I V.“ ' 1v- , ‘- 1 ICObC III-IIIITI'I’IIII-I‘IIII [IV-[1' .... ...... _ I . I l' I I v waif: "1-2-1d'14'1vt'20!ddfifiufiin': .'Z~2'I"*1~13131'3-."rI-I'3'1'.'1-.v1'2-.~2+I-' gave 0“ ”('0‘ 0-0-0‘41I‘w'OOCQOQIIOOI no (I Q¢-JOGI'Q.I¢|1‘1QIOI” . 4‘0 th‘fi OIOIIIOIIOQQOIIOIIO‘)?IDO§{IVVIIOI QOCIOVIQO’IO III 0. 100.1! I.) ’1‘:ch O-OOIOOO!‘OI19,IIID“O’ CIQ’ (IIIIIIIII'IIIfoIIII II’III‘I ., I III I ll JIOOII110Q1O [ll-IQ! {I 1" _|lIQ.IIlO[-OI|1‘O|I II I I m w": .I'I‘IIIIII SHHII'IIII IIIII- IIIIMJIII'IH InIIIIIIIIIIIIIIIIIIIIw IIII- . QIIIIIIIIIIIIIII oIII-IIIIO'I'I'IIIIICIIII IQ Ip-OIIIIIIIIIIIIIIIIIIIIIIIIIII 00(‘1 IyIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIII '.IIIIIIIII’IIIIIIIIIIIIIIIIIIIIIIOII IIIIIIIIIIIIIIIII‘IIIOIIIdQUOIIOIIIIIIIW'IIIIIIII‘I IIIIII-I OQ'OQOCl‘lt'O‘IlO'Q§I pggaaquorot OIIID'OQI4-‘.‘I’A‘lliliOJOIOVO IOIIIIIIIIIIIIIII ICIOOOQ'OIhUO Ii_III'y ' I IIIIII IIIIIIIIIIIIII [‘0Dr‘lQ‘l-IOpOOO‘QlOIIQCOQ0‘.U¢O|QOIOIIOQO IO4IIIII ., a- 'IIIIIIIIIIIIIIIII'AIIIIIIJIIIIIIII‘IIIAIIIIIIII’IIIIIIII-IIIIIIIIIIJIIIIlIIIIIvi r5. Q.C‘I.i.0.0.0.l.l'0’l’0'l'0'.".1 (O'IOOOIOIII.OI iU‘IIIO‘QICD. Ild‘idliileollI‘OO'lvll‘tlll‘.‘ .. 1:. II .Igon oa'caoioaoascunuIIIIIIIIIIIIIIIIIIIII IIIIIIIII a ‘ W fi§$.:.:.:‘:‘:.:.:’:q 03:41:41“: I:Q:I:I:I€I:I:I:I:I'I: ':;;’:. :IzozI: I. I 5:033:40? :0: 0:0: 40:. :I: 0:! :Izatd: (9:40?:1:I‘I'I:I:I:I:I:I:I:I:I:I.I‘Q}: I IIIIIIIIIIIII-IIIIIIIIIIIIII IIIIoooocIIIIIIIIIIIII”awning to IOCOI-C‘I‘ IQII " ' 0". ‘I’I'Inauu’o'tfl'0%“.0' cl.I'I’I‘I‘Q.:|.0.0'O.I.!.I‘I.I.I'I.I'I.I.1"“.I‘l‘i'1.4.l‘¢‘V.O.Q.l.O'Ina":I‘O’I.I.0.0.3.Q.0.0.I.l.I.I.I‘I.J.Q.!.C' t'a’ 45.05553? a'n'I’I'o' o'o'o'o‘o' I‘I‘I'I'O'd'b' I‘o'v‘v’o' c'u'a'o' n'o‘n' a'u’v'a'I's'o'c'o'o‘.‘o'j'o't'c't' .'.'.’ I"o'o's'v'o‘o‘o'o'o'a'f“I'I’I'I'I'I' I" ' I'I‘I‘a’o'c'I'o'o‘u'o'o't’fi'o‘v’l'I'I's'o'v'c’n'u‘o'I‘u'o'o'a'o'o'u'u'o°.'~'o':'o‘1'-'I'c'o'u't'v'v'o‘o‘I'A'A'c'c‘b'{AVI‘I‘I'I'I'I'I'I'IV-VI'I' ’ ”I‘ - I‘lgn'lcooia'b'la...In...“I. .Q‘i'0.0'J'I.\.I.0.0.I...“C.‘*C.I.|.I‘I.V.I.J".0.0'0.I.0.0.I.0.0.I".0.0.-I.O'A‘J.I.J.i.t.'.!'0.0'3.9.0.3.0.4. ' ‘v‘t' IIIII :IIII.10II I’IIOO§100010 DCOO‘IDIOQI'CLOCOJCQQilitlfiIJI“.I|OO|I¢O“II¢ I ’ ' II: '0' "I.:'I. “'30.”. .v' I'I' . . .O.I‘I'I.U‘I’I':1 .I'I'I‘I.I‘I'I.I'I'I'I'I'I‘I’I'I'I‘I'I‘I‘ .Q‘I‘I.C.I.I.I‘I.I.l. ‘C."I.l.1‘.l‘ ‘0'I'I'I‘iloui i 3'}. .0 0.0.! I I 1.! I I I I'.’§ I‘ll I’l‘aao O I I I.I I 03:! I "I I I I" I’!".I’I I 0.3(.0'1"l:l'0'0 I‘l.'.l ¢.I.|‘O’.l.i:I.v.I.Q.I.I ”0.1““ '1‘ t I". q'a'o'q'q'I‘I'I'I'I'I'c'q‘ 'o'c I.I,6‘I"0.I.O'§'I.O I'I‘o I o'I'I "0'3. 0'. n u I I'I'I I v o a 1-0 I I I‘: I a q'c o I O I I I I I :0 IVI I II I o I I also”...Inc-IIHIIJHIIHIIIIIII-IIIIIIIIIIIIIapI-IItousoaIIIoIIoII-a-u on; I'I'I ‘ IIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII‘IIIIIIItIIIIIIIIIIIIII £14.! I 0 IIIQII ‘ ‘1‘f’CCIII'IO[00.00.000.10 IIIIIIIIIIIIIIHIIIIIIIIII-IIIII«Indclno‘i IOI‘WI‘IIIII-III ‘III «IIII IIIIIIIII-IIIIIIIIIIIIIIIIIIIIIIII IIIIOIQI‘IICICI‘UIIO'OI"-OOO‘IIQCBSOIJO{ pIOQIIIIIIIIIIIII-I. It."Q0.00IIIC...CI‘UIO“III‘"Ol000101l09IIIQ‘IUQVOICUCIC'III IIIIIIIIIIIIIIIIIQ QOIQO‘OIIIIOJI-OIOII..OiQOiCQOCOI"VOG‘OIQIJI'I‘IIOQI‘IOUCCI I‘..‘II|.III'OII'.§O QIIO'OOOQ-OIO'OICIIOICIUI‘IIOIIICICQ‘1‘OICIIC‘,'OOC‘I‘A81“IQ .QIIIIIIIIIIoIoIIIOIIIIIII-II-IIIIIIIIOIIIIIIIIIIIIIIIQIIIIIIIIIIIIIIIIIIIIIIIII'I: 3.. oIIIIIIIIIIIIIIIIJI .O'IOIDOQIIt{I‘UOQ‘COCItt'lQIlIIO‘IItllOI'OO‘ IIIIIIIIII p... I'D.OOIIIIOIM|Q¢II.O“‘O.O!I'!$COOCIC‘CQ‘."1OO‘IOIII'III‘QI'OI. I40 Cl IQIIII III 0'] “I.I§0.0'I‘1.I'I.I'o'a'I" II‘I’I'Ib‘) I‘I'I.I’i>fl‘lzl.o.vfl1 .’ I‘I\ . .l .5? 1?}. g4? Lrfllx ID... 3|» . fillnFli £13. #31! .. I 1:25.:in 1:13.? C GB: T.) .31 I: G I if r13 “I \ . ’1 Lil, IZTG C’ IZTEII'Z‘Y G. Roderick Youngs A THEM I '3 Submitted to the Graduate School of‘Hicnigan State College of Agriculture and Applied science in partial fulfiment of the re1uiremente for the degree of 'r VT“?! 7'3 73:1 :‘ imttu l4“ Oi 110.1. ) Department of Sociolagy 1940 _ ‘r-v-‘v Preface y This study was undertaken during the summer of 1969 in the oociolo;y department of Kichigan otate College. fhe preliminary outline was drawn up in con- sultation with or. Keyer Kimkoff, Professor of Jociology at bucknell University, and tuest Professor at hichigan otate that summer. The primary object of this study was to arrive at an estimate of the amount of counsel- ing in the field of marital and premarital counseling in the Lansing community, and to ietermine which pro- “‘3 blems‘appeared most iregue tly in such counselirs. The author has long been interested in marital and premarital counseling, and has for two years been the director of marriage education.and counseling at t'e local Young Ken's Christian association. in addi- tion he has agpeared before church groups and other organizations as a lecturer on marriage problems and preparation.for marriage. The author wishes to acknowledge his debt to the constant help of his wife; to ur. Keyer Limkoff of Sucknell Cniversity; to Dr. tobert nreakey, L.D., and fire. areakey; to ur. Harold Tiller, L.D. Valuable suggestions were received from Dr. Zrnest Harper L U a) b , J and Er. Duane Gibson of the Sociolo_y Departm The value of this study has been increased by the guidance given by my facultf Sponsor, Dr. Charles R. Hoffer of the qocioloéy Department, Kichigan \_.J C) O z- 4- ~19. we L, Lamiqh thgmn. Kay l6, 1940. ii II. III. IV. Introduction A. The Growing interest in Karital Counseling 3. The Purpose of This Study C. The Kethods Deed in the survey D. The bistribution of the muestionnaires The Activities of Physicians in Iarital Counseling A. The Listribution of Phys- icians According to specialty B. The Lumber of Cases seek- in; Xarital advice C. The Doctor and Iorital Problems I) . 5 1111318ij The Age of Physicians in Rel- ation to marital Counseling a. The distribution of the Physicians according to Age 3. The Age of the Physician in Relation to the Lumber of Cases and the Iumber of hours Sgent in Counseling 0. The Age of the Physician in Relation to the Prequency with which harital Problems are hat in Practice The specialization of the Phys- ician in nelation to harital Counseling a. The Distribution of Physicians Classified according to Specialty B. The Specialization of the Physician in helation to the Number of Cases and the hum- ber of hours ipent in Counseling .5853 oomre r~ 10 74 Chapter VI. VII. VIII. '. The specialization of the Physician in nelation to the neplies Given to the Problems of the Questionnaire The Training of Physicians in Relation to narital Cainselin; ninisters and other age ncies Conceried Jith Larit al Counse lin.;r 1. ins hinisters as harriage Counselors A. The Distribution of the Kinisters According to Age and Denomination h. The activities of th 3 lin- ’;tcrs in Counselii C. The Linister and Iarriag e Problems D. The Training of the [in- istsr 'or Givi“-f Coi 31 II. “ther Ayencies in the Conn- ‘ o L', 0 ~ 9 ‘ 90" o .1. unity active in marital 1 - ~,‘q . - ,1 boailsellllo .\ mu, 3. "'. -. -. A. 4.133 21.13 it fl A'aLllqseo 45..) B. The Katernal Hea th Clinic C. The Eocial bervice Bureau D. The Young Ken's Christian Association n. The ColleHe Young Ken" Christian Association F. The Friend of the Court G. The Young wonzen 's Christ- ian Association H. The College Young Women's Christian Association I. The College Health Service J. The Lansing Children's Center Bursary and Conclusions Appendix iv Pas 81 97 100 106 F” ,n a: ,. ()1 [VJ Chapter a. COpies of the Two Quest- ionnaires B. Tables Listing Replies of Specialists to the duestion— naire Classified According to Field of Practice C. Bibliography 150 156 Table 1. l0 ll List of Tables Percentage of Physicians Replying According to Field of Practice Distribution of Specialists According to specialty Average Number of Cases Per Ionth of Marital Counseling Reported by Physicians Average Pumber of hours Per Ionth Spent in lIarital Counselin5 byP hysicians aver 5e number of Premarital Consultat- ions rer honth deported by Physicians umber of Problems Listed by Physicians Ireqa ency of Technicue of Sexual intercourse as a LIarital Problem as hated by Physicians Frequency of rear of sex as Larital Problem as ha ted bv Ph533 ic inns dating 01' r'reguency oI‘ contraception as a harital Iroolem by rhyzicians hating of rrsyuency of -3 Lrbation as a Marital Problem by Physici 3:3 $3 L ' . a n ,- -. , n r» l 1. Katina oi Fiegoenc r oi IenopIIIIl Pheno- n ‘1 ~' "fl 1- 3" - f" - ‘ - 1 nena as a lal it,‘1l £ roblen b5 Pn5I ciens ue ncy of Sterility as a 1 by Ph53 icians Reting of FIe~IenC5' of Tenereal Disease as a Yarital Problem by P‘yoicians ' - ,- , *‘1 ,,,,- , RatiI of rrezIency o f Pin naI icial Diffi- culties as a Karital Pio nle m by Physic :12. ns vi Pag 12 18 l9 N f" t o (is U" 0 > C 2.9 N N 0 DH (>3 0 N 03 o 27. e \IYOJ. -LLi—Q 5 PLgvs icians Ratin5 of Ire Differences a :‘-1"-:- ‘ is 133.113 U Personality 1 Problem by Ratin5 of Pr eoziency of Reli5ious Differ- J. enceo as a Liarital Prob em by Physicians Problems JCLU; According to I by Physicians, Arran5ed q ency of Lention O H 11') H H (I) Number of Physi Considerir5 Problems 4. U Si5nifican A5e Distribution of 69 Physicians Replying to Questionnaire Avera5e Kumber of Cases See k in5 Karita Advice of Physicians Classified According to 538 Average Tumber of Hours Per Honth Spent in Marital Counseling 3y Physicians Classified ,\ According to A53 Avera5e Humber of Cases of Premarital Coun- seling by Physicians Classified According 4- '.-. U0 A58 Rating of Frequency of Technique of Sexual Intercourse as a Karital Proolem by Physic- ians Classified Accordin5 to A5e Ratin5 of Frequency of Fear of Sex as a fiarital Problem by Physicians Classified According to Age Ratin5 of Frequency of Contraception as a Marital Problem by Physicians Classified Accordin5 to Age Ratin5 of Frequency of masturbation as a Marital Problem b5 Physicians Classified Accordin5 to A5e Ratin5 of Frquency of K nopausal Phenomena as a Karital Problem by Physicians Class ified Accordin5 to A5e ' vii [:3 08 "I; 9 U 41 43 47 49 50 55 U] 0) 58 Table 29. 40. 4i. Ratin5 of Frequency of Sterility as a fiarital Problem by Physicians Classified Accordin5 to A5e Ratin5 of Frequency of Venereal Disease as a Marital Problem by Physicians Classified Accordin5 toz5s hating of Frequency of Financial Difficultie as a Karital Problem by Physicians Classifie Accordin5 to n5e 3 -I Cl Ratin5 of Frequency of Jife Workin5 Out as a marital Problem by Physicians Classified Accordin5 to A5e Ratin5 of Frequency of Personality Differences as a Karital Problem by Physicians Classified Accordin5 to A58 Ratin5 of Frequency of Reli5ious Differences as a Larital lroblem b5 Physicians Classified Accordin5 to A5e Number of'rroblems Submitted by Physicians Classified According to A5e Rating of Frequency of Problems Submitted by Physicians Classified Accordin5 to Age The Distribution of Physicians Classified by Field of specialization Accordin5 to Age Avera5e fiumber of Cases of flarital Counseling Per Lonth by Physicians Classified according to specialty Average Humber of Hours Spent in Larital Coun- seling 3y Physicians Classified Accordin5 to Specialty The Avera5e Number of Premarital Consultations Per Month by Physicians Classified According to Jpecialty The Opinions of Physicians Classified Accordin5 to specialty Re5oardin5 Influence of Premarital Examination Law on Premarital Counseling viii Pa5e O) N O) 5;, O) U} 70 71 75 80 Table 0 flu. 45. 44. 47. 48. 49. 50. Figure 1. Rating of Frequency of Problems of Finan- cial Difficulties, Rife Working Out, Person- ality Differences, and Religious Differences by Physicians Classified Accordin5 to Specialty Eumber of Problems su55ested by Physicians Classified accordin5 to specialty Ratin5 of Frequency of Problems Suggested by Physicians Classified Accordin5 to specialty Avera5e A5e of the fhysicians in Relation to the Humber of sources Reported Problems Rated Host Important by Physicians Classified Accordin5 to Lumber of sources of Preparation'Listed Humber of Cases of Karital Counselin5 Reported by Kinisters Humber of Hours Per Konth Jpent in Karital Counselin5 by Linisters Number of Cases of'Premarital Counselin5 Reported by Linisters Rating of Frequency of selected Problems Listed in the uuestionnaire by Kinisters Ratin5 of hrequency of Selected Problems Listed in.the Questionnaire by Kinisters Problems 3u55ested by Ministers Comparative Raking of Problems by Kinistere and Physicians Kumber of Ministers Considerin5 Problems 315nificant Number of Sources of Training Listed by Physicians ix 92 94 101 105 109 111 112 118 Chapter I Introduction A. The Growing Interest in.marital Counseling. The growing volume of books, pamphlets, and maga- zine articles dealing with marriage and the family is an indication of a growin5 concern with the various problems in these fields. Along with the recent devel0p- ment of interest in these problems, existing facilities to meet them were modified, or new agencies deve10ped. In previous civilizations the medicine man, the village sages, the priest, the philOSOpher, and the pastor were the wise men to whom the people of the community turned for advice. In primitive societies the adults prepared the adolescents for marriage and adult responsibility by means of initiation ceremonies and education. The activities of ministers, physicians, psychologists, psychiatrists, and sociOIOgists in marital and premari— tal counseling is therefore nothing new. It is only with the growth of the Social Sciences that anything like a scientific approach to marriage and marriage problems has been made. -2... Various surveys of the remedial agencies dealing with the family and marital problems have been made. Some of these are published in books, pamphlets, and ma5azine articles. Among the important reviews of the a5encies in the field is that by Ralph Bridgman, “Guidance for Marriage and Family Life", Annals 3f the American Academy g£_Political and Social science, March, 1952. Another in the same issue is by Joanna Colcord, "Remedial Agencies Dealing with the American Family," The Journal 33 Social hygiene, January, 1956, gives a list of Family Consulta- tion Centers, and of references concerning these agencies, pp. 34-37. There were in 1956 some thirty two family consultation centers, most of which were located in the Eastern part of our country. How many are in existence today is unknown, since no survey similar to that in the Journal g£_Social gy5iene just referred to has been pub- lished since that time. The list there reported was limited to centers under the auSpices of welfare societies, social hygiene associations, churches, and other incorporated institutions or organizations. Ho attempt was made to report those centers whose services can scarcely be differentiated from private practice. The review of the remedial agencies by 3rid5man, -5- mentioned above, is concerned largely with the approach to marriage problems of the various agencies dealing with these problems. He points out that the prevailing philosophy of guidance work is realistic in that it aims at the adjustment of the individuals concerned, and not at the preservation of existing institutions or forms. The trend is toward concentrating all contacts with each client in one worker. The general conclusion drawn by Bridgman is that in the long run and to most people, guidance for marriage and family life is going to be given by local professionals in social work, religion, medicine, law, and education, in whom the general public has confidence. his conclusion is very interesting in view of the fact that this survey is an attempt to dis- cover what is being done in the field of marriage coun- seling in the Lansing area. There are a few works dealing with the minister and the physician as marital counselors. Among these are Dexter, a., and 23., T1333 1-: 2315:3332. Into PATZILY moons, Harper's, 1958; Jacoby, G. W., PHYSICIAK, PASTGR, ARD PATIEZT, Harper's, 1936; Doheny, W. J., MARRIAGE CASES, Bruce, 1958; Dickinson, R. L., THE scores :13 .1 13131111933 COURSELOR, Jilliams and Jilkins, 1956. These and others are included in the bibliography. -4- These books and articles deal mainly with the type of services offered by the various agencies and pro- fessions, and give little information as to the frequency with which certain problems appear and little with respect to the amount of counseling actually being done. natharine Davis in her book,FnCTOR§ IE THE SEX IFE OF 2200 JOKER, and R. L. Dickinson and L. Beam in their book GEE THOUSAKD KARE AGJS,“ come the closest to giving data on the fre- quency with which problems appear in counseling. How- ever, both studies are limited to women, the one of Davis being wider in scope than the field of marriage and that of Jickinson being the eXpansion of the case records of a gynecologist. In brief, scientific data on the amount of counsel- ing being done by various agencies throughout the United States is not available, as the scientific approach to counseling is comparatively recent, and such data have not been collected. In many cases accurate records are not kept, and so are not at the disposal of students. B. The Purpose of this Study. This study is an attempt to make a survey in metro- politan Lansing with reSpect to marriage counseling. The -5- metropolitan area includes East Lansing, Haslett, Okemos, Holt, and Dimondale. The population of this area is about lO0,000. Lansing and its environs are in the north- west corner of Ingham County, Kichigan, in the center of a good farming country. Lansing is a manufacturing community, its main industries being in the automotive field, though many others are also represented. since Lansing is the state Capitol, many are employed in the various state and federal offices. East Lansing is chief- ly known as the location of Iichigan state College, and its main service area is Lansing. There are many cultural advantages to those living in Lansing and its environs. Two libraries are in the city, one the property of the city, and the other being the state library. an excellent library is also Open to the public at Kichigan state College in East Lansing. There are several good music conservatories in addition to the music department of the college, three symphony orchestras, and two concert courses are available to those interested. Two lecture series are offered each year in the community. There are three hospitals in addition to the college health service, a Childrens' Center in charge of a psychiatrist, an isolation hospital for contagious diseases, a tuberculosis sane- r. -0- torium, and a maternal health clinic. The city also maintains a venereal disease clinic and a health service f3? ifldi gent persons besides the city public health department. The religious needs of the citizens are met by near y one hundred churches and other religious organizations, a community church in East Lansing, the YKCA, and the YJCa. All of the major denominations of Protestant Christianity are represented, and a large number of the minor church groups. Lansing is also the seat of a bishopric of the Roman Catholic Church. This survey seeks to discover, as far as is possible, the amount of counseling being carried on in the Lansing area. The full amount of counseling in any given community can probably never be fully determined. Some counselors will be unwilling or unable, because of group regulations or tabus, to cOOperate with this project. also there is a certain amount of non-profession- al counseling, such as advice given.by respected neigh- bors, midwives, practical nurses, Sunday School teachers, and relatives. This type of counseling cannot well be estimated. It is probable that some lawyers attempt to preserve marriages through counseling when their pro- fessional advice is sought concerning divorce; but when a lawyer is consulted with a view to the procurement of a divorce, the particular marriage situation is such -7- that little can be done to preserve the union. This study then is limited to the more professional type of marriage counseling. It includes the physician, the minister, YKCA and YWCA secretaries, the Iaternal Health League, the College Health Service, the Friend of the Court, Red Cross, Social Case Work Agencies, the Visiting Kurses, and the Children's Center. The problem of course is not only the volume of counseling in a given community, but also its quality. The survey therefore seeks to determine also the pre— paration the counselor has had, or has obtained himself for marital counseling. Both eXperience and adequate scientific information are requisites for the good counselor. This study seeks to determine which problems pre- sent themselves most frequently to the physician, to the minister, and to the other agencies concerned. It might be eXpected, for instance, that the physician would be largely concerned with problems of a medical or psycho- sexual nature, and that the minister would be concerned more with problems of a Spiritual nature. But is the physician, for instance, counseling only within his field of specialization, or are people seeking spiritual advice from physicians? If it is true that the physi- cians' counsel is being sought on problems apart from his -8- specific training, then it is also true that the practice of medicine is wider in scope than the field of pure medicine. The purpose of this survey is to de— termine the actual situation in this community. In dis- covering which problems in the field of marriage loom as most important in actual practice, it is possible to place the proper emphasis in preparation for giving counsel. [1 u. The Kethods Used in the survey. The questionnaire method was used in this project, and was supplemented with interviews where the latter were necessary. A copy of the two questionnaires is found in Appendix A. The attempt was made to obtain numerical results in as far as possible. Because these questionnaires were sent to busy professional peeple, they were made as brief as clarity and the needed infor- mation would allou. The form sent to the doctors was drawn up in consultation with a practicing physician, a urolOgist who was chairman of the state Kedical Society Committee on Jenereal Disease, Lecturer on Sex Hygiene in the school system of Lansing, and Lecturer on the V15 rfl ' Karriage Education series at the inch. -9- While the questionnaire method was used in the sur- cf . -..a ‘0‘ - beinD une mos U) ey, a efficient means of obtaining infor— mation from busy professional peopl (D , it has also its dis— advanta;es. fhe replies to a C: stionnaire are apt to be selective, and not representative, and as a rule are too brief for more than factual reportinr. The factor of selectivity ho Hve , is of no particularc di3advant1ge as far as this survey is concerned, since it is de- sipned to discover that is being done in the community in the way of maritil counselin . Because this study is a survey, the facilit r of contact offered by the questionnaire and the anonymity of the replies which induces a larger return, the use of the questionnaire ct- 0‘ (D as a fact-finding method was felt o justified. .. a word of eXplanation i3 necessar about the use Ir '\ or a rating system in ques tion 5 been u3e many doctors would not take time to thoroughly sift their 'ilee and compile numerical Ie3ult3. Lost physician3 are familiar v . L‘ I ‘ rfi “ "I ’ . " 0" fl . ' "' Wlufl tne systeu.:u..-rasind em .J H C.) 1 (D I”), I0 11') rd r.‘ ‘ F (D P ( r O. (J (.0 L) estimate of frequency in other survevs. in this system the ;1ade3 range from O to four plus. If the figure 0 is marked after a partieula r problem, it mean that the (I) doctor does not meet this problem in his practice. The + fi ure blue-sinus - means that the doctor does not C. v 3 meet the problem often enouph to consider it significant. -10.. when a problem is graded one or one plus, the doctor sees it frequently enough to consider it significant. The grade of two or two plus means that the problem is of average frequence and significance. The grade of three or three plus indicates that the problem is met frequently, while four or four plus indicate a very frequent occurrence of the problem in the doctor's practice. While a rating scale does not give absolute accuracy, the law of compen- sating error would Operate here however, and the results be sufficiently accurate for the purposes of this study. Only simple analysis of the data is used in presenting material, since the data do not warrant the use of ad- vanced treatment, nor is such treatment essential in this particular problem. D. The Distribution of the questionnaires. The questionnaires to physicians were sent to the active members of the Ingham County Xedical Society, and were restricted to include only those who practiced medi- cine for fees. The group was further limited to those doctors in the metropolitan area of Lansing as above de- fined. The resulting list of doctors contained one hundred and twenty one names. after the questionnaire -11- had been sent to this list it was discovered that several of these doctors could not be eXpected to reply because '3 01 their field of practice. A brief enumeration of these will show why they should have been excluded from the questionnaire. There were in this group eye, ear, nose and throat specialists, proctologists, opthalmoloaists, radiolo;ists, industrial surgeons, and a state medico- legal Specialist. In all, the number was sixteen. where- fore replies were eXpected from one hundred and five doctors, while seventy txo actually did reply, or 68 . 6;) . Five of the seventy two returned questionnaires were blazk. wherefore the effective replies number sixty seven, or 65.8; of the replies that could be eXpecte to the questionnaire. Hhether the total number of replies that were received be considered, or only those who actually answered the questionnaire, we find approximately a two-thirds return, which was judged a sufficiently representative sample. As a further test of the adequacy of this sample we might consider how many doctors in tie various classi- fications answered the questionnaire as compared to the number in that same classification in the official roster of the American medical association, edition of 1938. -lg- This information is given in the following table. Table l. Percentage of Physicians deplying According to Field of Practice. No. of Ho. Kc. not Percentage Qpecialty Phys. Replying Replying Replying Gen. Pract. 60 48 17 71.6 surgeons l6 7 9 48.7 Ob. & Gyn. 12 6 6 50 Pediatr. 6 3 3 50 UrolOg. 4 3 l 75 Other Class. '7 _ A 5 A 2 '71 Totals_p 105 67 38 It will be noticed that only one of these groups has a percentage below 50%, namely the surgeons. The nature of a surgeon's work is such that for many phy- sicians the only contact with patients is during the course of an Operation, or during post-operative pro- cedures. It seems then that we have a sufficiently high return.to render the results trustworthy. The questionnaires sent out to the ministers differed slightly from hiose sent to the doctors. Io classifica- tion of the ministers was attempted since in general so few were found of each denomination that comparisons were not practical. A question concerning the types of service ~15- the minister renders in his parish was substituted for the question on field of practice. This questionnaire was also restricted to metropoli- tan Lansing as previously defined. It was sent only to active members of the Lansing Kinisterial Association. The number who received questionnaires was sixty seven, and twenty four or 363 of the questionnaires were returned. Of the twenty four, only twenty answered the questions, or 29.8% of the questionnaires sent. This is a much lower figure than that for the physicians. Twenty of the mini— sters who did not reply the first time were contacted again, by personal interview or postal card. 0 these nine refused to cooperate, and eleven reported that they did no counseling of any significance. Since most of the Catholic counseling is done in the confessional, it follows that the Catholic clergy would be among those not cooperating in this study. among the others not cooperating were some ministers of extreme Fundamentalist persuasion, and some Lutheran pastors. These men do not coOperate with the pragram of the Xinisterial Association either. It would seem then, that replies to the questionnaire were received from most of the ministers who are doing any amount of marital counseling, and that the results there- fore represent the nature of the counseling being done by the ministers in the Lansing area. -14- The other agencies, such as the Social Service Bureau, the maternal Health Clinic, the Friend of the Court, the Visiting Purse Association, the Children's Center, the EHCA and the YMCA were all visited per— sonally, and interviewed according to the scheme of the questionnaire. in this way results similar to the major part of the survey were obtained. -15- Chapter II The Activities of Physicians in Karital Counseling. 1 A. The distribution of Physicians According to Jpecialty. The replies of physicians were classified according to the nature of their practice. Those engaged in general practice were the largest group, forty three in number. The next group was designated as specialists, and it con- tained twenty members. The third group was designated in the schedule as ”Other Classification." These men were also specialists, but their work is of such a nature that few would be eXpected to give counseling service. However, replies were received from seven, of which five were blank. The specialists were further classified as surgeons, pediatricians, obstetricians and gynecolOgists, urolo- gists, neurologists and psychiatrists. There are of course other kinds of medical Specialties, but these are the main groups that would be likely to deal with marriage problems. it is of some interest to see how these Specialists are classified numerically, and this is shown in Table 2. -15- Table 2. Distribution of opecialists according to specialty. épecialty Iumber of Physicians. Surgeons 9 Pediatricians 3 Obst. m Gynecol. 6 UrolOgists 3 Heur.& Psych. l Dermatol. 1 Pub. Health 1 Total 24 Included in the group listed as "other classifica- tion” were two eye, ear, nose, and throat men, two OpthalmolOgists, two industrial surgeons, two public health doctors, and one proctologist. B. The Number of Cases decking Iarital Advice. One of the first things that we are interested in learning is how many people are seeking the doctors' advice concerning problems in their marital life. He know that many today are not seeking such a remedy for their marital ills, but are turning to divorce as a way out -17.. of their difficulty. The problem asked the doctors was, ”How many persons consult you for marital advice?" Only three of the sixty six doctors who replied to this question list no cases coming into their offices for help. Iwenty four doctors list one to three cases a month, twenty doctors list four to six cases a month, sixteen physicians list seven to ten cases, and three doctors list eleven to fifteen cases per month. This gives an average for all doctors in the survey of 4.8 cases per month. fhus on an average, three hundred and twenty four people are seekirs a doctor's counsel twelve months of the year. Over the span of a year approximately 5,888 individuals approach the physicians of the Lansing area nith marriage problems, or 3.8 percent of the entire population. seen in this light, the problem looms large indeed, and presents itself as one worthy of careful study. Hot only do the physicians see a considerable num- ber of cases seeking marital advice, but they also spend much time in counseling these individuals who come to them. There were sixty seven doctors who replied to this . onlv . . . . . question, andAsik spert no appreCiaole time in this way, thirty one doctors spend one to three hours in counseling, -18- eighteen doctors sperm foui'to six hours, four doctors Spend seven to ten hours, five physiciazs sperm ele en to fifteen.hours,‘tdoafimih sixteen to twentyixnumg arfl one doctor spends an.avera5e of tweity one hours or more. This is an average of 4.0 hours per month for all doctors in the survey, ani shows that they spend on an average almost one hour per patient per month. The data are Table 6. average gumber of Cases Ier Konth of Iarital Uounseling Ket by Physicians. Average mo. of “o. of Cases Per Konth Physicians O 3 1-5 24 4-6 20 7-10 16 11-15 3 The detailed replies show t at three physicians spent more than 11-15 hours in counseling, while none report- ed more than 11-10 cases of counseling a month. This indi- J cates that some of the doctors ‘pent more than an hour -19- in counseling for each case reported. Table 4. Average Kumber of Hours Per Konth 7'." Spent in marital Counseling by Physicians. Average No. of Io. of Hours Per Konti Physicians. 0 6 1-5 31 4-6 18 7-10 4 11-15 5 16-20 2 21 plus 1 Included in the cases coming into the doctor's office are those who come for advice before marriage. In the questionnaire this question was separated from the question pertaining to married people so t-at there might be no ambiguity and no duplication of numbers. A question as to the effect of Michigan's premarital venereal disease examination on the numbers coming into the doctor's office for premarital advice was included in the schedule. The doctors were asked to give their Opinion as to whether the law had increased the number ‘who sought other advice, or whether the number had not in- creased. -20.. Jhen we turn to the data we find that t elve doctors list no cases of premarital advice per month, five doctors have an average of one case every two months, nine doctors have an.average of one per month, three doctors have one and a half per month, eight physicians have an average of two a month, one doctor has two and a half per month, five doctors have three per month, seven have an average of three and a half cases per month, seven have an average of four cases, and four, five cases. fine doctor reports six cases per month, one eight, and one nine, while three doctors have an average of ten cases per month. This gives an average for all doctors in the survey of 2.6 cases of premarital advice per month. This meais that on an average one hundred and seventy four young people are seeking premarital advice per month, or approximately tvo thousand and ninety in a year's time. Table 5. Average Kumber of Cases of Premarital Coun- seling Per month for all Physicians in the survey. Average Ho. of No. of Cases Per Honth Physicians 0 12 Less than 1 5 1-2 21 3-4 19 5-6 5 7-8 1 9-10 4 sleven doctors made no reply to the question con- cerning the effect of the premarital examination law. Of these eleven, only three equal or exceed the average number of 2.6 cases of premarital advice per month. As a group therefore they are probably not seeing enough peeple a month to eXpress an opinion on this point, and probably do not see many to take the premarital test required by law in this state. Twenty four doctors answer that in their Opinion the law has not affected the number who come into their offices for premarital counsel. But as a whole these twenty four doctors have a group average of 1.9 cases a month. because they are below the general average they -22- are definitely seeing less cases than other doctors, and therefore feel that the law has not had an effect on their practice. Thirty two doctors answer that the law has increased the number of young peOple who seek other premarital advice. The average number of cases for these doctors is 5.5 per month. It thus appears that those who believe that the premarital examination law has had an influence in bringing young people to them for counsel, are seeing more of these young folks in their practice than those who do not believe that the law has had such an.effect. A majority of the doctors who reply to this question believe that the law has increased the number who seek premarital counsel from the doctor. u. The uoctor and fiarriage Problems. In this section we shall analyze briefly the problems suggested by the questionnaire, and those sub- mitted by the doctors themselves. There were eleven specific problems mentioned in the questionnaire, and in addition a twelfth space in which the physicians could suggest problems not listed in the schedule. Pour doctors list no problems at all, one lists one problem, four doctors list two problems, ten list three problems, five list four problems, eight list five, (VL three list six and four list seven proble;s, nine doctors list eight problems and eight list n'ne pro— blems, four list ten, three list eleven, and four doctors list all twelve problems. This gives an ave Sge for uhe entire group of six problems per doctor. Table 6. number of Problems sted by :h siciahs. Lumber of Problems :1 11-12 Humber of l. The specific problems the doctor was asked to grade were listed in question o. The first of these proble:.s was that of the technique of sexual intercourse. In asking the doctor to rate the frequence with hich this problem appears in his pznctice, we have a more objective stands rd tian t’e doctor's subjective opinion of the i:a)orte cc of the problem. The data shoW'that the doctors did not find the -24- problem of the technique of sex'nl intercourse to be a very important problem in their practice. Yet the problem appears frequently enough to warrant preparation for giving counsel. Thirty seven doctors did not meet the problem at all in their practice. One doctor rates the problem plus- minus, an indication that although the problem is met, it is not seen frequently enough to count it significant. Sixteen doctors grade 1 plus, and therefore find the problem of significance in their practice. Seven of the physicians grade the problem 2 plus, indicating that it is of average frequence. Two doctors grade 3 plus, meet- ing the problem frequently. Four doctors grade 4 plus, showing that they meet this problem very often in their practice. It is interesting that the six doctors who meet the problem frequently or very frequently are all men in general practice, and five of the seven doctors who grade it of average frequence are also in general practice. It is apparently not a problem that comes frequently to the attention of the specialist. -25.. Table 7. Frequence of Technique of Sexual Inter- course as a Karital Problem as Rated by Physicians. Rating of Number of Frequency Physicians 0 57 4F _. 1 1+ 16 2+ 7 3+ 2 4+ 4 2. The problem of the fear of sex. This was, of course, a very general question, and it was meant to be. The fear of pregnancy is often the basic fear of a whole complex that includes everything connected with sex. hut '\ yr. R. L. Dickinson reports that out of two hundred and nineteen cases of fear of sex,l one hundred and fort six were sex repulsion, sixty three were fear of preg- nancy, and ten were fear of venereal disease. However, his figures based on case records show that a more generalized type of fear of sex, usually resulting from childhood training and experiences, is more frequent than fear of pregnancy. l Dickinson, R. L., and Beam, L., 0H3 THOUSAZD HARAIAGES, Williams and dilkins, Baltimore, 1951, p. 336. (Research study from medical case records of factors which affect marriage favorably or otherwise.) -go_ The doctors in this survey also find that fear of sex enters as a marriage problem into their practice quite frequently. Twenty seven, or 40$, of the doctors in the survey meet the problem, though they do not rate it a very important one. Forty doctors do not meet the problem in their practice, sixteen grade the problem one plus, eight grade two plus, one grades three plus, and two doctors grade four plus. These figures show that only eleven doctors, or ldfi, rate the problem of fear of sex as average or more than average in.frequence in their practice. Table 8. Frequency of Fear of Sex as a Karital Problem as Rated by Physicians. Rating of Number of Fre quenpy Physicians 0 40 l 16 hp ()3 A“ (D D) 3. The problem of contraception. This question seeks to determine how frequently the problem appears in the practice of the physician. No attempt was made to discover the reasons which impel married peOple to seek F .g?. contraceptive advice. hamilton and XacGowan found that out of two hundred people in their study only nine had never used contraceptives, and the reason assigned for non-use was in each case sterility. l Davis in her study of 2200 women had a group of nine hundred and eighty five 2 who answered a questionnaire on birth control. Of the nine hundred and eighty five women, 74p admitted the use of contraceptives. The problem of contraception seems to be a very important and frequent one. what was found in our study? Only six of the sixty seven doctors do not meet the problem at all in their practice. Two of the six who did not meet it are doctors in general practice, but they not only do not list this problem, they do not list any problem. Two of the six are pediatricians, so they naturally would not meet many cases of this kind. The other two are surgeons, and one of them is an industrial surgeon whose field of practice would not involve such cases. Thus for the six physicians who do not meet this problem we can assign good reasons why they do not en- counter it in their practice. Thirty one doctors grade the problem 4 plus, ten grade 3 plus, ten.grade 2 plus, and ten.grade 1 plus. It l Hamilton, U. V., and LacGowan, K., WHAT IS WRONG WITH MARRIAG37, Boni, H.Y., 1950, p.98. (Summary of psychiatric study of lOO husbands and 100 wives.) 2 Davis, h.B., 53K FACTORS 3 THE LIVES OF 2200 JOKER, Harper's, K.Y., 1929, p.14. -28.. is therefore evident that the majority of physicians in the survey find the problem of contraception a very im- portant one. Almost one half of the doctors give this problem the highest possible grade, and fifty one doctors, or 765, rate it as average or more than average in fre- quence of appearance in their practice. Table 9. Rating of frequency of Contraception as a Karital Problem by Physicians. hating_of frequency fumber of Physicians 6 10 10 10 tbODNHO 231 a. The problem of masturbation. This problem was in; cluded in the questionnaire in order to obtain an estimate of the frequency with which the physician meets it in his practice. Dickinson does not believe that auto-erotic practices play a large role in the field of marital problems. he believes that auto-eroticism is a typical experience before marriage, bu that its continuance in marriage is exceptional. L That may be true; however, wenty five of the sixty seven physicians reporting in this study encountered the problem of masturbation in their practice. slightly more than one third of the phy- f‘ -ag- sicians replying met the problem frequently enough to con— sider it significant. Only four physicians graded it of average or more than average frequenqy. Therefore the data indicate that while a considerable num er of physi- cians met the problem, not many found it to be very fre- quent in their pr:ctice. Y Fort two of the sixt” seven doctors did not meet tne J C): masturbation and wra ed it 0, one doctor graded plus-minus, twenty rated it 1 plus, one graded 2 plus, one 5 plus, and two 4 plus. Table 10. Rating of Frequency of Kasturbation as a Karital Problem by Physicians. n Ratinf of :requencv fumber of ths. --‘-- fin” — O 42 l 20 [\3 5. The Problem of Kenopausal Phenomena. Questions concerning the menarche appear quite frequently in the syndicated newspaper articles of Dr. William Brady. Books written on the sex life refer to it also. And with just ordinary observation of acquain ances one notices that -30-, the menOpause seems often to bring with it marital difficulties. Dr. W. J. Rob'nson in his book, 1 HAS; HER 33: ADD L073 IFS, 1 points out that the organic changes involved in the menopause.frequently cause a temporary emotional and psychic instability, and then.states that during this time the woman is in special need of sympathy and support from her husband. Since the menarche usually extends over a considerable period of time, the possi- bilities of tension and discord are evident. The majority of physicians in the survey found meno- pausal phenomena to be a marital problem. Only nineteen doctors did not meet the problem at all. Five physicians grade it 1 plus, eight rate it 2 plus, seven grade 5 plus, and twenty eight grade 4 plus. Kore than one half of the doctors grade the problem frequent or very frequent, and almost two thirds of the doctors rate it average or more than average in frequence. This problem, then, is important both because of the large number of doctors who meet it in their practice, and because of the frequence with which it appears as a problem in the doctor's office. l Robinson, a. J., WOKAE: HER 33X.AED LOVE L F3, Eugenics Publ. Co., E. Y., l93l,pp, l28-l32. 421 -U - Table ll. hating of Frequency of xenOpausal Phenomena as a Harital Problem by Physicians. Rating of Number of Freguency ghysicians. 0 19 1+ 5 2+ 8 3+ 7 4+ 28 6. The problem of sterility. The census of 1930 showed that Zbfi of married couples are childless, but the question is, of course, how much of this is due to sterili- ty. pr. Meyer Himkoff of Bucknell University, says in his class notes in the summer Session at Kichigan State College, that one out of ten marriages is sterile. Dickin- son says that a third of the cases that came to him were concerned with sterility. 1 However, since Dr. Dickin- son is a Specialist in gynecology it is natural that he should get a high proportion of such cases. But there is evidence from the data of our survey that the problem is wideSpread in the Lansing community, since forty six of the sixty seven doctors meet the problem in their practice, and forty five of the forty six consider it significant. l Dickinson, R. L., pp, cit., p. 436. '— f -ua_ Iwehty one doctors grade the problem of sterility O, indicati>f that they do not meet it in their practice. the doctor grades plus-minus, twenty three grade 1 plus, ten grade 2 plus, three grade 0 plus, and nine grade 4 plus. Iwentv two doctors find the problem of average or more than average freguence in their practice. Six of the nine doctors who ¢ive this problem the hiphest grade are Specialists, four of the six are gynecoloyists, one is a urologist, 83H one a surgeon. rhese facts snow that in tnis community sterility is a real m {33 rital problem, occurrin; freruently and being met by two thirds of the J ‘ doctors. table l2. mating of :reguency of sterility as a v s ‘arital Problem by Ehysicians. L natiig of Iumber of nre;uency thsicians l+ 25 23+ 10 4+ 9 7. rhe problem of venereal disease. The attention of -55- the entire country has been focused on the general problem of venereal disease through the drive initiated by the surgeon.ceneral of the United states. This survey seeks to determine the frequence with which the presence of venereal disease led at least one of the married couple to seek not only the medical aid of the physician but his counsel as well. In his 1008 case records Dickinson 1 found ninety four cases where venereal dis- ease entered the picture. This represents about one twelfth of his cases. In this survey only thirteen of the sixty seven phy- sicians do not meet the problem at all in their practice. This means that fifty four, or 8l35, of the doctors in the survey meet the problem. Of the fifty four who met it, iiifty one find it to be significant. The problem of con- txraception is the only problem that more doctors found syignificant than the problem of venereal disease. Three of the doctors in the survey rate the problem Pldis-minus, fifteen rate it 1 plus, seventeen grade 2 Ellis, four doctors grade 5 plus, and fifteen grade 4 plus. Thj;rty six doctors consider this problem average or more tfleun average in frequence of appearance in their practice. Rizmeteen physicians rate it frequent or very frequent. ."'1 n . . . . ibf? data indicate that this is an important one because l Dickinson, n. L., 02. cit., p. 455. or the large number of doctors who meet it, and because of the.frequence with which it appears in their practice. As the problem of venereal disease is so widespread, and appears so often as a marital problem, evidently the physician should be prepared to deal with it as a ma ter of counseling, even though he may turn over the medical treamnent to a specialist in the field. Table 15. dating of frequency of Venereal uisease as a Karital Problem by Physicians. Rating of Humber of Frequency Physicians. 0 13 ¥ - 5 1+ 15 21» 1'7 3+ 4 4f 15 8. “he problem of financial difficulties. with this PPOIILem we leave the field of medical questions, and seek t0 deetermine the frequence with which the physician is cOnsulted about other problems. Of course these problems are loot entirely separated from the medical field since an 1J1adequate income may result in malnutrition and dis— ease, tmt this survey is concerned only with the question -35.. ‘ I whether the doctor does or oes not give counsel with respect to such problems. Hamilton and nacGowan found fortyltwo cases of marital friction because of finances. This is a little over one fifth of their two hundred subjects in the re— search. The majority of these were dissatisfaction with income. This study is not concerned whether size of income or disbursement of income is the cause of friction. it seeks only to determine if friction is present, and if the doc- tors‘advice is sought in the matter. Thirty six physicians did not meet the problem at all in their practice. Three doctors graded the problem plus-minus, twelve graded 1 plus, six graded 2 plus, three graded 3 plus, and 7 doctors graded 4 plus. The majority of physicians did not find the problem to be si in their practice. sixteen doctors found the problem average or more than average in frequence f appearance. This means that the majority of doctors who found the problem of financial difficulty significant also found that problem to be average or more than average in frequence in their practice. Only three of the doctors who found the problem average or more than average in frequence l Hamilton and KacGowan, on. cit., p. 70. I C)? O a I were specialists. It seems to be a problem that is met most frequently by the general physician. Table 14. Rating of Frequency of Financial Diffi- culties as a Marital Problem by Physicians. Rating of Humber of Frequency Physicians 0 36 + - 3 1+ 12 2+ a 31. 3 4+ 7 9. The problem of the wife working out. At first sight this problem and that of financial difficulties may seem closely connected. There is a connection, but also a real difference. The working wife generally faces the difficulty of working at two jobs, and the problem calls for great cooperation on the part of both husband and wife. Where this cooperation is lacking, conflict may and frequently does result. There may be difficulty also simply because of strain from overwork. This survey seeks to determine the frequence with which the physician is consulted in such cases. In general, relatively few of the doctors found the problem of any significance. -37- forty seven of the doctors did not meet the problem at all in their practice, one doctor grades plus-minus, four— teen doctors grade 1 plus, three grade 2 plus, one grades 5 plus, and one grades 4 plus. Only five physicians rate the problem of the working wife as average or more than average in frequence, and only tvo doctors rate the probleui frequent or very frequent. Though the doctors do not rate the problem as appearing very frequently in their prac- tice, almost a third of them do meet it at least occasionally. Table 15. hating of Frequency of wife Working Out as a Marital Problem by Physicians. Eating_of :requency No. of Physicians 0 47 + - l 1+ 14 2+ 3 34- 1 4+ 1. 10. The problem of personality differences. nr. Heyer Eimkoff of Bucknell University contends that the basic problem in marital adjustment and maladjustment is a personality problem.1 He may be perfectly correct in this contention, but it is equally true that this basic l Rimkoff, M. F., Class Hotes, K. 3. C. Summer Jession, 1959. .‘A8 -U - problem may never reach the surface and receive treatment by the consultant. ln.this survey we seek to determine the frequence with which the physicians met the problem. Almost one half of the doctors met the problem in their practice, thirty one physicians finding it signifi- cant. Thirty six doctors did not meet the problem at all in their practice. Eighteen doctors grade 1 plus, eleven grade 2 plus, one doctor rates 3 plus, and one 4 plus. Thirteen doctors find the problem average or more than average in frequence, though only two doctors find it frequent or very frequent. Although not quite one half of the doctors meet the problem of personality differences, yet a sufficient number do to give it some importance. Table 16. Rating of Frequency of Personality Differences as a Marital Problem by Physicians. Rating of Erequenqi Number of Physicians 0 36 1+ 18 21' 11 34- 1 4+ 1 11. The problem of religious differences. This ‘might be considered a problem for the pastor, and not for the physician. The only reason for raising it here is to -39- determine if people whose religious Jifferences are causing marital rifts are seeking the advice of the phy- sician on this point. It does not seem that they are. Only fifteen of the nineteen doctors who meet the problem consider it significant, and only six doctors rate it average or more than average in frequence. Forty eight doctors do not meet the problem at all in their practice. Four doctors rate the problem plus- minus, nine doctors grade 1 plus, five grade 2 plus, and one grades 4 plus. Only one doctor finds the problem of more than average frequence, and only five rate it average. Table 17. Rating of Prequency of neligious Differences as a Karital Problem by Physicians. Rating of Number of Frequency Physicians 0 48 4 1+ 9 2+ 5 3+ 0 4+ l 12. The problems submitted by the physicians them- Selves. Twenty one doctors list problems, but only six list more than.one problem. Three doctors list two problems, -40- no list 1 L 1' J g 1. CuOI‘S 3:) l L lfirA mu 3- U is doctors l 3 thre e and CG .4 .A A [198.0% . re 1 A Q / v _'l ion of .3 .LI‘ 1. U '3 1n ":3 f1 A..V g..- -I he , v A K.) ne 1" r“ ,\l ._J \I -0 EV , "y 1.718 1 "11 I l +- U D t \l 7,9 3 llI' “ADJ. . Lily. “d i (I .L l I‘V“ _'_.‘ .~ 9 (V v J .3 v 1 l;ll'1(-_ ’1 O 1.31 8 _: L I.) A I fi 1‘ ,3; V me {1 a V a re L) a L. . I) J :1 ‘ l L) \l A l roblemr u lib the 9 problems a 1 We 0; n0 .3 ha npu e 3 .1 +4 9.. .V. - A 9 'r' '1 b&‘.\‘ I r- sales, 01“ .L- 51 rspareunia is men— n ~L e '3. Oil 8 118 v U -I 1.311 3 ") \x .3'!‘ ‘— fl. .l‘ V‘AU V L L. :‘ JALJ 1-. ;ldloy - .L 1 J V 14“ LJ' “1 obl 'y- .5 a It: 1"? OJ once . lgldi a \4 1.3116 0. ~L‘ 118 I'VJ '15 J. U -41- Table 18. Problems ouggested by Physicians, arranged According to :requency of Lention. Problem Times Kentioned infidelity 5 Frigidity 5 Impotence 4 Difference in Libido 4 Dyspareunia 2 Care of oelf Perversions Pre-adolescent Proolems Incompatibility In-laws Artificial Insemination Adoption r4 r~ P‘ re we k‘ r» id Celibats nervousness Riddle Age H The first part of this study shows that the physi- cians in the'Lansing community are meeting a large number 0f cases in which their advice concerning marriage pro- blems is sought. The physicians also are spendinr a considerable amount of time per case and per month. They m *3 (D D F U‘ U E) (D (D c r r ,\ N; 'l- 1 n v o ‘ 7" Q , lar.3 inn.o3r oi younj people JED , !' | 1‘ or ‘ ‘ . ' -‘ r . .~ _’ —‘. .‘ ' A“ 7"!“ ‘ . ‘ 0 seek the yn.elclad'$ coin el before mufflh,eo ‘Lw : 4. 1;:‘_ L: .‘L FHQ I? r“. .‘ L ' r5 5" '11(1. 466 .5518 I 3 O u. AJ U81; J Sp); V 2-. r .lAO‘J U lL-.')j -1’LU ’ Cs“) JbLu‘u LJ ’n- L' -. . ..‘.\ 2" " L- ‘-, L',,. 1 '. 3.1”“:- DJ £111.: {led}; DPS-I. 01 Q 30 Jars \LQO Lie 0 uh‘jlfl 8 VIC! b ‘vr U A13 8 ~J U lL-::k Lied I ‘ . Lu, u.r.r‘ . t ‘- p- ‘ '.. -‘ 1 f ‘- L a ' we uelce with which the problems a;«pe.:r in the doctor 3 practice, listed in the order of 1-. sol t. ..ce or frequence are: the proclem of contraception, the problem of A. U) venereal disease, of menopausal phenomena, of terility, ‘ "‘1 J" :n" ”I; v“ 1’ N v. ‘ . ‘, I 5"? q . "I fl I f and tn- o-oulem oi oeruonalioy eiiierences. .3 above D11 ’3 U (1’ H (D ,3 U1 9 Ll) H (.1 U c-J :3 OJ F . (D ,- 0') are: the problem of the technique of sexual intercourse, the pioclem of linanoiel difficulties, of fear of sex of masturbation, of workin; Jife and the problen.of religious differences. ence in libido, and dysoareunia. The first four of these are mentioned often enough to be included in some further tudy oi the problem of marital counseling. in general, the doctors found those problems mo cf 0) closely connected with medical practice to be the most frequent. fhe one exception to this is the problem of per- sonality differences. She problem of rail ious differences is the one that tile physicians meet the least. nut even -48— so, nineteen doctors meet this problem, and fifteen found it significant. This indicates that the doctors are doing a considerable amount of counseling in fields not strictly medical. Table 19. Humber of Physicians Considering Problems Significant. E0. of Percent of Problem _ Phys. Total No. (67) l. Contraception - 61 - 91 - 2. Venereal disease - 57 - 84 - 3. Kenopausal Phenomena - 48 — 72 - 4. Jterility - 45 - 67 - 5. Personality Differences - 31 - 46 - 6. Technique of sex - 29 - 45 - Intercourse 7. Financial Difficulty - 28 - 42 - 8. Fear of Sex - 27 - 40 - 9. Kasturbation - 24 - 36 - lO.Hife Working Out - 19 - 28 - ll.Religious differences - 15 - 22 - Thus out of every hundred doctors ninety would meet the problem of contraception compared to twenty who would meet the problem of religious differences. Kore than one half of every hundred doctors would meet the problems of -44- contraception, venereal disease, menopausal phenomena, and sterility. Almost fifty percent of the physicians would meet the problem of personality differences. The problems of sexual technique, financial difficulties, and fear of sex would be met by four of every ten doc- tors. Une third of the physicians would meet the problem of masturbation, one fourth the problem of the wife working outside the home, and one fifth the problem of religious differences. -45- Chapter III The Age of Physicians in Relation to Karital Counseling A. The Distribution of Physicians According to Age. 1. The average age for all physicians who replied was 43.5 years. This figure is for sixty nine doctors since three did not give their age. The median age_was 42 years and the modal age 58 years. When the distribu- tion was ranked by five year age groups there were fifty two physicians 50 years of age and under, and seventeen above the age of 50. The youngest doctor listed was 29 years of age, and the oldest was 72 years old. Table 20. Age Distribution of 69 Physicians Replying to suestionnaire. Age Group Humber of Physicians 26-50 3 51-55 14 56-40 13 41-45 10 46-50 12 51~55 7 56-60 4 61-65 4 O) O) '- N (J (\5 —40-. 2. The Division of the Physicians into Older and Younger axe Groups. The doctors were divided into these two groups for the purpose of comparing the answers submitted in the questioziaire, and also to determine thetier the older or younger doct rs are consulted most freCuent y by people with marital proclewi . The are of 50 years rough- ly divides the physicians into tJo groups, since the introduction of s'ecial preparation for marital counsel- ing in the re wular modie al c; riculum is comparatively recent. aheth r the doctors are ranked by five year age groups, or by ten year groups, the mid-age is 50 years. Therefore it was selected as the dividing point between the younger and the older doctors. when the doctors are classified in age groups as in Table 20, it is evident at once that the physicians below the age of hi are definitely in the majority. since there a1 s only seventeen doctors above the age of 50, comparison of r to the questionnaire will be made only with (D plie O) ( res* ct to the two large groups of youn er and older doc— ‘- J. tors. This is done because the number of physicians in the five year groups, especially above the age of 50, is too small for significant comparison. Also in this section of the survey the findings by age groups regardless of the field of practice will be repor ed. -47 .. 3. The Age of the Physician in nelation to the Lumber of Cases and the Jumper of hours spent in Counseling. 1. n3 indicated in the previous chapter, the doctors were requested to pive a monthly average for the past year of the number of people who came into their offices solely for marital advice. Ihree physicians report no cases at all, twenty four doctors report an average of 1-6 cases a month, twenty doctors report an average of 4-6 Cases per month, sixteen physicians report 7-10 per month, and three doctors list ll-lb cases a month. rhis gives an average for the doctors replying of 4.82 cases a month. rable kl. Average dumber of Gases seeking Larital advice of rhysicians Classified According to Age. 2&3 59- 0f ho. of Cases ze-ao years raéso 3 lie 416 viio 11615 ol-LS " 14 1 5 5 5 55‘*O “ ll 0 4 3 3 1 41'45 ” 10 1 e a 2 1 46-50 " 11 o 5 o a 0 51-50 “ 7 1 e 1 1 1 56-60 " 4 o z 1 1 0 61-65 ” 4 0 g a 0 0 66-75 ” 2 o 1 1 o o metals as 5 a4 20 16 a fl“ , r: e3 m p . r“ . we lne averabe number oi cases oi marital counselino per month for the forty nine doctors 50 years of a'-e or young er is 5.l, and the average for the seventeen Uh"”lClaJ over the age of 50 is 6.9 cases per month. rhese figures indicate tmlxt proportionately the younger doctors are meeting more peoole per month who seek their advice on marital problems. L. fhe physiciezs were also re1uested to give the average umber of hours per month for the pee t yea spent in counseling the cases in section 1 above. by placing the question concerning time immediately after tr e Question 4.; , n -. ,. . .3 at- ' -1 I. ' , . L‘, uv - 1‘3 ‘ 311 .1118 111.131.3323 3.1. Cc; .: e , 8 l’lU. o ~~ lilo erui 1 1 .118 u: 3 rd 3 SLICII , J .2 counselliny" the attempt has made to avoid including the 1.;_ "39 -.1. 1.1.1.1118 0‘ UVLLU in ore—marl tal counseling. As a check, five of the physicians were consu ted in person wit‘ respect to this point. 1‘1ese five doctors were selected at rand 3. none reoorte d ir eluding premarital cases in this question. dix doctors list no amount of time spent in counse l~ ing, thirty one doctors report an average of 1-3 hours t so per month, ei; :hteen re oort 4—6 hours, four doc— b) pen tors report 7-l0 hours, five report 11-15 hours on an average per month, two doctors list 16—20 hours, and one physician reports more than Zl hours. This gives an average for-all doctors of 4.6 hours per month in marriage cou seling. -49.. Table 22. Average Uumber of Hours Per Month Spent in Kari- tal Counseling by Physicians Classified according to Age. no. of number of Hours nae <_¥“hys. 0 1-3 4-6 7—lO 11-15 16-20 a1 bd-EO years 5 0 l O 2 O 0 O él-bh “ l4 1 6 4 2 O l 56-40 " 12 l 3 3 O 4 l 0 41-45 “ lO 1 3 4 0 l l 0 46-50 " ll 2 8 l O O D 0 51-55 ” 7 0 4 3 O O D 0 56-60 " 4 l l 2 O O O O 6l-65 ” 4 O o l O O 0 0 66-75 " ##AQ 0 2 O 0 O O O rotals 67 6 51 18 4 5 0 l Here again it is evident that the younger men.are more active in counseling. None of the physicians listed above the age of é5 spends more than 4-6 hours a month in counselire. if we again take as our mid-age. the age 51 the contrast is very marked. The physicians so years of age or less spend on an.avera e 5.2 hours per month in counseling, while those above the age of 50 aver ge only 2.6 hours per mont . fhe youlver men thus reported twice the amount of time spent with the cases that they meet in their practice. -50- o. The younger doctors are seeing more people who re- quest pre-marital advice than are the older doctors. The average number of cases per month for the doctors 50 years of age or less is 5, and for the doctors over 50 years of age is 3.1 per month. done of the doctors past the age of 00 report more than an average of eight cases a month, while three of the younger doctors report ten cases, one reports nine, one six, and four report five a month. fhe first three sections of this survey then, show a definite trend toward the younger doctors. Eroportionally more people are seeking them out for counseling than are seeking the older physicians. The younger doctors also Spend more time with their cases than do the older men. .. -_ .. L‘er Iio nth _ ”able ac. average number of CBSGSAOf rremarital Counseling by Physicians Classified According to Age. 30- 03 Less Humber of Cases and. Phys. O,than_l_ 1-2 5-4 5-5,.y-a lsglo L6-oo years 5 O 0 0 3 O O e1-eo “ l4 1 2 0 v e o 0 56-40 " 12 2 1 a 2 2 o 2 41-47 " 10 2 1 3 2 2 o 0 46-50 " 11 2 1 5 o 1 o 2 51-55 " 7 a o 1 2 o 1 0 56-60 " 4 1 o 1 2 o o 0 61-65 ” 4 1 o a o o o 0 66-70 " 2 <0 11 j_ 11 yli 0 11 Totals 67 l2 5 El 19 ll 1 4 g— -01- a. The Effect of the Premarital Examination haw. nleven doctors made no reply to the question whether in their Opinion the premarital examination law had in- creased the number who sought advice on ot‘er problems before marriage. rwenty four physicians replied that the law had not increased the number, and thirty two doctors replied that in their opinion the law had increased the number. wherefore of the doctors who reply to this question the majority beiieve that the law has had the effect of increasing premarital consultations, but the Opinion is so evenly divided that conclusions cannot be drawn.from their replies. Jhen those who give no reply to this question are not considered, the data show- more of the younger doc- tors proportionately answer that in their Opinion the law has increased the number of young people who seek other premarital advice. rwo thirds of the younger doctors reply affirmatively wnile two thirds of the older doctors say that the law has not had such an effect on their practice. U. The Age of the Physician in Relation to the frequency With Jhich harital Problems are fist in Practice. In this section a double analysis will be made. Bhe first is an attempt to discover whether more of the younger or of the older physicians are meeting the problems of marriage in their practice. The second is an attempt to discover whether the old er or young er physicians are by t he C): L' - . a' A ”V -. .-L.‘ - ... -,,., 4. meetinw the problens more frequeno15 as indic:te (‘9 grade given the problems. m if we look first o all at the number of problezns listed by the physicians the average number for all phy- sicians is six oroblegs. however, the physicians below ‘ the £13 Cu 11) of bl years grade on an averape 6.5 problems, while the {sen above the a:"e of 50 have an aver? '1 of W 4. 8 problems. i'ne d' ffe rence bet.1een the two groups 1 U1 not so marked at this point, and yet there is a diffs H ence of nearly two problems per doctor. This is an indi— cation of the fact that the younger physicians are meet- ing a sider variety of marital problems in their practice than are the older physicians. This survey does not set up any causal factors for this disparity, out only points out the fact. 1. the Problem of the rechnique of sexual Intercourse. rhs evidence gathered in this survey reveals that in this community the younger doctors are meeting more frequently questions concern'ng the technique of sexual intercourse. snly one doctor past the age of follows page 55 Table Inter -54- 24. Rating of frequency of Technique of sexual course as a Karital Problem by Thysicians Classified According to age. No. of natirrr; of Frequencev! age "Phys. 0 f - 1+ 2+ 5+“ 4+ za-tO years o O O 2 0 O l ul-fifi ’ 14 4 l 6 l l l o6-4‘O " 12 5 O 2 :5 l I 41-40 ‘ lO 6 O 2 2 O 0 46-50 " ll 9 O l O 0 1 51-30 " 7 5 O 2 O O 0 56-60 “ 4 3 O O l O 0 61-65 " 4 3 0 l 0 O 0 66-75 " 2 Z O O 0 O 0 Totals 67 57 l 16 7 2 4 h a. The Problem of the rear of Sex. This problem was not met by as many physicians as that of the techniques of sexual intercourse. The data again reveal a sharp trend toward the younger men among the physicians who found this problem signi- ficant. Only three doctors above the age of 50 so listed the problem, and none of them found it to be of average or more than average frequency. Almost one half of the doctors 50 years of age -55.. or less list this problem as occurring frequently enough to be significant, while less than one fifth of the phy— sicians over the age of 50 so found it. Zone of the ten physicians past the age of 55 even mention the problem. Only two doctors past the age of 45 found the problem of even average frequency in their practice. The results of the survey show that this is a problem that is definitely being reported by the younger doctors, and not by the older physicians. Jith respect to this problem also, it is probable that the training of the younger physicians is a factor in the frequency with which they report it. Table 25. dating of rrequency of fear of Sex as a Karital Problem by Physicians Classified according to Age. Ko. of Rating of rrequence 4&3 Ph's. 0 1+ 2+ 5+ 4t. 26-50 years 3 0 5 O 0 0 51-55 " l4 5 4 5 O 0 56-40 " 12 6 5 l l 1 41-45 " lO 6 5 O 0 1 46-50 " ll 9 0 2 O 0 51-55 " 7 4 5 O 0 0 56-75 " 10 10 0 0 O 0 Totals 67 4O 16 8 l 2 5. The Problem of Contraception. sixty one doctors met this problem of contraception, and almost one half of them gave it the highest rating in -55- 50 rated the problem Of average or more than average frequency, while twelve of the younger doctors so rated it. Jne half of the younger physicians considered it a significant one, while less than one quarter of the doctors over the age of 50 did. This problem seems to be one found by the younger doctors, for only the first three have a majority who found the problem signi- 0] age group ficant. Only six physicians found questions concerning sexual technique to be frequent or very frequent, and all six were 50 years of age or less. shile this study did not attempt to find causative factors for the results obtained, it is the Opinion of the author that the disparity between the Older an younger doctors on this question is in part due to the difference in training. Emphasis On sexual matters as factors in marital difficulties is found in the litera- ture today, and this emphasis was lacking in years past. It is therefore probable that the younger physicians meet the problem more frequently because they are making inquiry about it in cases of marital problems that come to their attention. The exact figures, as given in iable 24, show that of the twenty nine physicians who found the problem of sexual technique significant in their practice, twenty five are 50 years of age or less. the scale. fhe factor of age seems to have less influence on the frequency with which the problem of contraception cussed in this (Jx‘ appears than on the preceding problems di' section. ln stranpe contrast to the previous trend toward the younger doctors we find that of the six doctors who grade 0, five are as years oi ape or less, and only one H is past the age of 00. :roportionatelv more o the older doctors are meeting the problem. sixteen, or 94}, of the doctors past the age of 50 do so, while forty five, or 90), of the younger doctors met it. when the frequency ratings are examined hosever, the trend towar‘ the younger doctors occurs again. thirty four, or 689, of the younger doctors met the problem frequently or very frequently in.their practice, while seven, or 429, of the older doctors found the problem to be that important. lt is evident that the problem of contraception is one that is met very frequently by the physicist. there is not a large difference in the relative number of older or younger physicians meeting the problem, but there is a difference in the r lative number wlo met (L the problem frequently. 4AA... -57.. rable 26. hating of frequency of Contraception as a harital Problem by Ehysicians classified According to age. ,9 So. i Rating of rrequence age Phys. 0 l+ 2+ 5+ 4+ 26-60 years 5 O O O l 2 51-55 " lé l 2 2 l 8 56—40 " 12 l 2 l 2 6 el-eo " lO 3 O l a 4 46-50 " ll 0 O 5 l 7 r1-55 " 7 l l O 3 2 56-60 " 4 O O 2 O 2 61-65 " 4 O 7 l O O gj-VS ' 2 AND " O O 0 Totals 67 6 10 l0 10 El 4. The Problem of Kasturbation. ct' This survey does no seek to determine how much of this probleu is a carry-over from the auto-erotic eXperiences previous to marriage. It only seeks to deter- mine the estimated frequency vnth which this problem appears in the office- of the physicians in the Lansing 0) area. Not many physicians found auto-erotic practices after marriage a very frequent problem. Only four report it to be of average or more than average frequency. All four are below the age of 46. Eons of the ten doctors past the age of 55 even lists the preblem, probably be- cause their training was not such as to make them aware of it. -58- Although only a few doctors found the problem very frequent, twenty five of the physicians occasionally met it in their practice, and twenty four of them met it often enough to rate it significant. Of the twenty four who found the problem significant, twenty one were 30 years of age or less. It is again evident that the'younger doctors in the community are the ones meeting this problem. Table 27. Rating of Frequency of Kasturbation as a Karital Problem by Physicians Classified According to Age. 3o. of Rating of Frequency Age Phys. 6 + - 1+ 2+ 3+ 4+ 86-30 years 3 2 O l 0 O 0 31-35 " l4 9 1 3 0 0 0 36-40 " 12 7 0 2 l 0 2 41-45 " lO 6 0 3 O l 0 46-60 " ll 3 0 8 O O 0 5l-55 " 7 4 O 3 O O 0 56-75 " 10 10 0 0 0 0 0 rotals 67 42 1 20 l '1 2 It is interesting to note that three of the four physicians who rate masturbation as average or more than average in frequency are specialists, one a psychiatrist, 1 one a pediatrician, and one a urologist. 1—; Appendix B, Table 7. -59- 5. The Problem of KenOpausal Phenomena. The problems connected with the menarche are with rare exceptions the problems of middle age. The question therefore is whether these middle-aged people are seeking advice from older physicians, from those approximately their own age, or from the younger physicians. Kore than one half of the physicians rated the problen frequent or very frequent, and almost three fourths of the doctors rated it significant, which would indicate that the occurrence of the problem is quite general. Proportionately more of the younger doctors met this problem. Thirty seven, or 745, of the doctors 50 years of age or less rated the problem significant, while eleven of the doctors past 50, or 656, did so. This difference, while not as large as on some previous pro- blems, does show that there is a trend toward the younger doctors in seek'ng medical advice regarding this difficult". With respect to the rating of frequenc* there were relatively more of the younger doctors who rated the pro- blem of menopausal phenomena as frequent or very frequent than of the doctors past the age of 50 years. Twenty seven, or 54p, of the younger doctors so listed the problem compared with eight, or 47p, of the older doctors. Again the difference between the two groups is not as great as in some other problems, but relatively the younger men are meeting more cases seeking advice where menopausal phenomena are causing marital rifts. Table 28. Rating of frequency of Lenopausal Phenomena as a Karital Problem by Physicians Classified according to Age. No. of Rating of frequency Agfi Phys. 0 1+ 2+ 3+ 4+ 26-30 years 3 O l 2 O 0 31-35 " l4 3 l 1 5 4 36-40 " 12 4 0 3 O 5 41-45 " 10 4 2 O l 3 46-50 " 11 2 O 0 l 8 51-55 " 7 3 1 O O 3 56-60 " 4 2 O O 0 2 61-65 " 4 1 O O 0 3 _§6-75 " 2 0 0 2 O 0 Totals 67 19 5 8 7 28 6. The Problem of Sterility. The physicians, by about two to one, found that sterility was a significant problem in their practice. While two-thirds of the physicians found the problem sig- nificant, less than one fifth found the problem frequent or very frequent in their practice. helatively more of the younger doctors found the -51- problem to be significant. Thirty-six, or 729, of the doctors 50 years of age or less so found the problem as compared with nine, or 535 of the doctors past 50 years of age. In rating the frequency with which the problem of sterility was met, proportionately more of the younger physicians rated the problem of average or more than average frequency. Kineteen.of the younger doctors so listed the problem compared to three of the older doctors. however, there is not any significant difference in the relative number in the two groups who rate the problem frequent or very frequent. The data therefore again show a definite trend toward the younger doctors as marital counselors, as far as the relative number of physicians meeting the problem is concerned. . It is interesting to note that there is just one age group, that of 46-50 years, in which no physician grades 0. seven of the eleven doctors in this group are Specialists, three are gynecolOgists, three are sur eons, (9 C) and one is a pediatrician. Table 29. hating of Frequency of Jterility as a Karital Problem by Physicians Classified According to Age. Ko. of hating Frequency sue Pin-'3 . o + - 1+ 2+ 5+ 4+ 26-30 years 3 1 0 1 0 1 0 31-35 " l4 3 0 4 5 0 2 36-40 " 12 5 0 4 2 0 1 41-45 " 10 4 l 2 l 0 2 46-50 " ll 0 0 6 2 0 3 51-55 ' 7 a 0 4 0 l 0 56-60 " 4 2 0 1 0 0 1 61-65 " 4 2 0 1 O 1 0 66-75 " 2 2 O 0 0 0 0 Totals 67 £1 1 23 10 3 9 7. The Problem of Venereal Disease. The physicians were asked to evaluate the problem of venereal disease as it affects marriage by causing marital difficulties. This question in the schedule was not meant as an attempt to discover the frequency of venereal disease among married people. nather its pur- pose was to find the frequency with which the presence of the problem causes at least one of the couple to seek the doctors' counsel. Kore than three fourths of the physicians found the problem of venereal disease in their practice. A relatively larger number of the younper physicians problem significant tnan of the older doctors. forty, or 809, of the doctors 50 years of age or less so rated the problem compared to eleven, or 64], Of the doctors past 50 years of age. when the relative nimber of doctors who considered the problem average or more than average in frequency is computed, the younger physicians again have pro- portionately the larger number. rwonty eight, or 56;, of the yonxger age gro_p rate the problem of venereal disease as average or more than ;Versge in i“re1uenc*r as compared gith eight, or 47g, of the older doctors. inere 13 no signiiicant fiifference in the relative number in the two groups who rate the problem as fre- ...,..—l- a- .4. quellt or vergr.creque;n . rated the The study of the data show only that the younger doctors considered the problem of venereal disease as being more serious than did the older physicians. Table 30. hating of frequency of venereal Jisease as a Karital Eroblem bx Ph“SlCiafl3 classified Accordinu to are. U w v no. of Rating of Frequency “5° “yo. 0 + - 1+ 5+ 3+ 41* 26-30 your; 3 0 0 O 1 0 2 3l-L5 " l4 1 0 4 6 O 3 36-40 " 12 3 Z 0 3 l l 4 41-45 " 10 3 I O l 3 l 2 4u-oo ” 11 l 2 4 4 0 0 51-5 " 7 3 l 2 l 0 0 76-60 " 4 l 0 l O l 1 61-65 " 4 l O O l 0 2 67-75 " ,f;_...--..19. 0 0 1 l 0 Totals 67 13 3 15 17 4 l5 8. The Problem of Financial Difficulties. The data for this problem, as found in the survey, do not reveal a clear cut trend toward either the younger or older doctors. with respect to the relative number of physicians who found the problem significant, the doctors over 50 years of age have the lead. In rating the problem average or more than average in frequency the younger phy- sicians are proportionally more numerous. 0f the seventeen doctors past the age of 50, eight, or 47p, found the problem significant compared to twenty, or 40p, of the fifty doctors less than 51 years of age. -55- The younger doctors have a relatively larger number who rate the problem average or more than average in fre— quency. Thirteen, or 269 of the doctors 50 years of age or less so rate the problem of financial difficulties, comlared to three, or lBfi of the physicians past the age of 00 years. It will be noticed that the relative differ- ence between these two groups is almost equal in these two comparisons. The only conclusion that can be drawn from this data is that while a relatively larger number of the older :1“ doctors e B (D th problem of financial difficulties, the younger doctors rated the problem as more frequently occurring in their practice. Table 31. Rating of frequency of Financial Difficulties as a Karital Troblem by Physicians Classified According to Age. \ Ho. of Rating of Frequency “~35 P113151 1 0 w {it 4;; 26-30 years 3 1 O O 1 O 1 51-35 " 14 a o a s 2 0 55-40 " 12 7 0 2 o o 3 41-45 " 10 7 0 2 O l 0 46-50 " ll 6 3 O l O 1 51-55 " 7 3 O 3 O O 1 56—60 " 4 3 O O 1 0 0 61-65 " 4 1 O 2 O O 1 66-75 " _;_f 2 0 O 0 O 0 Totals 57 36 3 l2 6 3 7 9. The Problem of the wife Working Outside the Home. In general, relatively few of the physicians in the survey found the problem of the working wife of any significance, only nineteen of the sixty seven doctors so 1isting the problem. ruo of the seventeen.physicians over 50 years of age consider the problem of average frequency, and none rated it more than average. Three of the doctors 50 years of age or less rated it average or more than average in frequency, one of the three grading frequent, and one grading very frequent. The older doctors have a relatively larger number who found the problem of the working wife siynificant in J v r"~ their practice. six, or 30p, of the physicians past the age of 50 rated the problem significant compared to thirteen, or £65, of the doctors less than 50 years old. The trend toward the younger doctors is reversed in this problem. Although the problem of the Wife working outside the home does not occur as frequently as most of the other pro- blems in the schedule, yet it was met frequently enough in the doctor's practice to be considered of some importance. dearly 30p of the physicians met the problem, and 295 rated it significant in frequency. "D -07- Table 32. Rating of frequency of working Wife as a Mari- tal Broblem by ihysicians Classified according to Age. No. of hating of frequency Ase Phys. 0 + - 1+ 3+ 5+ 4+ 26-30 years 3 2 l O O 0 0 31-35 " 14 8 O 3 1 1 1 36-40 " 12 8 0 4 0 O 0 41-45 " 10 9 O l O O 0 46-50 " ll 9 O 2 O 0 0 51-55 " 7 3 0 3 1 O 0 56-60 " 4 3 0 O l O 0 61-65 “ 4 3 O 1 O 0 0 66-75 " 2 2 O O O O 0 Totals 67 47 l 14 3 l 1 10. The Problem of Personality Differences. Almost one half of the physicians met this problem, although only two rated it more than average in frequency. 3; one might expect the psychiatrist, psycholOgist, or minister to meet this problem frequently, it is interesting to note that so many physicians were consulted concerning personality differences as these caused marital difficulties. it is probable that because people consult the physician for advice concerning other marital problems, they also seek his counsel when differences of personality are the cause of disharmony in the marriage. -68- None of the physicians past the age of 30 rated the problem even average in frequency, while thirteen, or 265, of the younger doctors rated the problem average or more than average in frequency. This indicates that the younger doctors met the problem more frequently in their practice. The data t'erefore indicate that the difference between the two groups of physicians is very marked, and probably points to a greater awareness of psychological ) factocs as they af*ect marriage problems on the part of F the younger physicians. Table 33. hating of rrequency of Tersonality Differences as a Karital Problem by Thysicians Classified According to Age. . Ho. of Rating of frequency 4:13 Physl 0 1+ 2+ 33- 41 26-30 years 3 2 O l O 0 31-35 “ 14 6 6 2 l 0 36-40 " 12 5 a 4 0 0 41-45 " 10 5 2 2 0 1 46-50 " ll 6 a 2 o 0 51-55 " 7 5 2 o 0 0 56-60 ” 4 a 1‘ o o 0 61-65 ' 4 2 2 o o 0 66-75 " 2 2 o o o 0 Totals 57 ”6 18 ll 1 1 -69. 11. The Problem of Religious Differences. The physician is not consulted on problems of a Spiritual nature because he is an expert in religion, but because he is so often the family confidant with respect to other difficulties. nineteen physicians met this problem but only fif- teen rated it significant. six of the fifteen doctors grade it average or more than average in frequency. The data do not show this problem to be very important as compared to the other problems in the survey. Kore- over, there is no marked trend observable regarding the age of physicians. The relative number who found the problem significant is about equal in both the younger and older group of doctors. Jnly one of the nhvsicians over 30 years of age rates the problem of religious differences as even average in frequency, while four of ' \"\ 1 o. I 7 L-ano (3 -. f‘. rv .-\ \Y-._ -' a. \n :1. -“ U-ie U Vw-‘lgvl («JG -J .IJ. u 43 I.) O M411.“ k'ne lJngr . LBJ-{wl ..'-;A u-' J -70.. .' T\c Table 34. Rating of Freq'ency of Religious uifferences a” a Karital Eroblem by Bhysicians Classified according Ho. of Rating of Frequency Age Phys . O + - 1-1» 3+ 5+ 43- 26-50 years 3 l O O l O l cl-US " 14 ll 0 l 2 0 0 36-40 " 12 10 O E O O O al-ed " lO 8 l l 0 O O ac—SO " ll 6 4 2 l O O Jl-55 " 7 4 l 2 0 O 0 06-60 " 4 5 0 O l O O 6l-65 " 4 3 O l 0 O 0 66-75 " 2 2 O O O O 0 Totals 67 48 4 9 5 0 l 12. The Problems Submitted by the Physicians. This section of the analysis is concerned only with the number of problems submitted by the physicians, and with the frequency rating given them by physicians of different ages. The problems themselves are discussed in Chapter II. Twenty one physicians listed problems met in their practice which were not found in the questionnaire, but only six of the twenty one listed more than one problem. Three doctors list two problems and three list three problems. -71— ’ .-',...+ :- Lu '..°. - v. .- ,1 .. ., r. -<' eighteen oi the pflcelcl?33 under a years of age list A L5. ... 1.. .' 3,. , - .' V. .4. ...1- 3", proole - they considered slyfilllcfljp, ufllle three of the "' 'u‘ !" N: *- ‘ ~'\‘ I" '\ "1! ”V .\ . \’ L T phxsic piano over do subnltoed procleas. llus proportionately - . a '..- '.' , . .. .- ».'t “ «v more oi the young er men sup eaten pI’Oul-s.13. Table to. nu gear of rocle :13 submitted bv shy sicians 0 Cla3sified according to n;€. aye So. of Lumber of :roblems éU-UO ye r1 To 5 l. O O ._3 I t' (J r CD 01 N O) F\ 1'". Zd—éO " 1: ()3 H C) 41-45 " 10 O: 01 r.- I (j C. \2 x: H O O D 54>» 46-50 " 11 11 POOOOO OOHOO 61-0J " 2 66-75 " .M* _ 2___L L‘__ O O (>3 \1 Totals 67 46 15 lions of the physicians in the older group rated the problems they listed as even of average ire aermy. Ten of the younger phvsicians rated their problems ave°ave or more than average. In addition the younger doctors ted their problems as more frequent in occtrre11ce than -72. did the older doctors the problems they submitted. It is apparent that people with difficulties in their married life are turning more frequently to the younger physicians as counselors than to t.e older ones. Table 56. Rating of Frequency of Problems Submitted by Physicians Classified According to Age. Ho. of Rating of Frequency Age Phys. 0 1+ 2+ 5+ 4+ 26-80 years 3 Z l O O 0 51-55 " l4 5 5 2 l 1 36-40 " 12 7 l 2 l 1 41-45 " 10 6 2 1 l 0 46-50 " ll 11 0 O 0 , 0 51-55 " 7 5 2 O O 0 56-75 " lO 9 l O O 0 Totals 67 45 12 5 3 2 In brief, it may be safely stated that there is a trend toward consulting the younger physicians, and that tendency is marked when the problems are those of technique of sexual intercourse, fear of sex, masturbation, sterili- ty, and personality differences, but less so when the problems are those of contraception, 1enopausal phenomena, venereal disease, and religious differences. Jhen the pro- blems are those of financial difficulties and of the work- ing wife the tendency is to seek the advice of older physi- cians. Chapter IV The Specialization of the Physician in Relation to Karital Counseling. a. The Distribution of Physicians Classified According to Age by Field of Specialization. There are forty three doctors listed as general practitioners. The average age of these forty three doc- tors was 44 years,and they ranged from 29 to 72 years of age. There were twenty nine general physicians 50 years of age or less, and fourteen who were more than 50 years old. There were twenty four doctors classified as Special- ists. The average age of’the specialists was 42 years, running a scale from 51 to 62 years of age. Of the twenty four specialists, twenty one were 50 years of age or less, and three were more than 50 years of age. The specialists were further classified as surgeons, pediatricians, gynecologists and obstetricians, urologists, psychiatrists, dermatologists, and public health doctors. There are, of course, other medical specialties, but the ones listed here are those giving replies that could be used in this study. There-were nine surgeons, three pediatricians, six obstetricians and gynecologists, three urologists, one psychiatrist, one dermatologist, and one public health physician. In Appendix B will be found tables analyzing the replies of the specialists by their particular specialty. in this section of the study they will be treated as one group. .— Table 57. The Distribution of Bhysicians Classified 3y Field of specialization according to Age. No. of General No. of figs Eractitioners specialists 26-50 years 5 0 51-55 ” 9 5 56-40 " 7 5 41-45 ” 6 4 46-50 " 4 7 51-55 “ 5 2 56-60 " 4 0 61-65 " 5 1 66-75 " 2 0 Totals 45 24 *3 n. The specialization of the Lhysician in Relation to the number of Cases and the Humber of Hours spent in Counseling. 1. The Number of Cases of Karital Counseling. The forty three general physicians had an average of five cases of marital counseling a month. sighteen of the forty three reported 1 to 5 cases a month, thirteen report- ed an average of 4 to 6 cases a month, ten reported an average of 7 to 10, and two doctors reported an average of 11 to 15 cases a month. f.- -70- The twenty four specialists also had a group average of five cases of marital counselinr a month. Three of the Q twenty four reported no cases, six doctor reported an U) average of l to 5 per month, eight reported an average of 4 to 6 per month, five doctors listed ' to 10 cases a month, and two doctors reported an average of 11 to 15 U case. of counseling a month. The three specialists who ( .0 L1 list no cases lower the average. Two 01 uhe three are surgeons and the other is a pediatrician. H Table 58. average number of Cases of Sarita Counseling fer Xonth by Physicians Classified according to specialty. lumber of Lumber of General Number of Cases Practitioners Specialists 0) 1-5 18 4-6 15 mm 7-10 10 0) 11-15 2 2. The Rumber of Ron‘s spent in i by the Physicians. counseling for tre fort" three docto;s in general practice was 4.7 hours. This means that nearl" an hour, n the aver- -75- age, was given to each consultation, as the average number of cases per month was 5 for this group of doctors. Of the forty three general physicians, one reported no hours Spent in counseling, twenty two doctors listed 1 to 3 hours, thirteen.Spend an.aver¢ge of 4 to 6 hours, three list 7 to 10 hours, two doctors reported ll to 15 hours of counseling, one physician lists 16 to 20 hours, and one reports more than El hours. The average number of hours spent in marital counsel- ing by the twenty four specialists was 4.5 hours per month. Five of the specialists reported no hours spent in counsel- ing, nine listed an average of l to 3 hours, five special- ists reported an average of 4 to 6 hours given to counsel- ing, one lists 7 to 10 hours, three reported an average of ll to 15 hours, and one reported 16 to 20 hours. 9. Average Eumber of Hours Spent in fiarital Counseliis ()1! fable by Physicians Classified According to Specialty. Average So. of Humber of General dumber of Hours Practitioners g§pecialists 0 1 5 1-5 22 9 4-6 15 5 7-l0 5 1 11—15 2 5 16-20 1 1 2l plus 1 O _77_ 3. The Lumber of Cases of Pre-Kar'tal Counselinr. The avera e number of premarital counsultations for \J the forty three doctors in general practice was 2.7 per "I month. Only six DI the fortythree listed no consultations, three reported less than one a month, fifteen listed an ($3 average of l to z a month, twelve reported an average of to 4 per month, four listed 5 to 6, one reported 8 cases a month, and two doctors listed 9 to 10 conferences per month. The average number of premarital conferences for the twenty four specialists was 2.8 per month. Table 5 in Apo- endix 3 shows that the reason for this los figure is the fact that none of the pediatricians listed any consultat- ions. The nature of their practice is a sufficient eXplan- ation for this result. Six of the twenty four Specialists reported no cases, two listed less than one a month, six had an average of l to Z consultations per month, seven reported 5 to 4, one listed 6 cases a month, and two doctors had an average of 10 consultations a month. The average number of premarital consultations per month for all physicians is £.6 a month. The specialists -73- Just equal this figure when the three pediatricians are not included in the reckoning. a further eXplanation of the low average of the specialists is that two of the other physicians who list no consultations could hardly be eXpected to do so. One of the two is an industrial surgeon, and the other is engaged in public health prac- tice. It over—simplifies the matter to say that the Specialists met fewer young people for premarital con- sultation. fable so. The Average Jumber of Eremarital Consultations Per Month by Physicians Classified According to specialty. Average Kumber of Ko. of Ceneral no. of Cases fer Konth Practitioners Specialists 0 6 6 Less than 1 6 2 1-2 15 6 3-4 12 ’7 5-6 4 1 7-8 l 0 9-10 2 2 4. The opinions of the doctors Concerning the affect of the Premarital nxamination Law in Increasing the lumber of Young People Jho Seek the Physicians' Advice on Other Problems. This question.was included in the questionnaire in -79- order to discover thether the premarital ex mination for venereal disease required by the state of Eichigan.had affected the number of people who sought the advice of the physician on other suestions before marr’age. The opinions of the doctors on this point will give an indication of the attitudes of young people touard premarital consul- tations, since the answers of the physicians indicate that some peOple take advantage of the opportunity afford- ed by the law and ask advice on other problems. Ehe re- plies of the physicians also indicate that in their opinion many young people sought this premarital advice apart from, and previous to the passage of the law. five of the general physicians did not express an Opinion as to the effect of the law. rhe rest of the forty three are evenly divided on the cuestion, nineteen answer— ing that in their opinion the law had increased their practice, and nineteen answering that in their opinion the law had not had such an effect. six of the twenty four specialists did not reply to the uuestion. rhirteen of the doctors answered that it was their Opinion that the law had increased the number of people who sought other advice, and five replied that they considered the law had no effect on their Jractice with respect to premarital counseling. fable 21. The innions of rhysicians Classified according to specialty aegar ding influence of ir knarital nxamination Lay on Ere-marital Counseling. LO. of Gene ral go. of lractit ior ers o peciali ist no. neplying Law Increased Counseling 19 3 ho. heplying Law bid got increase 19 3 Counseling Ko. nxprescing no Opinion (I! O in; doctors in general practice and the specialist marital counsel- q ('1) H S.) (D :3 :3 Ln" ( L3 I . (- I. O ‘ :3 l 1’) (D ( ‘1 U H: Have the same a 5 But the field of practice of some srecialists, such as pediatricians and surgeons, is such that fewer people would consult them concerning marl ia5 e problem. The other specialis s have a higher average number of cases than the doctors in general practice. The same causes affect the average number of hours Spent in counseling. The data simply shows that the general physicians and the specialists spend approximate- ly the same average amount of time in couns sling. But where, because of the field of practice, there is a -8l- lesser amount of consultations, there is also less time spent in giving counsel. Pediatricians, as baby specialists, would naturally not have much occasion to give premarita l advice. Bit be- 1 cause they are classified as specialists, they reduce the general average of the specialists in premarital consul- tations. This is also true of industrial surgeons and public health physicians. Th (D unqualified data shows that the :hyoicians in,general practice see slightly more young people per montl than do the specialists. The general physicians are evenly divided in their Opinions respecting the effect of the state's premarital examination law on premarital consultations. Half of those who express an opinion believe that the law has in- creased the number who seek other advice from the physi- cian, and half do not believe that the law has had such an effect in their practice. a majority of the specialists believe that the law has increased the number regu sting premarital advice. The number eXpressing this opinion is greater than the n umber of those who do not reply to the question and those who do not believe the law aff cted tz‘ieir practice ombined . C. The Specialization of ?hysicians in Relation to the neplies Given to the Proble.ns of the guestionnaire. -82- l. The Problem of the Technique of Sexual Intercourse. The doctors in.general practice found the problem of the technique of intercourse more significant than did the Specialists. Twenty, or 47;, of the general physicians found the problem significant compared to nine, or 383, of the specialists. Twenty two of the forty three doctors in general practice grade the problem of sexual technique 0, denot- ing the fact that they did not meet it in their practice. One doctor‘5rades plus-minus to show that the problem was met very infrequently, nine physicians rated the problem 1 plus, indicating that the problem occurred fre- quently enough to be considered significant. Five of the general practitioners graded the problem 2 plus, signi- fyin5 that they considered it of average frequency. Two doctors rated it 3 plus, or frequent in occurrence, while four physicians graded 4 plus to indicate that the pro- blem was very frequent in appearing in their practice. fifteen of the twenty four specialists did not meet problems concerned with the technique of sexual inter- course. oeven of the doctors graded l plus, and two rated the problem a plus. Hone of the specialists consi- dered this problem to be of more than average frequency. Eleven of the doctors in general practice found the problem of average or more than average frequency com- pared to two of the specialists who so rated the problem. -83... 2. The Problem of the fear of sex. The specialists found fear of sex a less signifi- cant problem than did the 5eneral physicians. hi 5hteen, or at”, of the doctors in general practice reported this problem as si5nificant, compared to nine, or EBQ, of the spe cialis ts . roenty five of the 5eneral physicians rated the pro- blem O, twelve 5raded 1 plus, three rated it 2 plus one rated a plus, and tso doctors ded 4 plus. Thus only CH \ six of forty three doctors in this group found the problem of average or more than avera’e frequency. sifteen of the specialists did not meet the problem in their practice, four graded 1 plus, and five of the doctors rated it 2 plus. hone considered it of more than avera5e frequenqy, and only five of the twenty four spe- cialists rated the problem that frequent. Jhile relatively more of the general physicians found the problem of the fear of sex si5nificant, pro- portionately more of the specialists found the problem of average or more than average frequency. a. The Problea of Contraception. The specialists and the 5eneral physicians found contraception to be a very frequent problem in their practice. Forty one, or 93p, of the doctors in.5eneral practice found it significant compared to‘twenty, or say, of the specialists. -84— Jnly two of the forty three 5eneral practitioners did not meet the problem in their practice, and so 5raded it 0. seven doctors 5raded 1 plus, seven graded 2 plus, five rated the problem L plus, and twenty two rated con- traception a plus as a marital problem. a majority of the doctors in this 5roup gave the hi5hest rating possible in the scale set up for this questionnaire. Ewenty seven, or 605, of the 5eneral physicians ated contraception a frequent or very frequent problem. flour of the tw nty four specialists did not meet the problem and graded it 0. Three doctors graded 1 plus, three rated contraception 2 plus, five doctors graded it 3 plus as {D marital problem, and nine specialists rated the specialists rated con- f' I) it 4 plus. :welve, or 50p, 0 traception a freguent or very frequent problem. veneral prac- k.) A proportionately larger number of the titioners met the problem of contraception, and also rated it a more frequent problem than the specialists. However, it is evident that both groups found the problem a frequent one. 4. rhe Problea of .asturbation. The specialists reported the problem of auto—erotic practices in marria5e more frequently than the doctors in general practice. Thirteen, or 05H, of the specialists found it a si5uificant one compared to eleven, or L63 of Q -85— the general physicians. eleven specialists 5raded the problem 0, ten rated it i plus, one rated it 2 plus, one a plus, and one doctor 1 3. Thus only three of the twenty four sue- ~— g: graded 4 )l cialists found the problem of {Aas tu rb:1tion avera5e or more than average in ireque ncy. The one physician .ho rated it as very frequent was a psycniatrist. Thirty one of the general physicians did not meet the problen of masturb21tion in their practice, and 5raded it 0. one doctor graded pl“'-minus, ten rated the problem 1 plus, and one doctor rated it 4 plus. «hile pro or ionat Hi more of the Specialists re— Both the specialist; and the doctors in goneral prac- tice found the problem of manopaus: phenomena a frequent one, however, relatively more of the 5on;.rel physicians met the problem in their practice. Thirty four, or 79;, of the 5e eneral practitioners found it a si5nificant pro- blem c mpa1ed to id, or 59}, of the specialist. nine of the forty three doctors in reneral ctice *J I" did not meet the problem, 5radin5 it 0. Four doctors rated it l plus, seven 5raded 2 plus, Six 5 plus, and seventeen -80.. physicians rated the problem 4 plus. Ten of the twenty four specialists graded the problem 0, one rated it 1 plus, one 2 plus, and one a plus. Ten Specialists gave the hi5hest rating to the problem, 4 plus. The two 5roups of doctors are about equal in their ratin5 of the frequency of this roblem. Eleven, or 50fl, of the soecial t“ 0) cf U H to c f' (D "' l c t“ I)” (D problem of menopausal phe- nomena frequent or very fre:uent, compared to twenty three, or 03p, of the doctors in eneral practice. C": 6, The Problem of Sterility. rroportionate y more of the specialists reported the problem of sterility than of the general physicians. Ji5hteen, or 76p, of the Specialists met the problem com- pared to twenty eight, or 64}, of the general physicians. Six of the tsenty four specialists did not meet it, and 5raded it 0. One doctor 5raded plus-minus, ei5ht r ted 93 the problem i plus, two 5raded 2 plus, one 3 plus, and six Specialists rated it 4 plus. Fifteen of the forty three doctors in 5eneral practice 5rade 0, fifteen rate the problem of sterility 1 plus, ei5ht graded 2 plus, two 3 plus, and three doctors rated it 4 plus. Jhen the data on this question were examined it was evident that not only do proportionately more of the spe- cialists meet the problem of sterility, but they also con— sider it a more freguent one than.do the "eneral practi- L) tioners. seven, or 29», of the specialists rated it -07- frequent or veiy frequent compared to five, or 12}, of the doctors in 5ereral practice. 7. The froblem of Venereal Disease. Relatively less of the specialists eported the pro- blem of enereal disease in their practice than did the general physicians. Eineteen, or 79}, of the specialists encountered it compared to thirty five, or Bl}, of the doctors in general practice. out the difference between the two 5rou s i not very si5nificant. 0] t 5 8' t forty three 5eneral practitioners did Pb 315 t o not meet the problem of venereal disease, 5radin5 it 0. One doctor 5raded it plus-minus, ten physicians rated 1 plus, nine rated 2 p us, four 5raded 3 plus, and eleven doctors rated it 4 plus. five of the specialists graded O, tuo rated the problem plus-minus, five graded it i plus, ei5ht ; plus, and four of the specialists gave venereal disease the hi5hest rating in the scale, 4 plus. The data indicate that the doctors in general prac- tice consider venereal disease a more frequently occurring problem than do the specialists as a 5roup, but the difference is not very significant. 24, or 55fi, of the general practitioners rated it average or more than average in frequency. l2, or 50%, of the specialists so rated the problem. Of the four specialists who rated isease a plus, three were urologists, and one £3: vene real was a dermatolo5ist and syphilolo5ist. These Specialists, because of their field of practice, would meet the pro- blem frequently. :one of the other specialists rated it as more than avera5e in frequency. 8. The Problem of financial Jifficulties. There was no difference between the relative number F") o specialists and 5ene al practitioners who found the problem of financial difficulties occurrin5 in their practice. eleven, or say, of the specialists reported it compared tozuenty, or 46p, of the general physicians. however, proportionately more of the general physicians found the problem significant, grading it 1 plus or more. Twenty, or 46}, of the doctors in general practice listed it as si5nificant compared wi5ht ei5ht, or 26p, of the specialists. Twenty three of the forty three general practitioners did not meet the problem of financial difficulties. seven doctors rated it i plus, five 2 plus, two 5 plus, and six physicians rated it 4 plus. Thirteen of the twenty four Specialists rated the problem of financial difficulties 0, three 5raded plus-minus, five rated 1 plus, one 2 plus, one 5 plus, and one specialist rated it 4 plus. The data above indicate that the doctors in 5eneral practice rate financial difficulties as a marital problem -89... relatively more frequent than do the so a) O P '1‘) r—o '4 OJ c I' U] U H: U H ‘.—a C U or so”, of the general practitioners rated the problem average or more than average in frequency compared with 5, or 15p of the specialists. 9. The Problem of the fife Working Outside the Home. 04 Hot many of the speciali ts reported the problem of the working wife as one concerning which they were consulted. Only four, or 179, of them did so. But about one third of :3- (D the doctors in general practice revorted t ‘ problem. Twenty seven of the forty three doctors in general practice did not report the the working wife as a marital problem, and graded it 0. One doctor graded plus-minus, eleven rated it 1 plus, three 2 plus, and one 4 plus. Twenty of the twenty four Specialists graded the problem 0, three graded l plu (f) 93 , nd one a plus. Only four of the spec- ialists found the problem significant, and only one found it average or more than average in frequency. Keither the Specialists nor the doctors in general [1 practice reported the problems as very frequent, although about 50p of all doctors met the problem in their practice. 10. The Problem of Personality Differences ’Proportionately more of the doctors in general practice listed the problem of personality differences as -90- a marital problem than of the specialists. rwenty one, or 48p, of the general practitioners encountered the problem compared to ten, or 52p, of the specialists. T..'enty tn’O of the forty three physicians in general u) practice graded the problem 0, ten rate} it 1 plu , nine 2 plus, one a plus, and one 4 plus. Only two of the doctors in this group met the problem frequentl‘. fourteen of the twenty four specialists indicated ‘: 1- L .. v ‘V ' l- , P, ' L., 1 ' "' w. ‘\ c r a uhaU they did not meet personality diiierence« as a to marital U“Dbl€m by nradin: it 0. sirht f the specialists K.../ ‘q u L-\ " ‘: ‘I‘ ~ ‘ ‘- r I o ‘ ‘ ‘3 1': - 1" ‘— jm‘; x ,~. H; rated is l plus, and two C,raced a -lus. hone oi .-e sp~~ :- - o m. - - 1.: .-- - ,. . -. ° v 0-. .. C 1.. _ a A. \ u'JC Ji..€; ‘- l )o‘ -_._ 1 .43113 'JLL")J..~ :tv IBM-ti)»: 1:1 4 -76 - " - J. ,‘o L - , . i ..r -' ' m- ‘ 1- nLenny, aha...ni~ u.o tn. the general pnpsicnzur: rated 1U more than average. On this point there is not much differeice betseen ti- ts groups f doctors. Eleven, or 25g, oi the general physicians rLted personality differ- ences as a marital problem average or more than average in frequency, compared to 3J3, or 8Q, of the specialists. The data therefore indicate that the doctors in general practice reported the pr.blen more frequently than did the specialists. ll. The Problem of Religious Differences. Proportionately more of the specialists than of the general practitioners met the problem of religious differ— ences in their practice. Eight, or say, of the specialists -91- found it a problem conpared to eleven, or Zdfl, of the doctors in general practice. Sixteen of the twenty four Specialists graded relig- ious differences 0 as a marital problem, three rated it plus-minus, and five graded 1 plus. Hone of the specialists graded the problem more than 1 plus, and so none considered it even of average frequency. of the forty three doctors in general practice, thirty three graded the problem 0, one rated it plus-minus, four graded 1 plus, five a plus, and one doctor rated it 4 plus. six of the general physicians rated relipious differences as average or more than aver- age in frequency. Thus the data indicate that while pro- portionately more f the specialists reported the problem, the doctors in general practice rat (I) d it a more frequent problem in their practice. I Table as on the following page snows the number of physicians classified according to specialty who reported the problems of financial difficulties, of the wife working out side the home, personality differences, and religious differences. adea pm. wdebm on macpfiobow on wuochem oH wapbonH UHHmHoanuam. eHHo aoewunm odd. HaemobmHuaw Upnwcuoboam. men onHmHodm Uuuwauouomw aw wumeonUm nHmmmHHHmn boaoumwum do memonHdw. ac. oH we mHoumsm wcbosdHem a -os b oneMonmosmHHdH.Uwaasouoom onH poem wwww. wmaHum spamsOHmH UwaHQstuom ow - ambasmH‘ oboe , econH nmumsmH‘ mbmum woo m weanm. wsmod. mmponHumdm memos. Hmdm memos. MMponHHmdm memos. Hmdm 0 ma Ha ma mo mm H» um Hm +0 o a H o o o H u H... q a HH u Ho m m a m+ a H a o a m u 0 6+ w H o H H o o 0 9+ 0 H H o H o H o -92- -9 U- lZ. The Problems suggested by the Doctors. Th (*4 J e content f these problems has been discu sed in Chapter II. In this section we are concerned only with the number of probleus listed and tie grading given them. portion to their number, more of the Specialist* ‘ ted problems than the doctors in general practice. Kine, specialists suggest a problem in addition *1 . ufle 't contained in the questionnaire, compared with thirteen, or 50p, of the (V Lr—w Q 00 Fifteen speciali physicians in general practice. did not suggest a problem, seven listed one problem, and two lis three problems. Thirty of the forty three doctors in general practice listed no problems, eight suggested one, three suggested two, and two doctors listed three. Table 45. Number of Problems Suggested by Thysicians Them- selves Classified According to Specialty of the Physicians. So. of do. of General ho. of Problems Practitioners Specialists 0 50 15 l 8 7 2 3 0 d 2 2 Proportionately more of the specialists raded the £0 s.) problems they sur~ sted as averace or more than.average in 1-94- frequency. Five, or 219, of the specialists so graded the problems sugge (I) ted compared with seven, or 16;, of the doctors in.general practice. Fifteen of the twenty four Specialists graded 0, four graded l plus, one 2 plus, two b plus, and two rated the problems they submitted 4 plus. Thirty of the forty three general physicians graded 0, six (>3 graded l plus, five 2 plus, and two plus. These figures A. show that more of the specialists rated the problems they submitted as frequent or very frequent in their practice. Table 44. hating of frequency of Iroblems suggested by the Physicians Classified according to specialty. hating of do. of General Bo. of Frequency Practitioners specialists O 50 15 1+ 6 4 2* 5 1 5+ 2 2 4+ 0 2 13. oummar*. In summarizing this chapter it must be borne in mind that the specialists are under a distinct handicap when compared to the general physicians. several of the spe- -95.. cialists who replied to the questionnaire have fields of practice in which they would meet relatively few of the ordinary marital diificulties. the three pediatricians who replied, Ior instance, would see few if any cases of menopausal phenomena. They are child specialists, and so meet only women of childbearing age. For the same reason they would encounter very infrequently cases of sterility. The doctor whose practice is limited to surgery would not normally nest many of the problems of married life in his practice, since his work would be confined to opera- tive and post-operative procedures. The doctor whose Specialty was the iield or public healtl Lould also not be in contact as a practicing physician with the problems of marriage. Jhus the specialists just mentioned lower the general average :or the specialists as a group. fihen these factors are considered the specialists compare very well with the doctors in 'eneral practice with respect to marital and premarital counseling. ouCh specialists as the obstetricians and gynecolo- gists, and urolopists meet the problems of marriage fre- quently. their field or practice has a great deal to do witl the sexual life, and marriage as an inst tution is rooted in sex. :he tables in Appendix 5 Show that these Specialists had a consistently high reSponse to the problems listed in the questionnaire. -96.. The data in this chapter indicate that the general physicians sported more problems in xhich psychological and sociolopical factors played the larger part. rhey outranxed the specialists with regard to the following problems; the technique of sexual intercou se, contra- ception, financial difficulties, wofiz’n; wife, and personality dii' Proportionatel" more of the specialists reported the problems of masturbation and sterility. rhey also submitted more problems not listed in the questionnaire than did the doctors in.general practice. with respect to four of the problems included in the questionnaire the results are balanced between the general practitioners and the specialists. who data on the problens of menopausal phenomena and venereal dis- ease Show no significant difference betJeen the two groups or doct rs. rhe doctors in general practice had ,1 a larger number proportionately who met the prob em of the fear of sex, but a relatively larger number of the specialists rated it of average or more than average fre- quency in their practice. Proportionately more of the Specialists met the prob en of religious Ciiferences, but a relatively greater number of "e“' u y— H (L H i" to P. L; F (‘1 F g \ ts H OJ 1- '4. :1' - .- - 1.1m . . . rated lb oi avers e or more than ever: \d ID -97- Chapter v The Training of Physicians in " nelation to harital Counseling. one of the problems S; gested by this survey is the question if the physicians who have had the most training as marital counselor: are actually doing the most coun— seling. There are thirty four doctors who do not list more than two sources of preparation for counseling, and there are thirty three who list three or more sources. The dis- tribution is almost perfectly balanced; there are five doctors who list no sources, eleven who list one, eighteen who list two, eighteen who list three, ten who list four, and five who list five sources. Figure 1. number of Sources of Training Listed by Ehysicians. 30. of Physicians ilumbe r Of ,. ‘000010000015000020 ,3 o urc e 3 0 Ill/II/I/ of 1 ////////////////////. Training; 2 \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\‘ '5 .\\\\\\\\\\\.\\\\\\\\\\\\\\\\\\\\‘§ g 7/lllllll/llllI/ll. The five physicians who listed no sources of pre— paration met an averaae oi three i the problems listed U in the questionnaire, While tie mean f r all doctors in the survey was six pro'oler.;s. They report ed an average of 4.2 cases a month of marital counseling , a fi5ure very little lower than the mean of 4. ’7 cas es a mor th. These jive padsicians soent an averare of 1.8 hours per month in such counseling. ihis is far below the mean of 4.6 hours reported by all physicians in the urvey. flore- (.0 over they reported an average of only 1.5 young people consulted concernin5 premarital probleas, a5a sin a lower figure, for the mean is 2.6 such conferences a month. There are eleven doctors who list one source of pre- paration for counselinyp These doctors reported an average of 4.1 cases per month, which is also below the general 0 5 O 0) avera5e of sea. They had an average of 5.5 persons coming into their offices for counseling compared to the 5eheral avera5e of 4.7. On this particular point this group is sli5htly below the previous group, and also below the ave ra5 e. These eleven doctors eper t an avera5e of 2.5 hours per month in such counseling, a hi5her' figure than the preceding gr ou up, but still well below the average of all doctors, which is 4.6 hours. They met on an avera5 e two young people a month for premarital con- sultations compared to the average of 2.6 for all doctors. -99.. jighteen doctors liste two sources of preparation. They reported an average of 5.6 problems in their prac- tice, a figure just slightly below the general average {DJ of 6, but which does not iffer enough to be significant. cf These doctors fall below he general average for the number of people they consulted on marriage problems, having reported an.average of 4.1 per month, while the figure for all doctors is 4.7. While the average number of hours spent in marital counseling was 4.6 hours per month these physicians reported an average of 5.1 hours Spent in counseling. They met 1.9 young folks per month for pre-marital consultation, again a loJer figure than the general average of 2.6 per month. Jith the fourth group of doctors we meet those who listed more than the mean number of sources of prepara- tion. The ei5hteen doctors in this group listed three sources. The doctors in this group reported an average of 7.2 roblems in their practice. This figure is well above the general average of 6 problems. They met an average of 5.2 patients per month compared to that of 4.7 for all (u doctor , and spent an average of 5 hours per month in counseling compared to the general mean of 4.6 hours. They met an average of 5 young peeple seeking pre- marital advice compared to the average for all doctors of 2.6. -100- There are ten doctors who listed four sources of preparation for counseling. These ten reported an average of 8.2 problems in their practice, a higher figure than that of the preceding group, and also much higher than the general mean of 6 problems. This group meets an average of 6.9 cases of marital counseling per month wnich is considerably above that of 4.7 for all doc- tors and they spend an average of 5.9 hours per month in such counseling compared to the mean for all doctors of 4.6 hours per month. These doctors met 2.7 people a month in premarital counseling, again a figure above the general average of 2.6 per month. in the last group are five doctors who listed all five sources of preparation given in the questionnaire. These men reported the largest number of problems of all the groups with 8.6. However, they did not meet as many persons for counseling as the preceding group, reporting an average of 5.7 per month, nor do they spend as much time in counseling, listing 4.6 hours per month. Jut these five doctors lead the other groups in the number of young people that they met in premarital counseling with an average of 6.1 per month, a figure far above the other groups, and also far above the general average of 2.6 per month. These results show that in.general as training -101- and preparation of the doctors increases the more counsel; ing they do, and the more problems they meet. The men with less than three sources of preparation, with only one exception, fall below the general average for all doctors in the survey. The men with three or more sources of pre- paration for counseling are above the general average for all doctors, with one exception which is just exactly average. The relationship between the age of the doctor and his preparation for marriage counseling is not entirely clear. in general it appears that the lower the average age the better the preparation. Thus between the five doc- tors who list no preparation and the five who list all five sources there 18 an average difference of about eleven years. Table 45. Average age of the P.ysiciahs in helation to l the number of sources Reported. number of sources Ho. of average age Reported Phys. of Physicians. 0 5 52.2 years 1 11 45.5 " 2 18 45.5 ‘ 5 18 41.2 “ 4 10 55.6 " U1 ()1 h’f. r... 0 lb ~102- The reason that the average age of the men with more pre— paration is not lower than it is, is the fact that many of these doctors are specialists, and consequently begin practice at a more advanced age than the general prac- titioner. . i The probleus found to be most immortaht, as judged by the frequency'uith which they are reported and by the 0 03 average gr.de given, are listed in table 46. Ihe table 1- . ' v" * ' ""'\ I ' y- ‘r', ‘ ,‘3 my 'V 1' t. j J- “ -$ ‘ J." ‘- inuicaues bulCfl pr.tlcms Jere lounu to U3 mporusnt by 4‘.“ 7" " " : . 'V (N . . . - re ‘- ‘ '7‘ the andslcians CleaSlfled according to the number oi -y all siX'groups; ‘4. CD ,1 '— J (4 cf (1) 1. ._ L'. ., , l... ‘7 .. ., contraception, neuooausal anenon Y . .5 ‘ "‘ , -.' L, n ., .- ril o, , and vener- eal disease. When the above listings are pvt into a com- posite arranp-;snt, the problem of contraception easily takes fi:;t place, menopausal phenomena are rated the next important problen, and sterility and venereal dis- ease are ranked equally in third place. It is interest- ing to note that the doctors with the greatest amount of preparation dissent quite siarplt from the total result, placing both sterility and enereal disease be— fore contraception. adeo pm. maodwoem mmdoo Home Haboudmbddw wwwmwonmbm ownmmBHHon booonoubm so afiaamu ow mosuaam ow maabmemdwob Hpmdmn. asadau on uneven ow mosuomm prdon NWNMPIIII o m wHodHoBm Humdon Mu ounmu ow wmawbm Hm V-lOE- a: H m m p u condemomc gouowmsm maoupwpau devout apou 9H wean: cow oembm 11‘ Upmmmmo condemn dammuomw amboemdu mamuuwpdw ombduob Unmommo mmH much oembm condemn Hobowmfia daumummw maoHHHa wwumboumw omwdwob may wwau uHmmmmm Haw Upmwpadpdw oamum condemn ambobmfim eoowbupwa dcumun Mdaauwudw oobduob pH mwobs on man He mmH bum oaonm douoosnmo ammo condemn mdawpwu :euoemsn «abouomw evades: oawduou Hum mmH wrob upmammo dmduou oeobm maoupwuaw dabmuamw noudumn Kwanzaa gobobnfimu bummmmo ombduou dmduou 9H about OBOE -104- One conclusion drawn.from this study is that the doc- tors witi the greater amount of preparation found more .4 important problens than did the octors with less pre- paration, finding an avertge of two more important problems. The general conclusion on the basis of the data sub- mitted is that the doctors with more preparation met a larger number of people for marital and premarital coun- seling. They found more problems in their practice an graded them as of higher importance. They found a greater number of important problems than did the physicians with less training. fhus the doctors with the greater amount of training are doing more counseling than the other doctors in the survey. -lO5- Chapter VI Kinisters and Other Agencies Concerned with Karital Counseling. ‘ The questionnaires were sent to the ministers in the Lansind area in order that their replies might be a check upon those of the physicians. It was also judged desirable to discover that was being done in the field of marital counseling by the pastors of this community. In order to obtain as complete a report of the counseling in the field of marriage problems as possible, the work of the Visiting Eurses, social service Bureau, Katernal Health Clinic, Young Ken's Christian Association and Young women's Christian Association, Children's Center, Friend of the Court, and the College Health Service, were in- vestigated, and are reported in this chapter. rhe first section of this chapter is concerned with the work of the ministers as marriage counselors, and in the second section the work of the other agencies Just listed is presented. I. The Kinisters as Iarriage Counselors. A. Distribution of the Iinisters According to Age and Denomination. l. The questionnaire sent to the ministers was -105- identical with that sent to the physicians with the ex- ception of the first question. Instead of the field of practice, the ministers were asked to check the services they rendered in their parish. Twenty three of the twenty five ministe s mio returned the uuestionnaire reported preaching as one of the services rendered. Twenty one reported counseling on personality problems, twenty one listed counseling on social problems, twenty one minis- ters reported marital counseling, and twenty listed pre- marital counseling. It is therefore indicated that twenty of the twenty five ministers returning questionnaires were active in counseling in various fields, including marital and premarital consultations. This number represents approximately LOfi of the ministers who received the questionnaire. necause this return is not very high, twenty ministers, selected at random, were approached a second tim , either by per- sonal interview or postal card. Of these twenty ministers, nine were unwilling or unable to coOperate, and eleven replied that they did no marital counseling of sufficient frequency to report. This made a total of 45, or 67p, of all the ministers to whom the questionnaire was sent and from whom som. reply was obtained. It would seem, then, that replies were received from most of the clerg who are active in marital counseling. —107— 2. The Age of the Kinisters. A only eighteen of the ministers gave their ages in reply to the question. The youngest minister reporting was 28 years of age and the oldest was 62. There were only four ministers 50 years of age or'more. The average age of the eighteen who replied was :9 years. The average ,p. age for the physicians was s years. The average for the ministers was four years less than that of the physicians. Because so few of ministers over 50 years of age I returned the questionnaire, it is not possible to compare the replies by groups of older and younger ministers. 5. The Denominational Affiliation of the Kinisters. There were eleven denominations represented among the twenty five returned questionnaires. five of the ministers who replied were Iresbyterian, four were Ketho- dist, four were Congregational, three were Baptist, and three Lutheran. The following groups were represented by one minister in the returned s hedules; Church of Christ, Christian Reformed, inscopalian, Jewish, Kazarene, and seventh Day Adventist. There were, however, twenty five denominations and religious groups not connected with any denomination re- presented in the official directory of the Lansing Kinisterial Association for l929. This means that many -108- the 0) groups were not represented in the survey as far a questionnaires returned are concerned. Jome were not re- presented because the minister had not been located 101g enouph in the community to be able to reply. Others were not represented because the clergymen were not in sym- pathy with the purpose of the survey, and felt that traditional church teaching was Opposed to this kind of research. still other: were not represented because the pastor: simply were not engaging in definite marital and premarital counseling. 3. The Activities of the Linisters in Uounseling. l. rhe Iumbor of Cases of Iarital Counseling. rhe twenty five pastors had an average of 2.8 cases of marital counseling a month. The physicians had an average of 4.7 cases per month. rhe ministers then are seeing on an average two cases a month less than the phy- sicians. The average of 2.8 cases means that approximately seventy cases of marital difficulty a month com to the attention of the twenty five pastors as a group. six of the twenty five ministers reported no cases of marital counseling, fifteen listed an average of l to 5 cases per month, 3J3 reported 4 to 6 a month, one minister listed 7 to lo, and one reported more than 81 cases a month. The pastor who reported more than El 00.3 (D ' '3 ' 1‘, ."I' L;- ‘vfi L‘ ' ‘- o‘ 34. CDLL'lsL lib 8. EDHol i133 ul’le 013.5321 3 time people with difficulties, marit-l o I Ln - '.:" n O.“R1?uloe, are go invited to come and GlSCQBS their problems. rhis pract ce I‘ ‘- 1 "j “o ‘- ' ~1 ‘.. .-. Q ~ LI I: accouios if: the large number oi cases reported. Table 47. §umbgr of Cases of narital U unseling neported by “inisters. . ,0 .- averuue no. oi no. of "‘ ,.., ., '- V' ,.,i.'. ° 'r, cases rer month bin sters #3 l O: N r.- O) l ['1 rd c, C) t~ rhe twenty five ministers reported an averase of 4.1 hours oer month given to counseling people with nzritai ,) -_~. (11- - ,, r .:1. a- -'4.1 1.? 3 313d qu81 x: O .LAle3 c 1.; ,""_; .389 Ki|'LJ-V e Claial—y Yvurl JA Une a VLIQsI'. e t a. U .. 4. J L- -. -. ,, '- .f: ~ L.‘ 1 .-, ° ° . rm..- . . amount oi uime repoiuso oy .ne ph'siCians. in: average -wr~.‘.~- 310 fl ‘. ”to c' \f‘ '7- ‘3? L11 ’3 d ‘- "s ' v ‘ n n a l I M " "O W [lam Li 3.. ADJ. o J 1164.“; J u“; QC yore: ll]. CQuillze 1.1.1.4) Lab A " A . ,1-‘ ‘2 .0 Ecol L’lJl’luLl. I'.'.:'v . ‘5‘ c '1 "j 1" " “' Lo " ‘1 .fl‘ “ M ‘ unile one avers. 3:) oi ufl’d to tal minder of “our: " ,~.’\ L -\ ‘- " -. -- . a L ’ ‘ P u' 1 ‘, 7“ ~ . - -' V 3 opcut in counselinp oy the min1303fo ans pflsilClfldo com- .. , .3. : 1. -. .3 -, - ~ - n - .i ”31.... , pare puioe closely, there is some difference LeuJeen L‘ ‘ I“ L‘ .v~\. ;- ‘1 ‘ ‘ 1- '\ uhe u o groups .men the number oi 1100f; ouenu 13 8011....1- dered in relation to the number Oi cases reported. H W cf 0 K7 oince the physicians reported an average 0“ cases of counseling a month, they spent on an average an hour with each use resorted. rhe ministers, however, reoorted an a era e of on y 2 to 8 cases a month, and therelore spent an average of an hour and half with each case listed. In proportion to the number of cases the ministers gave more time to maritcl counseling than did the physicians. seven of the twenty five pastors reported no time Spent in marriape counseling, nine listed 1 to 5 hours per month, four reported 4 to 6 hours, three spent an average of 7 to 10 hours a month, one reported l6 to 20 hours, and one Zl plus per mont . six of the seven ministers who reported no time spent in counseling also reported no cases of marital counseling, while one pastor reported an average of one to three 0 ases a month, but failed to list the amount of time Spent in this counseling. -lll- Table 48. Number of hours Per Konth Scent in Karital Counseling by Einisters. Average Io. of Kumber of Iini- IEMirs Per Heath sters. O 7 l—5 9 4-6 7-l0 11-15 16—20 2i and over r- t- c> cs m a. The number of Cases of Premarital Counseli s. The ministers reported an average of about two cases of premarital consultations a month compared to the phy— sicians who listed an average of 2.6 per month. There is not a dreat deal of preportionate disparity between the two gro ups on this point . Twelve of t‘e twenty five ministers reported no pre- marital consultations. one pastor reported one case in t‘e course of a year. five ministers listed an average of 1 conference a month, three reported an average of 4 a month, one minister listed 5, one 6, one 7, and one pastor reported an average of l2 a month. seven ministers reported four or more consultations a month, compared to seventeen physicians who listed four or more a month. —112- ?roportionately there are more ministers who list four or more cases a month than there are physicians. There are twelve ministers who reported no cases of premarital counseling compared to twelve physicians who listed no cases. rhus almost one half of the ministers reporting did no premarital counseling, while less than one fifth H, o the doctors did not report such conferences. fable 49. Kumber of Cases of Premarital Counseling Reported by Kinisters. average Eo. of lumber of Cases per Yonth Linisters ** 0 12 l 5 4 3 5 l 6 l 7 l 8 and over 1 ** One minister reported one case in the course of an.entire year. 5. The Average Number of Hours spent in Premarital Counseling. The ministers spent on an average a little more than an hour with each case that came to them for counsel, the average being just a little over 2 hours per month. -ll$- cf Thirteen pas or a] reported no time spent in premarital counseling, almost twice the number that reported no marital couseling. one minister listed an average of one half hour a month, four listed an average of one hour a month, one reported two hours, one three hours, one six hours, two ministers listed an average of eight hours, one reported ten, and one listed twelve hours per month. Ihis question was not included 'n the schedule sent to the physicians, and so there can be no comparison between the two groups on this point. C. The hinister and Karriage rroblems. The average number of problems listed by the minister was :.6. This was a considerably lower figure than that of the doctors, who averaged 6 problems. Six of the twenty five ministers listen no problems whereas only four of the sixty seven physicians did. It is probable that the min— isters reported a smaller variety of problems because they J came in contact with a lesser number of cases than did the physicians. Iinisters did not meat the problem of the technique of sex intercourse very frequently, as only four of the twenty five reported it as significant. Jone of the ministers rated the problem more than 1 plus. Thus the data indicate that no many of the ministers met the prob- it even (D Q. .. :I 4- i. a, L: ‘- i. 1 - I” . I :41,- r lem, and 0 those that did, none consider of average frequency. Only four, or ldg, of t'e ministers -114— rated sexual technique a significant problem compared with twenty nine, or 435, of the physicians. Apparently I when people had questions concerning sexual technique they sought the advice of a physician and not of a minister. not many of the ministers met the problem of the ) I" fear of sex as defined earlier. fwezty one of the twenty five pastors did not meet it. Three of the ministers f‘. rated the problem l plus, and one praded it a plus. Thus only four found the problem to be significant in their counseling. in contrast twenty seven, or 40;, D oi the p‘vsicians found fears connected with sex a significant problen, while only four, or ldfl, of the ministers met it. t is again evident that when people had a problem connected with specifically sex matters they consulted the physician and not the minister. That is true, whether the question be of a medical or psycholOgical nature. It is known that some religious organizations are Opposed to the limitation of the size of the family by so-called ”unnatural methods." Included in these organi- zations were some of the regularly established denomina- tions as well as those not no established. it might be expected therefore that the conflict between traditional religious mores and the economic and social pressure of -115- gtion would brinv many to the s‘J } r today toward iamily limit= pastor for counsel. Ihe fact is, howev r, that only four ministers reported this problem while twenty one did not. Ewo of the four ministers who found the problem of contraception significant in their counseling graded it l plus. rhe other two graded it 4 plus, thus indicating that they thouw'ht it was very significant. noth of the pastors who found the problem freuuently are known in the community fo“ their s rh in counseling. thus while 849 of the ministers did not meet this problem, Blp of the physicians did meet it in their practice. rhe data snow that people are seekinn the advice of the ph;;ician rather than the minister on this protlet. (ii in reportin; ! A r“ : ,~ . L * .1 P - ‘ - ‘ - ". ”v -"-'. . lhe ministers were alhost unanimou l... 4. _. ~L.-,. -1.° -. .. l , 4. no ,- ,'s. 1 - '. , ' A34 utstirbwtion has not ioihd as a marital proclem in LR. ' , . aw :. -. r1 hams... " .i .-1. 0 J.‘ ,. .L... 41' their counseling. inert; four out o- the toenty live -,. ".‘IJ‘ fi "‘- ‘2’ - .L' ' . 1 v ‘ I‘ I‘ ‘ L‘: \ 1: " ministers gram-3Q it 0, and onlyr one iound the proolsi. :iyhificant, pradin; it 1 plus. On the other hand more than one third of the physicians found masturbation to be a marital problem. Lore of the ministers met the problem of meno— pausal phenomena than those previously mentioned. Kevertheless eiphteen did not meet it at all and accord— ingly graded it 0. seven ministers found it to be sig— nificant. Two of the pastors graded it 1 plus, three 2 plus, and two 4 ~l The doctors far outranhed the ninisters in report- ing this problem. Forty three, or 645, of the doctors found the problem averave or more than ave ra3e in fre- quency com; ared to five, or 20}, of the ministers. The physicians therefore also rated the proble1 of 1enomena as occurring much more frequently Y The Bible is the accepted reli3ious book of the Christian denominations. In it ar found references to he blessin3s attendant on the presence of children in the family. For this reason uhenc hi ld le saness is found (D amon3 church families it is reasonable to eXp ct that the pastor be consulted. But the great majority of ministers who returned the questionnaires did not report the pi oclem of sterility in marital counselin3. Eineteen of the twenty five ministers did not meet the problem of sterility, and 3raded it 0. Four ministers rated it l plus, one rated it 2 plus, and one 3 pl s. n8 one would expect, again the minis ers fell far behind the physicians in reporting this pro- blen1. fiith many of the stricter Protestant groups as with the Catholic church, the problem of venerea disease is not regarded as a purely medical or social problem. To r” -l17- then it is also a moral and reli3ious problem, involving the breakih3 of the seventh command :1ent of the Decalogu Churches, as the heforneu, may also re uire a cor ession k2L of sin when the breakin3 of the commentiment is established. (1) C‘s Thus it mi3ht be eXpecte that the minister would be con- sulted about this problem, but twenty tJO of the thenty #- five ministers did not meet it at all. foenty too of the minis teis 3raded the problem 0, two rated it l plus , and one rated it 2 plus. Hone of the ministers considered it as more than avera3e in frequency. (f to ’3’ (:3 rhe data on the physicians presents a great cont 0 u that on the ministers. The doctors rated it to be the cr second :1o3t impor tan problem of all those listed in the questionnai ire. Table so on the following pa3e shows the rating of freguency by ministers of the first seven procle 3 list- ed in the guestionnaire. The problem of financial difficulties is the first one in the guestionnaire which was m t by a majority of the ministers. dleven of the ministers did not meet the problem,. 3'rad in3f it 0. Cne minister rated it plus-minus, five 3raded l plu us, three 2 plus, three 5 plus, and two ministe rs 3raded 4 plus. Eroportionately more of the ministers met the problem of i’inancial difficulti . Fourteen, or 565, of the ame mo. mmgbm ow. muopfimnofi ow mowwonmm , mHochSm Humdmo nu duo pummduobbmuso cw apnumamam. meadow ow prumamum movoedwum wmdubm eaowuHQSa some oobnumu sundae: gobovmdmmw maouuwwaw dobouamw 0% 0H moudmw on oawdwou dmauob wrouoaanm Upmommo seams. Hbdmaooaemo max 0 NH NH NH m» Hm Ho mm +1 o o o o o o o H+ a u m H m a m m+ o H o o a m H A» m+ o o o o o H o ”M ¢+ o o m o m o o ~119- ministers met the problem compared U3 :1, or 469, of the physicians. deletively more of the ministers rated 3111 the probl average di3ht, or cap, of the ministers compared to sixteen, 01" LEOI' 8 than avera3e in frequency. so rated the problem or 24,2, of the physicians. To3ether with the physicians the min'sters did not find the problem of the wife workin3 outside the home as frequent a problen as financial difficulties; but more of the ministers than the doctors. seventeen of the meet the problem, and plus, one 3raded 2 pl t2”, of the ministers the wife workin3 outs ‘R r‘ marital counseli the physicians. Ieither the ministers or the rated the problem as fhe problem of p ported by a m ajority in3 as only nine did ministers 3raded the plus, two '5 plus, and (D 64p, of th twenty fi compared found it a si3nificant problem cf 1"" went? five ministers did not 3raded it 0. six rated it l d , and one 4 plus. Bight, or found the problems raised by ide the home significant in their to nineteen, or zap, of doctors occurrin3 very frequently. ersonality differences was re— of the ministers in their counsel- not mention it. seven of the problem l plus, three rated it 2 four 3raded 4 plus. aixteen, or ve found the problem si3nificant in their marital counselin3 compared to thirty one, or -120- 48}, of the sixty seven physicians. The ministers also rated the problem more frequent in occurrence than did the doctors. A bare majority of the ministers met the problem of religious differences, and only twelve considered it significant. while this indicates that the ministers met the problem much more frequently than the physicians, it is a little surprising that more of the ministers did not meet the problem in their counseling. this is a specifically religious problem, and therefore within the field of specialization of the minister. rwelve of the twenty five ministers did not meet the problem, and graded it 0. One pastor graded it plus-minus, four rated it l plus, four 2 plus, two a plus, and two 4 plus. Table ol. dating of frequency by Iinisters of Selected froblems listed in the Muestionnaire. number of ministers reporting Rating of financial Jife Fork; Personality Religious Frequency Difficulty inngut Differences Differences 0 ll 17 9 12 + - l O 0 l l 5 o 6 4 2 o 4 (>1 (N t“ c) r4 #3 N (>3 (N .-121- five of the twer ty five minis ers suggested problems not listed in the cues tionna.i; e. fhree of the five listed 2 problems, one listed thr e, and one 4 problens . Although only five of the ministers submitted problems, five others listed Mr des without report ir" shat he problems were. rhe problem of infidelity was mentioned three tin.es, and graded 2 plus, a plus, and 4 plus. rhe use of alcohol was mentioned ttice, and graded 2 plus and 4 plus. uis- cipline of children was mentioned t ice 3 a cause of L0 marital difficulty, and was graded 5 plus. fhe following problems were mentioned once: education of children, 5 plus; emotio; al ilma.lr ty, s plus; drug addiction, 4 plus; frigidity, a plus; lrfeV33nolOllluJ, a plm neuroses and psychoses, 4 plus. Five of the ministers graded “other problems," but did not suggest any specific problems. rhree of the five rated ”othw problems” 1 pin one rated plus—minus, and one rated 4 plus. (1') Proportionately .fizor of the physicians than of the ministers suppested prob em:. roenty one, or blg, of the doctors did so compared to five, or zoo, of the ministers. The problem of infidelity was mentioned most fre1ue1t y and it was also one of the problems mentioned most fre— luently by the pl’L}.1’31 ciazls. :1. q t- (_ ‘_ -__I a V ’7' -1 . _’. I L “. ‘11". fit} ‘r’ : . L. ’_ _ _' leole on. rroclsmo sugges.ed by the ~lul3uflf5. ‘.)-. ‘ ‘ m:,.., :I-,;., .’ -‘3'- 1.; .. .‘..L.-.‘:33 Ll; 4‘36. Infidelity 3 Use of Alcohol 2 Discipline of Children 2 . _‘ . 1 -1 _ 1 3‘" ' " - , tsqution of vnllfircn —l""“ " J" ' " l“ ' "‘o '31. 1' ' --|AAA\.) U lDl-Ldl I‘d-4C2 3-1. A. Us 7- ."‘:‘f.l.' Dru“ sculc.ion F‘ re ad P‘ Fripidity ers found the following problems most important, as jud ed by the number of ministers who met the problem and by the estimated frequency uith xhich these problems n.038? in the minist rs' counseling. The .I. (3 *3 problems are listed in the order of their frequency: \ the proul (D m of personality differences, financial diffi- 3 1nd 0 culties, relipious differences, Wife wortinv out, A.~‘J y...‘ [191 opeussl phenomena. The less important problems, a (1) DJ Jude above, are also listed in the order of their C} freguency. They ere, the problem of sterility, the problems of sex technilue, fear of sex, and contracep- tion, (these three received an equal rating), the pro— ab D blem of venereal diseas-, and the problem of mastur— ( bation. This listing is considerably different than that of the physicians. The doctors listed contraception as the most imoortant problem, while the ministers rated it seventh. lne ministers found personality differences the most im— portant problem while the physicians rated it fifth. In Table as the problems are listed in the order given in the 1 Y questionna're witl the comparative rankings of both the ministers ard physicians. Table 55. Comparative nanking of froblens by Iinisters and Physicians. nanking by flanking by Problem Kinisters Physicians Technique of sex intercourse 7 6 Fear of sex 7 8 Contraception 7 l Kasturbation 9 9 Kenopausal phenomena 5 3 sterility 6 4 Venereal disease Financial difficulties 10 Wife working out HIP-Na) Personality differences ll C2] Religious differences U The problems of personality differences and financial 4‘. n I difficulties were repor ed by more than half of the minis- Cf ters. Almost a half of the ministers met the problem of religious differences, and about one third met the problem of the wife working outside the home. The problems of sterility and benopausal phenomeia were met by about one fourth of the ministers. Table 59. Number of Kinisters Considering Troblems Jidnificant. Number of Problem Kinisters l. Eersonality Differences la 2. Financial Difficulties 15 5. heligious Differences 12 4. Jife Working out 0) 5. Menopausal Bhenomena 7 6. sterility 6 ’7. Techniuue of sex intercourse 4 rear of sex 4 Contraception 4 8. Venereal Disease 3 9. Kasturbation l The data therefore indicate that the physicians did more counseling on psychological, social, economic, and Spiritual problems th the ministers did on problems which reached into the medical field. The work of the physicians in counseling is on a wider scale than that of the ministers, and it is also indicated that many people turn to the physician for counsel on spiritual problems rather than to the minister. D. The Training of the Linister for Giving Counsel. Kore than half of the ministers listed three or more sources of preparation for giving marriage counsel- ing. four of the ministers reported no source of prepara- tion, two reported one source, four listed two sources, H: ive had thre sources, five had four, and five minis- ters listed all five 3 urces mentioned in the schedule. Comparatively speaking, the ministers were better prepared to give counsel than were the physicians. Five, or 20;, of the ministers listed all five sources com— pared to five, or 8p, of tfe sixty seven physicians, Fifteen, or do}, of the tw nty five ministers reported three or more sources compared to thirty two, or 48%, of the doctors. doth groups nave an average of three sources of preparation. fighteen cf the twenty five ministers reported personal eXperience from special interest as a source, nine listed post-grad ate study, eleven reported read- ing specific material in scientific journals, wenty -126- listed reading in books, and twelve resorted other sour— ces of specific reading. comparatively more of the mini— sters reported post-graduate training as preparation for marital counseling than of the physicians. nine, or 56p, of ale ministers reported it compared to ten, or lop, of the 911;, s 10 ians . fhe four ministers who listed no sources of prepara- tion reported an average of l case of marital counseling every two months, and spent an average of 1 hour in counseling these cases. rhey met none who sought pre- marital advice. fney reported only two of the problems. There were two ministers who listed one source of preparation. whey met an average of 2 cases of marital counseling a month, and spent an average of two hours time a month with them. Only one of these ministers met any young people seeking premarital advice, and he met an average of l a month, and spent an average of one half hour in counseling. rhese two pastors reported an average of three problems met in.counseling. Hour ministers had tso sources of preparation. They met an average of 2.6 cases a month of marital counsel- iny, and spent an average of 3.8 hours with these cases. nut only one of the four was sought out for pre- marital advice. He met an average of l a month and spent -l27- one hour in counseling. These four ministers met an averade of a.l problems listed in the questionnaire. Five of the twenty five ministers had three sour- ces of training for giving counsel. fhree of the five met no people for marital counseling, one met an 'average of l to 5 a month but failed to report the time spent with the cases, and one reported an average ’1 of 4 to 6 cases a month Lith an average of 4 to 6 hours Spent in counseliny. Three of the five met no young people for premarital counseling, one met an average of A l a month but recorded no time spent in counseling, u- and one repor ed an average of l2 conferences 3 month with an average time of one half hour given to counsel- in; each case. rhey reported an average of 2.2 of t'e problems listed. There were five ministers who listed four sources of preparation for giving counsel. Uhese ministers met an average of 2.6 cases requesting marital advice, and spent an average of 2.8 hours per month in marriage counseling. rhey met an average of 2.2 young people who sought advice before marriage, and spent an average of 4 hours per month in such counseling. rhese ministers found \ an average of 2.8 of the problems isted in the gues- tionnaire in their counseling. ters who listed all five .1»- - 5‘" .'.~'-~ here .geoe also live minis n. - " 4“ -'~r‘-\ L. ‘0 " I ' ’ V‘V'a - f‘ ‘ sources oi preparation. inc; were connulted concernlm. tfle i133- problems of mar isge by an avera"e of e.’ persons a month, and spent an average of 9.6 hours in coun;elin;. an average of 4.e young people sou at them for pre— al advice, and these ninisters spent an average of 5.2 hours per month in giving such advice. These five L‘ t‘ ministers me an average of 7.4 of the problems listed in the giestionnaire. Qhe data therefore indicate that a“ the training of the ministers had increased the number of people they met for marital counseling increased. also they spent more time with their cases, and were consulted about a wider range of problems than mere the ministers with less training. The m'nisters with more training were also sought more frequently by youn; people who desired advice before marriage than were the ministers with less training. rhis conclusion is the same as that reached after an analysis of the training of the physicians for giving counsel. Kore people sought the counsel of the men who had more training for giving counse , phether concerning marital or premarital problems. II. Other Agencies in the Community Active in Iarital Counseling. The report of the activities of "other" agencies was obta ned by personal interview with the head or director of the agency concerned. In the inte‘view the attempt was made to obtain replies that could be placed in the framework of the questionnaire sent to the phy— sicians and ministers. This was not always possible be- cause of the varying ways in which agency records were he t. fhe arenCies consulted were the social Service u l I... - Bureau, the fisitin' Nurses Association, the .aternal Health Clinic, the Lansing Children's Center, the Young Men's Christian association, the Young Women's Christian Association, the Eichigan State College Health, and the College "Y." some of these agencies, such as the city and college "Y", are primarily educational in th ir procedures with respect t marital and premarital problems. It might be added that one of the downtown churches also offered a course of lectures to those contemplating marriage and also to those already married. The services of some of the agencies to their clients such as the Social Service Bureau.and the Children's Center, are more remedial in character. +150- A. The Jisitin; Nurses association. Host of the work of this agency is concerned with prenatal and postnatal visits to families on relief, was, or with other low income groups. Che counseling that is done is incidental to these visits, and covers both marital and premarital problems. There are in all six nurses, one of whom is the director of the agency. These six nurses, in the course of the year 1959, were in con- tact with eight hundred families. Very little of the work of this agency was concerned with premarital counseling. it was not enough to be con- sidered significant, but occasionally the Opportunity was presented in connection with care given to another member of the family. fie counseling work of the nurses covered quite well the range of problems included in the questionnaire. Jhile it is true that the nurses were not sought out by indivi— duals who requested advice on these problems, the indivi— duals contacted in the routine duties of a visiting nurse took the opportunity, nevertheless, to ask advice on their problems. The nurses in conjunction.with the director rated the frequency of the problems listed in the questionnaire. The problems of contraception, menopausal phenomena, per- sonality differences, and financial difficulties were -lél- rated 4 plus, as being most frequently met. fhe director remarked that naturally the visiting nurses would not get the case unless financial problems were involved. fhe problems of sterility, vener al disease, and religious differences were rated 5 plus, and so were also met fre— quent y. fhe problems of technique of sex intercourse, fear of sex, and masturbation were not met frequently enough to be rated significant and were graded plus- minus. Ihe nurses did not meet the problem of the working wife. with the exception of the problem of financial diffi- culties, the problems that; the nurses found most frequent are more like those the doctors listed as most frequent than they are like the problems so listed by the minis ters . rhe nurses suggested the following problems not in- cluded in the questionnaire: the sex education of children, infidelity, and frigidity. rhe problems of infidelity and sex education of childre; were graded 4 plus, and the roblen of frigidity a plus. noth the ministers and the physicians also suggested the problem of infidelity. Only one minister listed the problem of frigidity, but it was mentioned by five physicians. The nurses carried as routine practice for the use .14‘1‘!’ of consultants the little book by I. J. Exner, SHE gun -152- 5155 03 LILE." 'ihis book W s also read as pa rt of the nurses' own preparation for giving counsel. ather books were keot in the office for the use of the nurses. ¢hat other preparation the nurses had for counseling depended upon their own interest in the matter. rhe visiting nurses are meeting many of the roblens '0 '-3e frequently, and are givin” counsel conc rnin; them. secause of the intimate nature of their contacts the nurses have a unique Opportunit r for effective coun- seling. without criticizing the quality of counseling done by these nurses, it seems evident that more trepara- tion for COQHSBLiQQ is desirable. rhis is especially true since information indicates that the nurses are meeting a ..id e variety of marital problems. 3. The Katernal health Clinic. rhe Lansing Clinic is affiliated with the Laternal Kealth league of hichigan, and is not affiliated with the Community Chest. it is serviced by a staff of rotating clinicians and nurses. Continuity of contact with the clientele is maintained through the lirector, who does most of the counseling, and ate histories. cf P! r7 ('0 01 F, C.) fhe Clinic is Open one m rnin; a week, and its clinical services are linited to those unable -inn1c1oll" to 1eet the regular Ft (D (D (u o t '2 £1 a ih' ici9.. rifty percent .2 1.x . 1.: z. ‘M. ° - ‘ "‘ ~ a O- the Datients chinr the year lye: were wholel; or - ' 1 n .- 1 - :o i 1 ~ 1 o - . - ' c 1... psit'tlle on 1-11-1. ut_o lintnoialld Cele a e re-orit1 4- - ~ ~r‘. z-t- ' — - “'- L: -.1- e 1-1' '. 3n n 1‘ u) CDQJ'chl uLish, J: ‘ .‘iCi- 113a fauLelluJ OJ. vile CllilJ-U 8+9 9018 L" w u - v- ‘ . e 0 ~ QVV‘A L L'." o ~ ‘- uJ gugxul- -9 :13CSSSEII'JSL1931 8::- +311 wile. U oiled? 3.128 8.3 ‘3 o 0 an average of ll to lo hours oer mont. was spent in coun- sellng. Almost no counseling was done ap-rt from the .0 specific purpose oi the clinic . The horie situation, ex- cept for iiiam cial ciiiicil ies, that leads the client to seek contraceptive advice was rarely a matter of counseling. r3 he two problems that were met almost exclusively were those of contraception and financial difficulties. These were both rated 4 plus in freguency. in add i ion to the mp cific counselin and giving of contraceptive advice the clinic seeks to educate the com: unity w'th re pect to maternal health problems. This (DJ is one through the distribution.of literature, by addresses cr given to Various civic g1‘ oups, an advertisement in he liichi.an Earner, a bi—rr onthly magazi:';e of over 145,000 circulation, and throu h puolic mee lhe avera'e nimber of premarit 1l consult .tions was less than one a month, and about an.avera as of an hour a -134- month was given to premarital counseling. The director did not observe that the state premarital examination law had in any way affected the number of clients seeking premarital advice. The director, who was esponsible for most of the counseling, listed these sources of preparation for counseling: personal experience from special interest, postgraduate study, and reading specific material in scientific journals, books, and other sources. The per- sonnel of the clinic is adequate, and only finances limit the extent of the services offered. 0. The Social service Bureau. because of the method of keeping records it was not possible to fit the work of the social Service Bureau into the framework of the questionnaire sent the ministers and physicians. Iuch of the activity of the case workers of the Bureau is concerned with counseling. in the year l9b9 the nureau contacted L06 falilies. From these families a total of 917 problems were listed, an average three per family, which is an indication of the rami- f’ b o fication of marital problems. when conflict arises in one area of a marital relationship such a" family finances, the conflict tends to spread to other areas as well. Of the 9i? problems, as; were economic in character, l7.8p were physical, 9.9p were mental, 35.19 were -155- relationship and overt behavior problems, 7.75 Jere environmenta , and 6} were educational. Shis listing includes not only adults but also the children. Ehe Bureau has no records that show the work done with cf adults only, excep for some specific problems such as nonsupport. Ihe mental problems for instance, included both neuroses and psychoses. The same case might be lie 3 . under this classification and also under that of husband- wife conflict. The same doubling of cases might occur with the classification of relationships and economic problems. Eighty one of the three hundred and six families were classified as showing husband—wife conflict. Four of the eighty one were cases of non-support. There is nothing in the classification of the nureau to show what was the problem, or problems, in the husband-wife con- flict. This could only be determined by consulting each case history separately. the Bureau met only three or four cases of illegite- macy in the past year. other premarital advice was inci— dental to other services rendered. D. The Ioung men's Christian Association. Jhile the Association has a long record in counseling the individual concerning his problems, its work in marriage -135- education is comparatively recent. Ehe Lansing Associa- tiOl has for the last two years carried on a program of discussions, lectures, and personal conferences designed for youn5 peOple about to be married, or recen ly married. This pro5ram is carried on by volunteers 5uided by the Youn5 Ken's secretary. Ihe staff included local physicians, educators, the director of the haternal Health Clinic, and a minister who was chairman and discussion leader of the program. The cha rman.and the 11 CA secretary were respon- sible for the couxselin5 done. rhe avera5e enrollment was JL, and the avera5e number of conferences was seven. In addition to the counselin5 in conjunction with the marria e education pro4 '-L“ -- ..- 1.1. .- '1... :: up: ,1;- CiiicallJ ”it- marital cliilculti (D v'1 _“"“ fi ‘- . "‘ ;. gulcaulaufil p33- DJ ru - - 3 OPONOOO I" OOHOOOO Table 3. Rating of Frequency of Tecnique of Sexual Intercourse as Marital‘Problem. No. of Rating Of Frequency Specialty; Phys. 0 14' 2+ 3 + 4 t Surgeons 9 6 1 2 O O Obstetr. 6 3 1 2 O 0 Pediatr. 5 3 O O O 0 Urolog. 5 9 2 1 0 0 Psychiat. l O 1 O O O Dermatol. 1 O 1 O O O _§gb.Healh 1 l O O O O 4_ Totalqu 24 13 6 5 4_O O -151- Table 4. Rating of Frequency of Fear of Sex as a Karital Problem. Bo. of Rating of Frequency Specialty Phys. 0 1+ 2+ 5+ 4+ Surgeons 9 7 O 2 O O Obstetr. 6 5 1 2 O 0 Pediatr. 2 3 O O O O Urolog. 5 O 2 l 0 O Psychiat. 1 O 1 O O O Dermatol. 1 O O O O O Pub.Health 1 1 O O O 0 Total 25 15 4 5 O O Table 5. Rating of Frequency of Contraception as a.Iarital Problem No. of Rating of Frequency Specialty Phys. 0 14 2+ 3 * 4+ .Surgeons 9 2 2 1 1 3 Obstetr. 6 0 O 1 O 5 Pediatr. 6 2 O O l O Urolog. o O O O 2 1 Psychiat. 1 O O l O O Dermatol. 1 O 1 O O O Pub.Health l O O O l 0 Total 24 4 o 5 5 9 Table 6. Rating of Frequency of masturbation as a marital Problem 30. of Rating of Frequency " Phys. 0 14 4 3r 14* ‘i‘ Soecial 4. t‘ Surgeons Obs tetro Pediatr. Urolog. Psychiat. Dermatol. Pub.Health PPPDT.'UJO:\D PPOOPNO) ocean-4pm 2 O 0 0 l O O O l H OOOOPOO H *OOP‘OOOO Total be VP- P H 10 ~ -152- Table 7. Rating of Frequency of hencpausal Phenomena as a Karital Problem No. of Retina of Frequency "pecialtz ‘uys. 0 17 2+ 5+ 4+ Surgeons 9 5 O O O 4 Obstetr. 6 O O O l 5 Pediatr. 5 5 O O O O Urolog. 5 l l 1 O O Psychiat. l O O O O 1 Dermatol. 1 O O O O l Pub.Hea1th l l O O O 0 Total 24 10 1 1 1 11 Table 8. Rating of Frequency of Sterility as a Rarital Problem 30. of Rating of Frequency Specialty Phys. 0 C 1+ 2* 3* 4r Surgeons 9 5 O 3 l l l Obstetr. 6 O O 2 O O 4 Pediatr. 5 2 O l O O O Urolog. 5 O 1 O 1 O 1 Psychiat. 1 O O l O O O Dermatol. 1 1 0 0 O O 0 Pub. Health 1 O O 1 O O 0 Total 24 6 l 8 2 1 6 Table 9. Rating of Frequency of Venereal Disease as a Karital Problem Ho. of Rating of Frequency Specialty Phys. t- 1+ 2‘t 3* O T Surgeons 9 Obstetr. Pediatr. Urolog. Psychiat. Dermatol. Pub.Health PHPCfiCfiC’ HOOOPON OOOOOI-“H OoHol—‘F-"P C0 OHOOI—‘Cfltfl 0 0000000 OOOUJOOH #3 Total 24 O N U ,p. Table 10. Rating of Frequency of Financial Difficulties as a Karital Probler So. of ' ting of Frequency Sgecialtj Phys. 0 ”L 1+ 2? 5+ 4+ Surgeons 9 6 2 O O l O Obstetr. 6 2 1 1 l O 1 Pediatr. 5 5 O O O O O Ural} . J 1 O 2 O O O Povcniat. 1 O O 1 O O O Dermatol. 1 1 O U 0 O O lufiéfioa th 1 O O l O ‘_Q___n9___ Tota 24 id 2 5 1 1 Table 11. Rating of Frequency of the Wife Working Outside the Home as a Karital Problem Io. of Rating 0 Suecielzg 1% e.; O f—J + Surgeons Obstetr. Pediatro UrOlOdo Psychiat. Dermatol. '_}-‘ T_T~ 4.. I. LLO 04-531. Un- I- PHI—'Hb‘rbbto OOODDOPO PHI-”036:0:KD 0 0000000 F OOOOOP‘O C) *OOOOOOO I—3 0 cf (1" H 1“ H: I" 0 Table 12. Rating of Frequency of Personalit Differences as a Karital Troblen 30. of Ratin; of Frequenc‘ Specialty Phys. 0 l-r 2-+ 5 r .Surgeons Obstetr. Pediatr. Urolog. Psychiat. Dermatol. Pub.Health I—‘t—‘P‘C‘lt 0H0 t-‘I-‘Ot-‘CSJNOw CD CHDCDNngoam 0 0000000 #3: N OCJ‘I—‘OOP‘O O 0000000 Total 24 H H5 -154- Table 15. Rating of Frequency of Religious Differences as a Xarital Problem Ho. of Rating of Frequency Specialty Phys. 0 1, 1+' 2+ 54-14t Surgeons 9 8 1 O O O O Obstetr. 6 2 1 5 O O 0 Pediatr. 5 5 O O O O O Urolog. 5 1 1 1 O O O Psychiat. 1 O O 1 O O 0 Dermatol. 1 1 0 O O O O £35.3ea th ‘El 1 O O O O 0 Total 24 16 5 5 O O O Table 14. Eumber 0' Problems Suggested by Jo. of . ' z... ‘v . ooecialuy Phys. 0. f Problems ‘ d b Surgeons Obstetr. Pediatr. Urolog. Psychiat. Dermatol. Pub.Hea1th I~HHmomuo HOOPN¢® Om OFONPPH HO OOHOOPO 0 0000000 P H O) O) N Total 2 Table 15. Average Humber of Premarital Consultations Per Ronni No. of Kumber of Cases doecialt" Phys. 0 1-5 4-6 7-9 10 Aver. 44 ”‘1 Surgeons 9 2 6 0 O 1 2.2 Obstetr. 6 O 5 2 O 1 4.5 Pediatr. 5 5 O 0 O O O Urolog. 5 O 2 1 O O 5.5 Psychiat. 1 O 1 O O O 5 Dermatol. 1 O 1 O O O 1 Pub.Realth 1 l O O O O 0 Total 24 6 15 5 O 2 2.5 i ~155- Table 15. Iumber of Sources of Preparation Reported by Specialists HO. Of Rumber of sources Specialty» Phys. 0 1 2 5 4 5 Surgeons 9 O 1 5 1 1 1 Obstetr. 6 O O O O 4 2 Pediatr. 5 l 1 O O 1 O Urolog. 5 0 O O O 2 1 Psychiat. 1 O O O O 1 O Dermatol. 1 O O 0 1 O O ‘Pub.Health l l O O O O 0 Total 24 2 2 5 2 9 4 -l56- Appendix C Bibliography A. Books: 1. 10. 11. 12. 15. 14. Bonnell, J.S., PASTORAL PSYCHIATRY, Harper's, 3.Y., 1958. . Davis, K. B., SEX FACTORS IN THE LIVES OF 2200 WOKEN, Harper's, N.Y., 1929. Dexter, 3.0., and 3., T33 31313 TER 33o FARILY TROUBLES, R. R. Smith, 3.Y., 1951. Dickinson, R. L.,and Beam, L., ORE THOUSARD RARRIAGES, Williams and Wilkins, Balt., 1951. Dickinson, R. L., THE DOCTOR AS RAR.MI E COJRSELOR, Williams and Wilkins, Balt., 1956. Flugel, J. C., THE PSYCHOARALYTIC STUDY OF THE FAIRY, Hegarth Press, London, 1955. Hamilton, C. V., and RacGowan, H., WHAT IS WRONG WITH RRRRIAGE?, Boni, R.Y., 1950. Hart, H., and E., ERSORALITY AND THE FARILY, Heath and Co., N.Y. and Boston, 1955. Jacoby, G.w., PHYSICIAR, PASTOR, 133 PATIENT, Hober, 3.Y., 1956. Levy, J., and Monroe, Ruth, THE HAPPY FARILY} Knopf, R.Y., 1958. Rowrer, B., DO"33TIC DISCORD, U. of C. Press, 1928. Rowrer, H., PRRSORALITY'ADJUSIRRJT AND D013 STIC DioCORD American Book Co., R.Y. and Cincinnati, 1955. Robinson, H. J., WOMAN: HER 3?: AND LOVE LIFE, Eugenics Publishing 63., R.Y., 1951. Winchester, B., CONFERENCE ON PREPARATION FOR RARRIAGE AND HOME MAKING, Pilgrim Press, Boston, 1951. B. Articles: 1. Beatty, J., "Do You Fight with Your Husband?", Rilwaukee 9. 10. -157- County Family Court, American Ragazine, 122:48-9. October 1956. Bridgman, R. P., "Guidance for Rarriage and Family Life", Annals g£_the American Academy, 160:144-64, Rovember 1952. Brown, H. H., "Marriage Clinic, Los Angeles" North American, 252:126-54, August 1951. Colcord, J., "Remedial Agencies Dealing with the Ameri- can Family." Annals g; the American Academy, 160:124-54, Rarch, 1952. “Cleric's Clinic for Happy marriage." Literary Digest, 125:19, Ray 22, 1957. Crowder, F., "Doctors of Ratrimony." Parents' Ragazine, 12:20-21, October 1957. Day, L. B., "Development of the Family Court." Annals of the American Academy'gf Political and Social Science, P36 :105-111, 1928 . Dickerson, R. H., "Prepare Them for Rarriage." Parents' Ragazine, 12:24-5, December 1957. "Divorce by Case Work." Dayton, Ohio. Survey, 68:192, Ray 15, 1952. Rdson, R. W., "Family Adjustment Thru Consultation Jer- vice." Journal 2; Social Hygiene, 18:198-211, 1952. Eliot, T. 0., "Current Efforts in Behalf of the American Family." Family , 9:87-94, 1928. Emerson, H., "Public Health Awaits Social Courage: Marriage Counseling." American Journal g£_Public Health, 24:1015-15, October 1954. "Family Institutes in the Episcopal Church." Religious Education, 24:907-8. "Fighting Breakdowns in Iarriage." Literary Digest, 121:17-18, April 25, 1956. Foster, R. G., "Device for Premarital Counselors and Teachers of Courses on.Rarriage." Journal g; Home Econo- mics, 27:575-7, November 1955. "Get It Off Iour Chest." Dr. Roreno's Therapeutic Theater at Beacon, R.Y. Better Homes and Gardens; 17:15, Novem- ber, 1958. 17. 18. 50. 51. ~158- Croves, 3. 3., "Some Sociological Suggestions for Treating Family Discord by social workers." Social For- ces, 6:569-75. Kirkpatrick. 0., "Techniques of Karital Adjustment." Annals 3; the American Academy, 160:178-85, Karch, 1952. Kletzer, fi., "Oregon Family nducation Council." Journal of Home Economics, 29:557, October 1957. Hixbaugh, E. H., "Reconciliation of Harital Adjustment: 101 Cases." Social Forces, 10:220-56. H" "Harriage for Keeps. nducational Program by Buffalo, H.Y., minister's Association, Survey, 64:67. "Harriage: Two Hen of God Working to do Something About Karriage." Time, 26:412, December 9,1955. "Katrimonial Advice." Outlook, 151:556, February 27, 1929. Hussal, A. H. "Home Economist in a Family Consultation Bureau." Teacher's College, Columbia, Journal gleome Economics, 28:79-85, February 1956. Pepenoe, P., "A Family Consultation.5ervice." Journal of Social Hygiene, 17:509-522, 1951. "Institute of Family Relations." Eugenics, 5:154-57. Pratt, G. K., "Doctors of Katrimony: Marriage Clinics." 4... ,7: survey, 67:559-60, January 1, 1952. Rosa, B. H., "Discussing marriage and the Home with Young Ken and Women". Journal of Home Economics, 51+56-7, Janu- ary 1959. "Settling Family Disputes Out of Court." Literary Digest, 118:22, August 4, 1954. "Shall Marriage Counseling Become a Public Health Function?" American Journal g£_Public Health, 25:554-6, Karch 1955. Shelly, P.J., "Social and Economic Value of the Family Court." H.Y. State Dpt. of Correction, Div. of Probation, Albany, N.Y., 1928. Smith, H. H. "Clinic for Sick marriages." Interview with Adler, Delineator, 115:12, October 1929. 53. -159- Swift, L. B., "Six Significant Books: Family Case Work." Survey, 74:167, Kay 1958. Wile, I. 3., "Dynamics of Liarriage." Urolo5 ;ical and ,Qutaneous Review, 55: 55 7-42, 1929. Suggestion of a five point scale of values as a means of analyzing marital difficulties. Zunzer, G., "Domestic Relations Courts." Annals of the American Acade of Political and Social Jcience, 124:114-125, 1 6.