation has been linked to social happiness in partnerships24,25,26,27 and is one of the factors that determine successful marriages.28,29,30,31 Positive relationships exist between psychological well-being and marital contentment. A general assessment of the level of happiness with many aspects of marriage is called marital happiness. Relationship interactions, disagreements, issues, and divorce propensity are all associated with spousal happiness.32

Emotional Unavailability and Marital Satisfaction

The foundation of an emotionally unavailable partner in Indian marriages is a combination of cultural milieu, familial environment, and early attachment type. Children who feel uncomfortable expressing their feelings because they are afraid of being hurt physically or emotionally have been discouraged from dealing with their emotional states at home. When a youngster is growing up when they do not have an emotionally expressive role model who demonstrates appropriate emotional management. As a result, the child never acquires those abilities.33,34,35,36

People in many households learn to conceal their emotions early on because they are not allowed to express their feelings. Because of this, Indian couples frequently do not consider emotions to be a key component of a happy marriage. A parent and child reunion study found a connection between emotional unavailability and disorganised bonding. Children with developmental problems frequently exhibit this attachment type, which typically arises as a result of neglect, abuse, or domestic violence.37

People frequently claim that they are accustomed to emotionally distant relationships and have grown to accept their spouse for whom they are without considering the potential negative effects this may have on their marriage.38 A couple frequently contests the idea that feelings bind them together but typically considers them to be excessive. Because they have become accustomed to not expressing themselves and are unable to break the practice of addressing emotions, people tend to mask or suppress their emotions.39 In both sexual and marital relationships, researchers discovered that regular emotional suppression was linked to reduced relationship satisfaction.40 Marital happiness is defined as emotional fulfilment with the interactions, experiences, and expectations of a person’s married life.41 For a relationship to be secure and healthy, emotional openness is essential.42 The study concludes that hiding emotions have an impact on marital satisfaction and happiness. So, a marriage’s overall quality will be improved by barely suppressing feelings.

Happiness and Happiness Pie Chart

Happiness is the feeling of fulfilment that a person has when their wants and desires are met.43 Happiness, according to Kahneman et al,44 is characterised by a rise in good emotions like joy, trust, pride, and enthusiasm and a decrease in unfavourable feelings like anxiety, irritation, insecurity, etc. A happy person is calm, upbeat, bright, vivacious, optimistic, productive, and in tune with their surroundings.45

The Sustainable Happiness Model, represented by a pie chart*, distinguishes between three different types of factors that can have an impact on a person’s happiness: current deliberate actions (40%), current life circumstances (10%) and genetics/biological (50%).46 It considers there to be a great deal of possibilities for people to act and work for their happiness. A person’s genetic predisposition and life circumstances play a role in their level of happiness, but there is also some influence from their intentional actions. For happiness, people consciously alter their behaviour and thought processes. People must be convinced that they can improve their own happiness (Figure 1).47


Figure 1. Happiness Pie Chart46


SBRPOJ-8-135 Fig 1



10%=Life Circumstances


40%=Intentional Activities

Happiness and Marital Satisfaction

The perception of life fulfilment, subjective well-being, happiness, and resilience are all connected to marital satisfaction.48,49 When the concept of subjective well-being is examined among married people, they report greater life satisfaction and contentment.50 Even after taking into account the initial level of marital satisfaction, Hawkins et al51 discussed how spouses who were married and those who reported a mean or higher-level of marital happiness indicated greater individual well-being over time compared to perpetually unhappy married individuals. According to Dush et al52 those with the lowest levels of well-being may have chosen to enter unpleasant marriages on purpose, which caused a fall in their general well-being. According to their findings, people who report higher-levels of overall happiness are more likely to experience long-term marital happiness.

The trajectory of marital happiness is also more likely to be at its lowest point for people with the lowest initial life happiness levels. They explained that the stressful interactions brought on by the distressed spouse had a detrimental track on the responders with distressed marriages over time. Being in a happy marriage has psychological benefits, while being in a marriage that is generally unpleasant has negative psychological effects. They also suggest that when a marriage is in trouble, there is a higher chance of decreased psychological well-being. Therefore, interventions designed to strengthen marriages also enhance the happiness of partners in unhappy unions.

The following case studies aim to gain insight into the impact of emotional unavailability on the happiness level in Indian couples and the effectiveness of the Happiness Pie Chart as a tool towards resolution.


Case Study 1

A 33-year-old client recently wed his partner after a two-year relationship. They initially began dating because they were drawn to each other physically and had a strong connection. Despite the fact that his wife had just recently gone through a divorce, the customer was a spinster when he first met her. The client was flirty and frequently had flings with other people, but he was never sexually involved with anyone. The client came to see us because he was both physically and emotionally estranged from his wife. He also spoke about the couple’s incompatibility problems. They had issues with communicating, which frequently resulted in heated exchanges. Despite being considered very intellectual and having a pragmatic outlook on life, the client found it difficult to share and express his emotions. However, the customer held the belief that having no emotions makes life easier and that having them makes one weak. The wife of the client had a difficult previous marriage because of her financial struggles. She found it difficult to create and keep wholesome connections. Following a few interactive sessions with the client to gain a deeper understanding, conjoint sessions began and injected that although the wife appeared to have a high-level of emotional awareness, she struggled in relations.

The couple is depicted by the Happiness Pie-Chart*.46 The pie chart taught the client that they are in charge of their own happiness. In order to help them understand that marriage is a part of their lives and that their partner is not completely responsible for their happiness, a few activities are conducted. Making the couple more responsible for their feelings and degree of happiness was the goal of using the pie chart to describe happiness. The couple’s emotional awareness was the major goal. They could express the same after they understood how to acknowledge their emotions. The individual’s happiness and identification of emotions was on focus first throughout counselling. Finding time for oneself and learning to put one’s own needs first were the main goals. The client began to improve and made deliberate lifestyle changes to better his life all around. Both clients demonstrated increased emotional awareness by being able to recognise their own feelings and better understand how their moods affect their conduct throughout subsequent sessions. As a result, individuals gradually developed the ability to control their emotions and trigger emotional connections by putting their happiness first.

Case Study 2

A 42-year-old client of mine wed his sweetheart, a 39-year-old female. They fell in love right away but battled over the course of their three or more year courtship to develop a deeper bond. They came from different backgrounds. She was born and rear in a large metropolis, but he was raised in a prominent family and was from a small village. He had always desired to go to a large city but was prevented from doing so by pressure from his family, who wanted him to be active in the family business. After being married, the husband made the decision to remain in a big city since he thought his bride could have trouble adjusting to life in a rural area. Because he had to start from zero to establish himself financially, his family was not very supportive of his choice. After a while, after the birth of their first child, marital problems started. The customer found his wife visually unappealing because she had put on weight after giving birth. She used to badger the spouse about his family, way of life, and habits because she did not support him. She was meticulous and very gloomy about marriage and life in general. The client complained that his wife is critical and grew unhappy with their growing number of years of companionship since he felt underappreciated. During the couple’s session, her mood swings and his feature of emotional incapacity stood up. The couple’s weekend ritual of joint or marijuana smoking was the only thing that ever brought them together. The customer felt uneasy or under other couples because the wife had a propensity to crib and compete with them. The client tried to talk to his wife when the problems first started, but he frequently felt ignored. He consequently showed stonewalling behaviour.

The pair was clarified using the Happiness Pie-Chart*46 and approaches for improved emotional literacy. The client improved at controlling his emotions as he obtained more understanding of them. Additionally, he tried to recognise and comprehend his wife’s emotions. Even if the wife has larger aspirations, she still considers leaving the client. She still finds it difficult to develop self-control and self-management, and she has trouble successfully expressing her viewpoint. The pair were urged to keep assessing their boundaries and to express their wants and expectations clearly. The customer has grown to admire his partner more and has adopted a positive outlook on life. The client continues to have faith in his union and works to mend fences with his wife.

Case Study 3

In the case study, a 36-year-old man was married to a 32-year-old woman for more than eight years in an arranged marriage. The wife used to work before marriage but has since become a housewife due to domestic duties. The customer had a lucrative profession before getting married, but he had to return to take care of the family business because of some family obligations. The customer shifted back without hesitation because he has a strong emotional connection to his family. Due to difficulties adjusting, the client saw a mental health expert. Soon after getting married, the wife had a hard time adjusting to her in-laws because they were a joint family. The visit revealed to the counsellor that the wife was emotionally unstable and unable to remain with the family due to her tendency toward paranoia and problems with trust. During the session, it was suggested that the couple switch to a nuclear family structure.

When the couple decided to start a nuclear family, things got better. The wife started engaging with friends and in-laws more frequently since she felt comfortable in her own skin and had her own personal space. The pair generally goes on vacations together with their in-laws. The wife had made significant progress, but the client found it difficult to be content. The client was struggling since his new job profile needed to be altered and he needed to be more competent to grow his firm. The client completed his studies at prestigious management institutes, but he was unable to operate at his peak ability since he found it difficult to transition from working and communicating with white-collar to blue-collar individuals. The client decided to wait to start a family until and unless his wife felt stable because he was unsteady in both his personal and professional life.

When the couple next visited us, they were having trouble getting pregnant and had made the decision to use a surrogate. The client’s personal life was being impacted by his discontent at work. The recommendation was to concentrate on detecting his emotions as he was emotionally unavailable and had trouble expressing them. It clarifies that his marriage need not be the focal point of his life using the Happiness Pie Chart*.46 Additionally, improve the methods he uses to become more self-aware. As soon as he mastered a thorough understanding of his emotions, he started to feel upbeat and joyful. The advice was to take control of their emotions in order to create a space where they and their partner could go through their feelings since the client suffered more with emotional awareness. As a result, both parties strived for happiness in order to establish a happy marriage.


The case studies mentioned above found that emotional unavailability has an impact on marital happiness. As seen in the aforementioned situations, it was difficult for the clients to connect with their partners on a deeper level when they were emotionally unavailable, which negatively impacted their marriage. Due to one partner’s ignorance of their own and their partner’s emotional requirements, the couples struggled to be happy in their marriages. So, low marital happiness may result from emotional unavailability. When couples are emotionally available and receptive to each other’s requests for intimacy, a stable connection can grow. However, insecurities and concerns may appear in the relationship when partners are emotionally unavailable. Differences in emotional awareness between partners lower men’s sense of connection and increase women’s contentment in a relationship.53

In order to boost their personal and marital happiness without having an emotionally available partner, The Sustainable Happiness Model was offered to married couples in India. According to the concept, circumstances (10%), intentional behaviours/activities (40%), and genetic predispositions (50%), define an individual’s level of pleasure. The 10% of circumstances apply to the life partner. Despite being upset with the situation (10%), the person should concentrate on scheduled activities (40%) to boost individual pleasure when a partner is emotionally unavailable.

According to the happiness pie chart*, when a person begins to see their spouse as a part of life, that is, in the 10% of life situations that they cannot change, they may evaluate the costs and benefits of the relationship, investing less to lower the expectations from the partner. Less engagement in the relationship means less expectation from the emotionally unavailable partner, which increases the likelihood of raising marital satisfaction levels. According to Dush et al52 those who are happier are more likely to follow a trajectory of marital happiness that is headed in that direction. The same is supported by equity theory, which emphasises relational benefits and contributions.54 According to the equity hypothesis, partners in a relationship evaluate their advantages and costs (including any resources they provide, such as kindness, time, money, etc). (which are benefits that the partners receive such as intimacy, support, sex, Etc.). When the benefits-to-costs ratio is proportionate, there is a sense of equity in the arrangement.55 When spouses believe their marriage is equitable, they are more likely to feel satisfied than spouses who believe it is inequitable.56,57

Regarding the Happiness Pie Chart*, the emphasis should be on the conscious effort to raise their happiness when one partner in a marriage is not emotionally accessible to meet the needs of the other despite changing the situation (i.e., in this case, the emotionally unavailable partner). By being more self-aware of their own needs, assessing their personal investment in the relationship and the resulting expectations from it, and striving toward their pleasure, the spouse will find marital fulfilment. They might also invest in other intimate connections that offer them the emotional support and solace they need from their partners, such as family and friends. It is important to keep in mind that only 10% of our happiness is influenced by external factors (such as an emotionally unavailable partner), with the remaining 90% being influenced by internal factors (including 50% genetics and 40% planned activities). In order to have greater happiness and become more adaptable, forgiving, open, forceful, have a let-it-go attitude, be less reactive, and handle marital disagreements better, it is crucial to work on 40% of planned activities/behaviours.

According to research, integrative self-knowledge entails self-insight and the proactive pursuit of meaningful growth and development in relation to integrating past, present, and future experiences. This integrative self-knowledge promotes openness, agreeability, and conscientiousness as beneficial marital traits. They are simultaneously attempting to reduce or improve potential interpersonal problems.58,59 Additionally, research suggests that marital satisfaction is closely related to elements like happiness, emotional awareness, and self-actualization.60 The current qualitative analysis of case studies aims to investigate the impact of emotional unavailability on marital happiness and the use of the Happiness Pie Chart as a tool for resolution in light of our observations and the dearth of literature reviews on emotionally unavailable in married couples in India.


First, through raising individual happiness levels, the findings of the current qualitative analysis of the case studies may have implications for long-term marital satisfaction. Second, by leading happiness workshops and educational programmes, marital counsellors and psychologists can increase the degree of happiness in both single people and married couples. In order to boost emotional availability and improve marital satisfaction, teach emotional awareness and regulation strategies. Fourth, it is advised that during marriage counselling, the counsellor should pay close attention to the client’s emotional intelligence and, if necessary, measure it. Fifth, the therapist might force a couple to acquire various techniques for being emotionally expressive and for managing their emotions well. The importance of forming emotional connections should therefore be emphasised. Sixth, there is not a specific phrase in psychiatry for emotional Unavailability, which also leaves room for more investigation. Seventh, dealing with the sadness of various relationships can be done using the same methods. Eighth, other cultures can use the Happiness Pie Chart approach to address the effects of a partner who is emotionally unavailable in married couples.


The main drawback of the current qualitative analysis of case studies is the paucity of research publications on the effects of emotional unavailability on marital happiness. Additionally, the case studies only look at heterosexual marriages; LGBT marriages are not included. It didn’t address cohabiting, live-in, or in-relationship couples; it exclusively dealt with married couples. The case studies are more gender-specific and do not account for the emotional Unavailability disparities between the sexes. The only participants in the qualitative research that were quoted were those who came for therapy. The current qualitative analysis of case studies only focuses on marriages in India. However, it can serve as a crucial solid foundation for further application of the chart to various global cultures, societies, and ethnic groups.

1. Barnett RC, Rivers C. She Works/he Works: How Two-income Families are Happy, Healthy, and Thriving. London, UK: Harvard University Press; 1998

2. Mae C, Palmer LA. A Knowing. Indiana, United States: Trafford Publishing; 2003.

3. Parker, H. If We’re Together, Why Do I Feel So Alone? How to Build Intimacy with an Emotionally Unavailable Partner. NY, United States: Penguin Publishing Group; 2017.

4. Smith S. The Cure for Emotional Unavailability: Discover the Source of Emotional Unavailability, Heal and Have Positive, Successful Relationships. – Large Print Version. California, US: Create Space Independent Publishing Platform; 2018.

5. Feeney JA, Noller P, Callan VJ. Attachment style, communication, and satisfaction in the early years of marriage. In: Bartholomew K, ed. Attachment Processes in Adulthood. London, UK: Jessica Kingsley Publishers; 1994: 269-308.

6. Carstensen LL, Gottman JM, Levenson RW. Emotional behaviour in a long-term marriage. Psychol Aging. 1995; 10(1): 140-149. doi: 10.1037//0882-7974.10.1.140

7. Halberstadt AG, Cassidy J, Stifter CA, Parke RD, Fox NA. Self-expressiveness within the family context: Psychometric support for a new measure. Psychological Assessment. 1995; 7: 93-103. doi: 10.1037/1040-3590.7.1.93

8. Feeney JA, Noller P, Roberts N. Emotion, attachment, and satisfaction in close relationships. In: Anderson PA, ed. Handbook of Communication and Emotion: Research, Theory, Applications, and Contexts. CA, USA: Academic Press; 1998: 473-505. doi: 10.1016/B978-012057770-5/50020-5

9. Gill DS, Christensen A, Fincham FD. Predicting marital satisfaction from behaviour: Do all roads really lead to Rome? Personal Relationships. 1999; 6: 369-387. doi: 10.1111/j.1475-6811.1999.tb00198.x

10. Feeney JA. Attachment, marital interaction, and relationship satisfaction: A diary study. Personal Relationships. 2002; 9: 39-55. doi: 10.1111/1475-6811.00003

11. Levinger G, Senn DJ. Disclosure of feelings in marriage. Merrill-Palmer Quarterly. 1967; 13: 237-249.

12. Gibson LC. Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, Or Self-Involved Parents. London, UK: New Harbinger Publications; 2015.

13. Guerrero LK, Anderson PA, Afifi WA. Close Encounters: Communication in Relationships. LA, USA. Sage Publications; 2011.

14. Pagani AF, Donato S, Parise M, Iafrate R, Bertoni A, Schoebi D. When good things happen: Explicit capitalization attempts of positive events promote intimate partners’ daily well-being. Family Science. 2015; 6: 119-128. doi: 10.1080/19424620.2015.1082013

15. Thompson CM, Vangelisti AL. What happens when the standard for openness goes unmet in romantic relationships? Analyses of stress, coping, and relational consequences. J Soc Pers Relatsh. 2016; 33: 320-343. doi: 10.1177/0265407515574468

16. Botwin MD, Buss DM, Shackelford TK. Personality and mate preferences: Five factors in mate selection and marital satisfaction. J Pers. 1997; 65: 107-136. doi: 10.1111/j.1467-6494.1997.tb00531.x

17. Watson D, Klohnen EC, Casillas A, Simms EN, Haig J, Berry DS. Match makers and deal breakers: Analyses of assortative mating in newlywed couples. J Pers. 2004; 72: 1029-1068. doi: 10.1111/j.0022-3506.2004.00289.x

18. Brown SL. How to Spot a Dangerous Man Before You Get Involved. Tennessee, USA: Hunter House; 2005.

19. Cori JL. The Emotionally Absent Mother: A Guide to Self-Healing and Getting the Love You Missed. NY, United States: The Experiment; 2010.

20. Field T. The effects of mother’s physical and emotional unavailability on emotion regulation. Monogr Soc Res Child Dev. 1994; 59(2-3): 208-227. doi: 10.2307/1166147

21. Feeney JA. Adult attachment, emotional control, and marital satisfaction. Personal Relationships. 1999; 6: 169-185. doi: 10.1111/j.1475-6811.1999.tb00185.x

22. Schaefer MT, Olson DH. Assessing intimacy: The pair inventory. Journal of Marital and Family Therapy. 1981; 7(1): 47-60. doi: 10.1111/j.1752-0606.1981.tb01351.x

23. Natarajan AS, Karibeeran S. Elderly wellbeing and intergenerational bonding. In: Happily Ever After: Factors Influencing Emotional Intimacy of Elderly Couple. Virginia, USA: Today Publisher; 2019: 38-44.

24. Thompson RA. Emotional regulation and emotional development. Educ Psychol Rev. 1991; 3: 269-307. doi: 10.1007/BF01319934

25. Eisenberg N, Hofer C, Vaughan J. Effortful control and its socioemotional consequences. In: Gross JJ, ed. Handbook of Emotion Regulation. NY, USA: Guilford Press; 2007: 287-306.

26. English T, John OP, Gross JJ. Emotion regulation in relationships. In: Simpson JA, Campbell L, ed. Handbook of Close Relationships. Oxford, UK: Oxford University Press; 2013: 500-513.

27. Levenson RW, Haase CM, Bloch L, Holley SR, Seider BJ. Emotion regulation in couples. In: Gross JJ, ed. Handbook of Emotion Regulation. 2nd ed. New York, NY, USA: The Guilford Press; 2015.

28. Gross JJ. Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology. 2002; 39: 281-291. doi: 10.1017/s0048577201393198

29. Gross JJ, John OP. Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003; 85: 348-362. doi: 10.1037/0022-3514.85.2.348

30. John OP, Gross JJ. Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. J Pers. 2004; 72: 1301-1334. doi: 10.1111/j.1467-6494.2004.00298.x

31. Lopes PN, Salovey P, Cote S, Beers M. Emotion regulation abilities and the quality of social interaction. Emotion. 2005; 5: 113-118. doi: 10.1037/1528-3542.5.1.113

32. Amato PR, Booth A, Johnson DR, Rogers SJ. Alone Together: How Marriage in America is Changing. MA, USA: Harvard University Press; 2007. doi: 10.4159/9780674020184

33. Rosenthal SS. The Unavailable Father: Seven Ways Women Can Understand, Heal, and Cope with a Broken Father-Daughter Relationship. Weinheim, Germany: Wiley-VCH GmbH. 2010

34. Brown SL. How to Spot a Dangerous Man Before You Get Involved. Tennessee, USA: Hunter House; 2005.

35. Lamb ME, ed. The Role of the Father in Child Development. Oxford, UK: John Wiley & Sons, Inc; 2010.

36. Collins B. The Toxic Parents Survival Guide: Recognizing, Understanding, and Freeing Yourself from These Difficult Relationships. FL, USA: Health Communications Incorporated; 2018.

37. Cassidy J, Shaver PR. Handbook of Attachment: Theory, Research, and Clinical Applications. NY, USA: Guilford Press; 2008.

38. Kohn JL, Rholes SW, Simpson JA, Martin AM, Tran S, Wilson CL. Changes in marital satisfaction across the transition to parenthood: The role of adult attachment orientations. Pers Soc Psychol Bull. 2012; 38(11): 1506-1522. doi: 10.1177/0146167212454548

39. Patrizia V, Stefania B, Semira T, Tammy E, Giulio CZ, Gross JJ. Emotional suppression in early marriage: Actor, partner, and similarity effects on marital quality. Journal of Social and Personal Relationships. 2016; 33(3): 277-302. doi: 10.1177/0265407515574466

40. Impett EA, Kogan A, English T, et al. Suppression sours sacrifice: Emotional and relational costs of suppressing emotions in romantic relationships. Pers Soc Psychol Bull. 2012; 38: 707-720. doi: 10.1177/0146167212437249

41. Ward PJ, Lundberg NR, Zabriskie RB, Berrett K. Measuring marital satisfaction: A comparison of the revised dyadic adjustment scale and the satisfaction with married life scale. Marriage & Family Review. 2009; 45(4): 412-429. doi: 10.1080/01494920902828219

42. Saunders H, Kraus A, Barone L, Biringen Z. Emotional availability: Theory, research, and intervention. Frontiers in Psychology. 2015; 6: 1069. doi: 10.3389/fpsyg.2015.01069

43. Csikszentmihalyi M. Flow: The Psychology of Happiness. New Haven, USA: Random House; 2013.

44. Kahneman D, Diener E, Schwarz N. Well-Being: Foundations of Hedonic Psychology. NY, USA: Russell Sage Foundation; 1999.

45. Argyle M. The Psychology of Happiness. NY, USA: Routledge; 2013.

46. Lyubomirsky S, Sheldon KM, Schkade D. Pursuing happiness: The architecture of sustainable change. Review of General Psychology. 2005; 9: 111-131. doi: 10.1037/1089-2680.9.2

47. Lyubomirsky S, Dickerhoof R, Boehm JK, Sheldon KM. Becoming happier takes both a will and a proper way: An experimental longitudinal intervention to boost well-being. Emotion. 2011; 11: 391-402. doi: 10.1037/a0022575

48. Heller D, Watson D, Ilies R. The dynamic process of life satisfaction. J Pers. 2006; 74(5): 1421-1450. doi: 10.1111/j.1467-6494.2006.00415.x

49. Çelik E. Married Individuals’ Sexual Self-Confidence Levels and Sexual Self-efficacy, Marital Life Satisfaction and Sexual Examination of Shyness. [dissertation]. Sakarya, Turkey: Sakarya University; 2012.

50. Taş I. Meaning of Life, Life Satisfaction, Social Comparison and Internal-external Locus of Control in Teachers’ Analysis in Terms of Variables. [master’s thesis]. Sakarya, Turkey: Sakarya University; 2011. doi: 10.11114/jets.v6i1.2773

51. Hawkins DN, Booth A. Unhappily ever after: Effects of long-term, low-quality marriages on well-being. Social Forces. 2005; 84: 451-471. doi: 10.1353/sof.2005.0103

52. Dush CMK, Taylor MG, Kroeger RA. Marital happiness and psychological well-being across the life course. National Council on Family Relations. 2008; 57(2): 211-226. doi: 10.1111/j.1741-3729.2008.00495.x

53. Beirne M. The Role of Emotional Awareness in Couple Relationships. Dublin, Ireland: Irish Association for Counselling and Psychotherapy; 2014; 14(4).

54. Walster E, Traupmann J. Intimate relationships. In: Duck S, Gilmour R, eds. Personal Relationships I: Studying Personal Relationships. London, UK: Academic Press; 1980.

55. Hatfield E, Traupmann J, Sprecher S, Utne M, Hay J. Equity and intimate relations: Recent research. In: Ickes DW, ed. Compatible and Incompatible Relationships. 1985; 91-117. New York, USA: Springer-Verlag; 1985.

56. Stafford L, Canary DJ. Equity and interdependence as predictors of relational maintenance strategies. Journal of Family Communication. 2006; 6(4): 227-254. doi: 10.1207/s15327698jfc0604_1

57. Weigel DJ, Bennett KK, Ballard-Reisch DS. Influence strategies in marriage: Self and partner links between equity, strategy use, and marital satisfaction and commitment. Journal of Family Communication. 2006; 6(1): 77-95. doi: 10.1207/s15327698jfc0601_5

58. Ghorbani N, Watson PJ, Fayyaz F, Chen ZJ. Integrative self-knowledge and marital satisfaction. J Psychol. 2015; 149(1): 1-18. doi: 10.1080/00223980.2013.827614

59. Zhou Y, Wang K, Chen S, Zhang J, Zhou M. An exploratory investigation of the role of openness in relationship quality among emerging adult Chinese couples. Front Psychol. 2017; 8: 382. doi: 10.3389/fpsyg.2017.00382

60. Anghel TC. Emotional intelligence and marital satisfaction. Journal of Experiential Psychotherapy. 2016; 19(3): 14-19.


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Floris Vandewoude* and Sören Verstraete

Original Research

2024 May

Mahashweta Das and Rabindra N. Das