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dissertation entitled

MIDLIFE MOTHERS IN TRANSITION: RELATIONSHIPS
BETWEEN SELF-IN-RELATION AND PERCEIVED HEALTH STATUS

presented by

Elizabeth Irene Price

has been accepted towards fulfillment
of the requirements for

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MIDLIFE MOTHERS IN TRANSITION: RELATIONSHIPS
BETWEEN SELF-IN-RELATION AND PERCEIVED HEALTH STATUS

By

Elizabeth Irene Price

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

IOCTOR OF PHILOSOPHY

Department of Family and Child Ecology
1994

ABSTRACT

MIDLIFE MOTHERS IN TRANSITION: RELATIONSHIPS
BETWEEN SELF-IN-RELATION AND PERCEIVED HEALTH STATUS

By

Elizabeth Irene Price

Women organize and develop a sense of self within the context of
their relationships. One goal of female development is to connect to
others. The theoretical framework posits that as a woman moves through
her life course her primary task is to "take care of" relationships.
When care giving she must strike a balance between caring for others in
the relationship and caring for self.

This study focused on the transition at midlife when a woman is
faced with reordering a relationship that has required a great deal of
care: the ”mother-child" relationship. How a women reorders and
balances this relationship may reveal something about her ability to
stay healthy both emotionally and physically.

The convenience sample of 145 women were married mothers who had
launched their last child from home within the 24 months prior to
questionnaire completion. Data were collected from June 1993 to
December 1993. Three hypotheses and five post hoc questions were
investigated using both Pearson Product-Moment correlation coefficients,
and analysis of variance. The instrumentation used included both tested
standardized instruments and those newly developed by the researcher.
Hypotheses which were supported indicated that a woman's orientation of
care was related to her health status. The hypothesis which posited a

relationship between a woman's health and a balance of her separate and

connected self was not supported. Implications for theory, research,

and practice are included.

This dissertation was inspired by my mother Leona
who taught me to care
and is dedicated to my granddaughter Onahlea
whose generation must learn to care
for themselves as well as others

iv

 

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ACKNOWLEDGMENTS

After months of intense focus, the time has come for closure.
Before embracing the future and a new beginning, it is with pleasure
that I stop and express appreciation for the numerous and timely
contributions make by both individuals and institutions that were
critical to my growth and success.

First a very special thank you to all the women who gave of
themselves by contributing to this research. Their willingness to allow
"self" disclosure helped further the knowledge about women.

I would like to acknowledge my appreciation for the help and
support of my committee chairperson Dr. Linda Nelson. She guided me
through the dissertation proceSs with caring and encouragement. She was
always there to gently push, pull, or comfort. The depth of her life
experiences and her knowledge helped me to look beyond the moment and
grasp the larger perspective. Linda much has been learned at your
elbow.

I am grateful to Dr. Linda Beth Tiedje for the time spent
listening and questioning as this work began as well as for her support
and encouragement of the development of the finished product from a
distance.

To the other members of my guidance committee, Dr. Tom Luster for
his knowledge of statistics and Dr. Dennis Keefe for his understanding

V

of role theory, a heartfelt thanks for the time and energy spent guiding
and directing my research inquiry.

For his encouragement and years of mentoring I am deeply indebted
to Joseph Sheets, MD. He taught me to make a decision and follow
through. His positive outlook on life helped me believe my goal was
attainable.

I would like to recognize the financial support provided by the
Sparrow Health System without which all of this would not have been
possible. I look forward to contributing to the quality service
provided to the community by this institution.

A special word to my co-workers at Lansing OB/GYN Associates. I
could not have achieved this goal without their help. From proposal to
data collecting to finished product I have felt their interest and
support. I greatly appreciate their flexibility and willingness to
accommodate my needs.

And the last shall be first. There are not words to express the
depths of my feelings to my husband, my wonderful family, and special

friends who love me...I love you too.

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TABLE OF CONTENTS

LIST OF TABLES ........................... x
LIST OF FIGURES .......................... xii
CHAPTER I - INTRODUCTION ...................... 1
Background of the Problem ...................... 1
Historical Perspective .................... 2
Integration of Theories .................... 3
Health Conditions ....................... 4
Social Conditions ....................... 5
Theoretical Framework ........................ 7
Conceptual Model ....................... 8
Statement of the Problem ...................... 8
Assumptions ............................. 8
Research Hypotheses ......................... 10
Definition of Variables ....................... 11
Transition .......................... 11
Midlife ............................ ll
Self-in-relation ....................... 12
Health Status ......................... 12
Emotional health status ................. 13

Physical health status ................. 13

Summary ............................... 13
CHAPTER II - REVIEW OF LITERATURE .................. 14
Female Adult Development ...................... 14
Adult Development ....................... 14

Male Theory Applied to Female Development ........... 18
Female Theory Applied to Female Development .......... 19
Feminist Theory Applied to Female Development ......... 21
Transitions ............................. 24
General Health Status ........................ 25
Emotional Health Status .................... 26
Physical Health Status .................... 29

Role Theory ............................. 30
Mother Role .......................... 31
Summary ............................... 32
CHAPTER III - METHODOLOGY ...................... 34
Criteria for Sample ......................... 34
Procedure .............................. 36

vii

Table of Contents (Cont.)

Data Collection Procedures ..................... 38
Instrumentation ........................... 39
Relationship Self Inventory .................. 39
Health Status ......................... 4O
Emotional health status ................. 41

Physical health status ................. 43
Construction of the health status measure ........ 45

Selected Contextual Variables ................. 45
Pretransition index ................... 47

Social support index .................. 47

Marital relationship index ............... 48

Parental relationship index ............... 49
Posttransition self-care ................ 49

Analysis of Data .......................... 49
Limitations ............................. 52
CHAPTER IV - RESULTS ........................ 53
Sample Description ......................... 53
Sample Size .......................... 53
Geographic Location ...................... 54

Age .............................. 54
Educational Level ....................... 54
Family Income ......................... 56
Employment Status ....................... 56
Family Composition ...................... 57
Hypothesis Testing ......................... 57
Hypothesis One ........................ 58
Hypothesis Two ........................ 59
Hypothesis Three ....................... 62

Post Hoc Analysis of Selected Variables ............... 62
Question One ......................... 63
Question Two ......................... 63
Question Three ........................ 65
Question Four ......................... 67
Question Five ......................... 69
CHAPTER V - DISCUSSION ....................... 71
Discussion of the Research Findings ................. 73
Sample Description ...................... 74
Hypothesis Testing ...................... 75

Post Hoc Analysis ....................... 76
Question One ...................... 76

Question Two ...................... 77

Question Three ..................... 78

Question Four ...................... 79

Question Five ...................... 80

CHAPTER VI - SUMMARY AND IMPLICATIONS ................ 81
Summary ............................... 81

viii

Implications ............................ 82

Theory ............................ 82
Research ........................... 85
Practice ........................... 88
Conclusion .......................... 89
APPENDICES
Appendix A: Relationship Self Inventory ............... 90
Appendix B: Health Status Instrumentation .............. 95
Appendix C: Questions Related to the Contextual
Variables ..................... 103
Appendix D: Midlife Women in Transition: Total
Questionnaire ................... 109
BIBLIOGRAPHY ........................... 133

ix

LIST OF TABLES

Page
Table 1: Sources of Study Population ................ 38
Table 2: Comparison of Means, Standard Deviations and
Cronbach's Alpha for Pearson et al. and Price
Data on Relationship Self-Inventory ........... 41
Table 3: Intercorrelations Between Emotional Health
Measure and Physical Health Measure ........... 41
Table 4: Dependent Variable Intercorrelations for
Emotional Health .................... 45
Table 5: Dependent Variable Intercorrelations for
Physical Health ..................... 45
Table 6: Descriptive Statistics for Sample: Contextual
Variables ........................ 51
Table 7: Descriptive Statistics for Sample: Health
’ Indicators ....................... 51
Table 8: Sample Characteristics .................. 55
Table 9: Means and S.D. for Health Indicators by
Balance Index ...................... 59
Table 10: Distribution of 145 Participants According to
Typology of High and Low Scores on Separate
and Connected Self Scales ................ 59
Table 11: Means and S.D. for Health Indicators by
Location in Balance Self Typology ............ 61
Table 12: Correlations Between a Woman's Health Status
and Relationship Self-Inventory Scores ......... 61
Table 13: Correlations Between a Woman's Health Status
and Selected Contextual Variables ............ 64
Table 14: Oneway ANOVA Analysis of Marital Index of
Self-Perceived Accuracy of the Marital
Relationship ...................... 67

X

List of Tables (Cont.)

Table 15: Oneway ANOVA Analysis of Parental Index of
Self—Perceived Accuracy of the Parental
Relationship ...................... 70

Table 16: Correlations Between a Woman's Health Status

and Her Involvement in Posttransition
Self-Care ........................ 80

xi

LIST OF FIGURES

Page

Figure 1: Conceptual Model ..................... 9
Figure 2: Classes of Psychosocial Variables and

Instruments Used to Measure Them ........... 35

xii

CHAPTER I
INTRODUCTION

This study is based on the belief that a female self is primarily a
self-in-relation (Surrey, 1991). This refers to the process of being-
in-relation-to-others, of knowing oneself and others through a process
of mutual relational interaction and caring. Much of the research done
on self-in-relation to date has been done using adolescent girls and has
been done in psychology.

Like adolescence, midlife is a time that relationships are
reordered both with the self and with others. At midlife this
reordering offers the opportunity to reawaken the self. It is a time
for women to redefine self-in-relation to others. The changing events
of midlife afford an opportunity to reassess how some women take care of
“self" and "other" and how they reorder the relationships in their'

lives. Of interest is if they accomplish this without deleterious
A health outcomes.

Today the average woman lives one-third of her life past menopause.
The concern is to make these later years happy and satisfying. A
woman's sense of well-being and general health for the last third of her
life are profoundly affected by the manner in which she makes the
transition to changing life events at midlife. Therefore, this
investigation will explore the impact of the self-in-relation theory on
the health and well-being of midlife mothers.

Background of the Problem
Many accepted theories view self-development as a growth process

that only occurs by separation from others. This does not seem to be

I

2
the self that fits women's experiences. Females do not separate from
others, but learn to care for them. They give up themselves in
relationships for the sake of relationship with the other (Surrey,
1991). If separation is the healthy orientation, then by default
connection is the unhealthy one. How the self-in-relation delineates
self and other relationships and the possible effects this may have on
health is the question under review.
mm

For a quarter of a century traditional definitions of health and
well-being have been male defined. American researchers like Erikson
(1959) and Levinson, Carrow, Klein, Levinson, and McKee (1978) have
placed high value on individual autonomy, self—reliance, and
independence. The goal of male defined human development was to
separate one's self from "other". Erikson saw this development as the
accomplishment of a sequence of life stages. At each life stage there
was a normative psychosocial crisis. With the accomplishment of each
stage the individual was to become gradually less dependent upon the
”other", until as a healthy normal adult "he“ achieved independence and
an inner separate self.

Self for_females is being conceptualized in new ways by such
feminist theorists as Gilligan (1982) and Miller (1976). A female self
is organized and develops most often in the context of relationships,
i.e., the construct self-in-relation. This represents a shift in
emphasis from separation to connection. In this model, relationships
are seen as the basic goal of development, and the self-in-relation is
at the core of the self-structure (Surrey, 1991). The expression of the

"self-in-relation” theory accounts for the strongly developed need to

3
"take care of" in relationships. Through caring, females express an
empathetic sense of connectedness to others and a much different pattern
of development than do males. This need to "take care" has very early
roots in female development.

The mother-daughter relationship is the prototype on which all
others are built (Surrey, 1991). A female child learns through the
interaction with her mother to listen to, feel with, and comment to the
“other". This process of development through relationships continues as
role relationships such as friend, wife, worker, and mother expand
throughout the life course, until development comes full circle and the
woman has learned the adult form of the relationship and becomes a
mother herself. "The pathway of development includes both the outer,
‘real' relationship and the inner sense of relationship. The goal of
development is to ‘become one's own mother'--that is, to internalize the
attentive, listening, caring relationship to oneself" (Surrey, 1991,
p.63).

W

The preceding theories suppose a single pathway to human
development, one that is gender based. However, some researchers (Davis
& Jones, 1992; Franz & White, 1985) have proposed a two pathway model
that would interconnect the psychological variables of (a) independence,
or the expression of the self, and (b) relationships, or the need for
connections, for both genders. The interconnection of both variables,
independence and relationships, is believed to "account for most of the
interpersonal life—span change" (Franz & White, p.247). To use the
Franz and White model to frame the knowledge found in the preceding

gender based theories seems to be appropriate for this study of women in

 

Ii

4

midlife. It seems appropriate because the opportunity is there for a
shift from the role of caregiver of others to a more egocentric role of
care for self. Therefore, at midlife the psychological pull is toward
independence and away from relations. But like any change, a pull back
is needed to reach a redefined level of personal comfort when the
transition is complete. This study proposes to explore the process of
this shift in relationships that occurs at midlife and the impact that
process may have on health. The need for knowledge about the patterns
of a woman's life during her middle years has become increasingly urgent
because of both health and social conditions.

H 1!! E !.!.

Women are living longer. There are 13 million women in the U.S.
between the ages of 45 and 55 years and this number is expected to
increase beyond 19 million by the year 2000 (U.S. Bureau of the Census,
1989). In less than a century, the time has doubled between when a
woman bears her last child and her own death. To quote a report on the
perimenopausal years by the National Institute of Health:

The physical and psychological changes that occur during this

part of a woman's life span are complex, and her health is

measured by more than just the absence of disease. Research

on the middle years of a woman's life must be a high priority

and must take into account a woman's health in the broadest

sense of the word (1992, p.21). .

Midlife women ages 45-64 make an average of seven visits to the
health care system a year, 25% more then midlife men (Adams & Benson,
1989). During the middle years, a woman's acute health care needs are
24% greater than men and her activities are restricted by illness 46%

more often than men (Givens, 1979). Because as a society we are living

longer and because health care is so costly, a better understanding of

5
factors that contribute to both the physical and psychological health of
midlife woman is needed. This understanding could help meet the
continued needs of women, and help contain health care costs.
Sggjal Qggdjtigns

The definition of midlife for women who are mothers may not be so
much chronological as developmental: the launching of the last child
from the home (Neugarten, 1968). In this time when there is a changing
pattern of relatedness, there is a loss of a major role identity:
mother. As her everyday patterns are changed and she does not daily act
out the role behaviors of mother, her sense of who she is may be
threatened. This is especially true if the mother role is at the core
of self. If she has played her role well in terms of her child, her
goal will be accomplished and her child will leave home and move into
society as a productive and secure individual. However, to achieve this
goal she must redefine her self-in—relation to others and to herself.
Therefore, one would expect the woman who feels her role as mother can
be redefined comfortably to include adult/adult relationships with her
children to make the transition with ease (Neugarten, 1979). She can
let go and feel pride in the product and she will be able to move on
with the reordering of her relationships. She will be able to mother
herself more easily than the woman who experiences a great sense of loss
and pain when she no longer has a child for whom to care.

The middle years are a period when important departures from the
conditions of early adulthood begin. ”Individuals move into their
middle years by ‘undoing' or reversing those events that originally
defined their movement into adulthood" (Smith & Moen, 1988, p.506). For

example, the decreasing centrality of the role of parent, the decreasing

6
importance of career achievement, and the loss of a mate selected in the
early adult years are events which may herald the middle years of life.

Many aging and life course researchers have investigated the
continued process of human development after young adulthood (Barnett &
Baruch, 1978; Brooks-Gunn & Kirsh, 1984; Rubin, 1979). Using the
developmental approach, the primary focus of research on women in their
middle years has been to examine the experiences of menopause and the
empty nest, both of which are assumed to be negative events.

Neugarten's (1968) study of the mental process of midlife women is a
notable exception. She found middle age to be a ”period of heightened
sensitivity to one's position within a complex social environment and
the reassessment of self as the prevailing theme” (p.93). The mental
processes of midlife for Neugarten were introspection and self-
evaluation. Her vision may be explained in part by the interconnection
of the psychological variables of independence and relationships
described by Franz & White (1985). Transition points in the life course
call for a greater or lesser degree of (a) self-expression or (b)
relationships. For women who have spent much of their lives as
primarily connected relational beings, the events that occur at midlife
such as the experience of menopause and empty nest may potentially
awaken the inner self and its need for expression.

In summary, for women the core of self-structure is self-in-
relation to others. For mothers, the time when children leave home
often coincides with midlife. For those women, two life events coincide
with each other, i.e., redefining role relationships and dealing with

physical aging. Because of this, this transitional intersection is

 

 

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7
intensified and therefore has a greater potential to be hazardous to a
woman's physical and emotional health.
Theoretical Framework

The theoretical framework for this study draws heavily upon early
research done by Miller (1976) and Gilligan (1982), and the subsequent
development by Surrey (1991) of the construct self-in-relation. Much of
the existing research to assess the self-in-relation has focused on
adolescent girls and proposes connections as the primary and single
pathway to female development. If one believes the separate self and
the connected self are not polar opposites but dynamic and separate
components of personality, and if one believes that times of transition
require self-inventory, then a shift or reordering from the primary
orientation of connection for women would seem logical at midlife.
Using Franz and Hhite's (1985) two path model to incorporate both the
separate self and the connected self seems appropriate for women at
midlife because life events that require a reordering of the self-in-
relation are present: decreasing centrality of role of parent and career
changes. .

Family ecology is an appropriate discipline to study this reframing
because the family is the social unit in which this process takes place.
It is understood that the family unit is a system that must adapt to
changes within the individual members. Indeed, although the entire
family must adapt to the reframing of the ”self-in-relation" process of
the mother, that family adaptation process is beyond the scope of this
study.

Hhat can today's cohort of midlife women expect during this time?

If they are mothers, they are entering the postparental period. This is

8

a time when they reflect on their life, its contribution to family and
society. It is a time of deeply felt life transitions, the negotiation
of which may affect both emotional and physical health status.
Therefore, it is both needed and appropriate to examine this window of
time in women's lives.
one a Model

The conceptual model (see Figure 1) for this study was designed to
view the process of the transition which occurs at midlife through a
single measure of the self-in-relation. The antecedent self-in-relation
is meant to hold all those life events and individual experiences prior
to this moment in time and is out of the range of this study. The
contextual variables were selected from a combination of literature
review and personal clinical experience of the researcher. How and if
the contextual variables were affected by the self-in-relation and
health status at the midlife transition will be addressed in the
discussion of the post hoc questions.

Statement of the Problem

This research seeks to examine the question: Is there a
relationship between a woman's ”self-in-relation' and her health status
during the transitional phase of midlife?

Assumptions

1. A woman's sociohistory, culture, and environment are all important

when attempting to accommodate transitions.
2. A woman is a semi—open, goal directed, dynamic, adaptive system.

She can respond, change, develop, and act to modify her

environment.

9

 

Antecedent
Self
In Relation

I

 

 

 

 

CONTEXTUAL VARIABLES

 

 

 

 

Pre
Transition
Index

 

 

Social
Support
Index

Marital

Index

 

 

 

 

Parental

Relationship Relationship

Index

 

 

Post
Transition
Self Care

 

 

 

 

 

| Transition

 

 

Self
in
Relation
(1) Separate Self
(2) Connected Self
(3) Primary of Other Care
(4) Self and Other Care

 

 

t

HEALTH
STATUS
(1) Emotional
(2) Physical

 

 

 

 

Figure 1
Conceptual model

 

 

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10

A woman's psychological development is a dynamic and continuing
process.
A woman's separate/objective self and connected/relational self are
two distinct developmental pathways that seek balanced expression
during the life course.
Transitions are inherent in a woman's development process.
A woman needs other individuals to achieve full potential as a
human being.
Midlife is a time for a woman to reorder her previous roles and
relationships. I
Taking care of relationships is a primary responsibility for a
woman in our society.
A woman relates to others primarily through a connected self.
Launching the last child from the home is a transition for a woman
who is a mother.
Midlife transitions require a change in the form and content of
relationships for a woman.
For a woman to be in a state of health, a certain amount of
introspective thinking and self-discovery must be attended to in
midlife.

Research Hypotheses
The more balanced a woman's separate/objective self with her
connected/relational self at midlife, the better her health status.
The higher a woman's commitment to the primacy of other care, the
more deficient her health status at midlife.
The higher a woman's commitment to self and other care, the better

her health status at midlife.

11
Definition of Variables

Both theoretical and operational definitions of four major concepts
are presented.
Transjtjon

A transition is a bridge or a passage from one stage or time to
another. It is a period of readjustment where lives, relationships,
daily routines, and assumptions about the self, and roles undergo change
(Schlossberg, 1986).

For this study, the transitional phase will be operationalized by
having selected and limited the study sample to married women who have
launched their last child from home within a narrow window of time,
i.e., 24 months.

Mite

Midlife is a transitory rather then a distinct phase of the life
course. For mothers, it is usually the time in a woman's life when her
last child leaves home. Within the life course, it is the antecedent of
old age and the outcome of adulthood. For many married women one of its
major results is an empty nest.

It is the time in life when a woman may become more egocentric,
attending to activities of personal success, self-achievement, and
mastery. She relearns the lesson of adolescence "That she must come of
age by herself---she must find her center alone" (Lindberg, 1955,
p.134). The operational definition of midlife for the women in this
study will be the sociological event of launching the last child from
home within the 24 month time period prior to completing the

questionnaire.

 

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Sglf-in-relation

Self-in-relation implies an evolutionary process of development
primarily through relationships. It is a dynamic self that is open,
flexible, and capable of change (Surrey, 1991). It is a self that
"achieves articulation through participation in and attention to the
relational process" (Kaplan, 1991, p.209). It is the "caring” voice
responsible to take care of others and the care of self in
relationships. It is the state of engrossment: to be responsible for,
to pay attention to, to feel with the other in relation. The connected
self (Gilligan, 1982) is "attuned to the affect of others, understanding
and being understood by the other, and thus participating in the
development of others" (Kaplan, p.208).

For this study the Self-in-Relation will be operationalized by
using the Relationship Self Inventory (Pearson et al., 1985). It will
include concepts from four scales. The first is The Separate Self (SS)
defined as: Independence and separation. The second is The Connected
Self (CS) defined as: Interdependency, connection with others,
egalitarian interchange and concern for individuals, including
themselves, in their own contexts. The third is the Primacy of Other
Care (POC) in which care of others has priority over care of self, and
fourth is Self and Other Care (SOC) in which self and others are treated
as equally deserving of care.

W

Health status "is a state of complete physical, mental, and social

well-being and not merely the absence of disease or infirmity”

according to The Horld Health Organization definition of health (Ware,

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13
Brook, Davies, & Lohr, 1981). This research includes both emotional and
, physical concepts in the definition of Health Status.

Emgtjgnal health Status. The emotional health status is a self-
appraisal of happiness, which includes the degree to which an individual
judges for herself her satisfaction with her life-as-a-whole. The
operationalized measure of this concept is the Rand Corporation's 22-
item Health Insurance Study-General Well-Being Scale (HIS-GWB) (Hare,
Johnston, Davies-Avery, & Brook, 1979).

si l he h t t . The physical health status is a self-
perception of a state of optimal body functioning. This concept will be
measured by three subscales: (a) perceived health status, (b) use of
health care services, and (c) reported health behaviors which were
developed for this research by the author.
Summary

The preceding has established the need to study the relationship of
the self—in-relation and health of midlife women. lhe ground work has
been laid to apply some existing theories to a sample of women to
determine if there is a relationship between health and the

psychological construct self-in-relation of married midlife mothers.

 

 

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CHAPTER 11
REVIEW OF LITERATURE

The theoretical framework for this investigation draws upon a
developmental perspective of the individual and family life cycles,
coupled with a feminist approach to the psychological theory of female
development. The family stage of launching young adults from the home
defines transition for purposes of this study (Neugarten, 1968). How
that transition impacts the self-in-relation and the health status of a
mother in a marital relationship is the focus of this study.

The information in this chapter will be organized into four
sections related to (a) adult development focusing on females and recent
thinking of female psychological theories, specifically the self—in-
relation, (b) the process of transition, (c) the general health status
of midlife women, and (d) role theory with emphasis on the changes that
occur at midlife for mothers.

Female Adult Development

A review of theories of adult development will be presented to
allow a historical perspective of the knowledge that pertains to this
research. The current thinking as it relates to female development is
included because of the impact that thinking has on this study.
W

The bulk of work that comprises adult psychosocial development was
traditionally based on the male experience. One of the most
comprehensive theories of adult development was the life stage theory
proposed by Erikson (1959). The developmental theory he proposed

encompassed the entire life span and consisted of eight age-related life

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stages. Each stage represented a crisis between primary developmental
tasks, the positive resolution of which was necessary to move on to a
subsequent stage. The adult stages proposed were: intimacy vs
isolation, generativity vs stagnation, and ego integrity vs despair.
Initially Erikson proposed that adolescent identity preceded intimacy
for both males and females and that generativity was the major goal of
the seventh life stage or mid-life. He later modified his stages for
women. For a women, he proposed, the process of identity was not
complete until she had committed herself to an intimate relationship and
taken on the care of children. Therefore, for women, intimacy preceded
identity and quite possibly engagement in "generative“ behavior because
of primary roles in childbearing and child rearing.

What was unique about Erikson's (1959) theory was the potential for
continued growth and change throughout one's entire life. His proposal
that there were various adult stages was both provocative and
controversial. Though he addressed only the most global of psychosocial
changes, his thinking offered an opportunity for further exploration of
the adult stages of life.

Erikson's (1959) theory has been expanded by Franz and White
(1985). They suggested that Erikson's model has neglected to account
for the process of interpersonal attachment. Therefore, they proposed a
two path model that filled a void in Erikson's theory. Their model
included the development of individual identity, and interpersonal
connections or attachment and posed these as equally important threads
of human development. Their model was built on the work of Bakan (1966)

and Parsons (1964) who found both orientations in men and women. Both

16
Bakan and Parsons concluded that the expression of identity and
attachment was not only possible in all humans but was healthy.

Franz and White (1985) took Erikson's (1959) eight stages of
development which they believed to be heavily dominated by the
development of identity formation or individuation and created a
separate but interconnected path which emphasized attachment. Erikson
had suggested that his model be perceived as a helix, Franz and White
thought the theory would be better served by perceiving it as a double
helix.

We believe, however, that to account fully for "healthy" human

development,...the field might better be served by the model

of a double helix in which two separate but interconnected

strands of psychological individuation and attachment ascend

in a spiral representing the life-cycle. Each stage

represents an intrapsychic developmental change in both

individuation and attachment; experiences in any one realm

will have ramifications for the other. Like the twisted

strands making up a rope. tension on one strand will pull the

other. (p. 247)

Davis and Jones (1992) support the work of Franz and White (1985)
that extended Erikson's (1959) theory of personality. They studied the
mental health of 83 southern mother and daughter pairs. The
psychological variables used were differentiation of self and
attachment. The researchers created a model of daughter's attachment to
mother and self-differentiation. The results showed that mothers and
daughters scored similarly in their levels of attachment to each other
and their mental health outcomes with one noticeable exception.
Daughters showed significantly less differentiation of self than
mothers. The researchers suggest this difference in self-

differentiation is the result of life experience. More research is

necessary to help determine if a relationship exists between a woman's

17
age and her differentiation of self. The finding of this study
supported the position proposed by Franz and White (1985) that
differentiation of self and attachment are two different strands of
human development which are not mutually exclusive but interconnected.

Jung (1933) looked at adult development across the entire life
cycle as well. Jung felt the personality could not reach its full
growth by age 20 and theorized the next opportunity for change started
about 40. Jung theorized that it was at this time that one moves from
an external view of life based on control and achievement to one where
peace is found from within. He used the term "individuation” for the
developmental process that begins at midlife and extends over the
remainder of a person's life; he indicated this occurred for both men
and women.

Jung (1933) also proposed that each person has both a male and
female personality. He believed that at different times during the life
course one or the other personality gains strength and dominates
individual behavior. He felt that middle age was the time the primary
personality had been ”exhausted" and it was at this time the secondary
personality would emerge. This explained why middle-age men could more
easily express their feminine side and why middle-age women could
express their masculine side.

Levinson et al. (1978) built their theory on the work of Jung.
Their conceptualization of the life cycle is based on age related
developmental stages which move through a predictable set of
developmental periods and tasks. The life structure evolves through a
relatively orderly sequence during the adult years. The pattern is one

of structure building/structure changing episodes which are the same for

18
all men. The structure building episode of middle adulthood is 40-60
years of age with 40-45 seen as the structure changing period. The
orderly progression of periods stems from a recurrent change in the
developmental tasks.

The transition or bridge from early to middle adulthood occurs at
40-45 years of age. Three major tasks must be dealt with during this
midlife transition. They are: (a) bring to a close the early adulthood
era, reappraise the past, and develop a desire to use one's remaining
life time wisely; (b) take the first steps in modifying the life
structure to move into middle adulthood shifting from the past to the
future; and (c) complete the midlife individuation process which
involves resolving four polarities specified as young/old,
destruction/creation, masculine/feminine, and attachment/separateness.
Each pair, though representing opposing tendencies, is not mutually
exclusive. The belief is both polarities can be found within the core
of each self. According to the theory of Levinson et al. (1978), the
two polarities of particular importance in the individuation process at
midlife are masculine/feminine and attachment/separateness.
W

In the 1980s theorists began questioning the male development
theories of Erikson (1959), Jung (1933), and Levinson et al. (1978), in
describing adult development. Roberts and Newton (1987) used Levinson's
theory to study women's adult development. They reviewed unpublished
dissertations. The impetus for this review was to help determine the
scope of Levinson's theory, i.e. its application to women, because in
the authors' view a comprehensive theory of women's adult development‘

does not exist.

19

Using the interview methods proposed by Levinson et al. (1978),
Stewart's dissertation (1977) cited in Roberts and Newton (1987)
constructed the life stories of 11 middle class women during the age 30
transition to see if Levinson's theories were applicable for women.
Stewart's findings supported Levinson's theory of adult development.
However, she found the order in which women accomplished specific
developmental tasks was more variable than for men. She observed it was
more difficult for women than men to establish an adult life structure.
She concluded that women differ from men in the way they develop their
life dream and in ways of relating to significant others.

Another study dealing with midlife women was conducted by Droege
(1982) cited in Roberts and Newton (1987). Her combined sample totaled
39 biographies of women. This review suggested that ”women progressed
through the same developmental periods as had the men in Levinson's
study and at roughly the same ages” (p. 154). The differences found
were not in events or their timing, but in the way a woman worked on the
task and the outcome. For the sample dealing with midlife women, the
life dream experienced was a "split dream," i.e. encompassing both
traditional and nontraditional expectations. Several women felt they
had not achieved their potential in either area.

Eemele Theory Applied tp Femele Development

Rubin (1979) interviewed 160 women between the ages of 35 and 54
who had spent their lives in the roles of wife and mother. She
specifically focused on the time in midlife when "the motherhood role
self destructs” (p.120). Rubin's study dealt with the problem women
have with identity. When asked to describe themselves, one-fourth of

her sample could not. They were only "someone” in relation to ”someone”

 

 

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else.' "A self exists in a social context; it grows and develops as part
of an ongoing process of interaction with the social world” (Rubin, p.
60). Not being able to distinguish who they were occurred when their
relationships began to change. For Rubin it was not the children
leaving home, i.e. empty nest, but the loss of the role, i.e. empty
life, that created the problem.

The underlying theme for adult growth and development as theorized
by Neugarten (1968) is orderly, sequential change. She noted that as
people age certain personality traits come to be of primary importance.
"Middle age is a period of heightened sensitivity to one's position
within a complex social environment; and that reassessment of the self
is a prevailing theme" (p.93). Unlike the stage theorists, her theory
allows for the impact of social change. Neugarten's research found that
“middle age marks the beginning of a period in which latent talents and
capacities can be put to use in new directions” (p.96). For mothers,
the social change of middle age is the launching of children into the
adult world, heralding a new round of growth and development.

Rubin and others (Barnett & Baruch, 1978) found women, but not men,
define their age in terms of the timing of events within the family
cycle. Middle age for mothers was marked by the launching of children
from the home.

For Neugarten a stage theory approach to the study of adult
development was oversimplified. Her individual-timing-life-cycle
approach was much broader and more flexible; it allowed for development

beyond adulthood.

 

 

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Eemjpjs; [heppy Applied tp Femele Qevelopmehp

Miller (1976) proposed a gender specific developmental theory. She
espoused the feminist thesis that "women have developed the foundations
of extremely valuable psychological qualities, but sexual inequality
devalues their importance" (p.26). Men and women in our society learn
basic but fundamentally different ways of being in the world. As a
result, women learn empathy and caring and develop a need for human
connections. Men on the other hand learn to repress their interactive
nature early and are rewarded for their development of an independent
self.

Existing adult developmental theories are based on the male model
and they have become the prescriptions of what should be, with the norm
identified as individualization and individual achievement. Therefore,
the concern women have for maintaining and nurturing relationships
appears as a weakness rather then as a human strength. Miller (1976)
identified what she calls the ”interacting sense of self” in early
infancy and believes it is present for both males and females. She
feels the fact that boys are not allowed to learn to feel as the ”other”
feels or to attend to the emotions of the "other" is depriving boys of
their full growth potential.

Chodorow (1978) expanded Miller's work by proposing that the female
self is a result of the way daughters are parented. Women have this
responsibility because women are universally responsible for early child
care. Mothers create a different social environment for sons then for
daughters. Mothers experience daughters as continuous with themselves,

extensions that never fully separate.

 

 

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Girls emerge from this period with a basis for empathy built

into their primary definition of self in a way that boys do

not. From very early then, because they are parented by a

person of the same gender...girls come to experience

themselves as less differentiated than boys, as more

continuous with and related to the external object-world, and

as differently oriented to their inner object-world as well.

(Chodorow, p.167)

Boys differentiate themselves from their mothers and establish
clear ego boundaries. Therefore "the basic feminine sense of self is
connected to the world, the basic masculine sense of self is separate“
(Chodorow, 1978, p.169). Thus, femininity is defined by attachment and
masculinity is defined by separation. The issue of attachment becomes a
liability when a woman's failure to separate becomes defined as a
failure to develop. Chodorow's solution emphasized a gender balance, by
recognizing the gender difference and moving toward an androgynous
nature for both men and women. Chodorow's view seems to place the
influence for the development of these personality traits on the
external environment, i.e. something that can be learned. Franz & White
(1985) view all human beings as androgenous. They claimed within each
of us is a separate and connected nature, the expression of which may be
demonstrated at various times in the life course. They express the hope
that by allowing for expression of both traits, individuals will not
neglect their capacity for developing both their separate and connected
nature.

The thesis proposed by Miller (1976) espoused the positive nature
of the relational qualities of women to care and nurture. This thesis
was further developed by Chodorow (1978) who saw these qualities as a

direct outgrowth of the self-structure of woman and a product of the

mother-daughter relationship. Gilligan (1982) expanded the idea still

 

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further and found women to speak with a "different voice”, a "caring
voice”, when confronted with moral choices. But she concluded it is not
a simple matter of a "caring voice", i.e. connected self, versus a
“justice voice", i.e. separate self. There is interplay of both voices
within the individual. Life transitions are times when the two voices
converge. ”As the events of women's lives and of history intersect with
their feelings and thought, a concern with individual survival comes to
be branded as selfish and to be counterposed to the responsibility of a
life lived in relationships" (Gilligan, p.127). Gilligan's two voices,
separate self and connected self, equate to the interconnected strands
of identity development that Franz and White (1985) see as intertwined
in each individual.

Gilligan (1982) proposed a life course development relationship
theory for women that is grounded in interdependence with others and
evolves through ”taking care" activities. She held that for women there
was fusion of identity and intimacy. She also said that women's
standard of moral judgment comes from their assessment of self. Their
standard of relationship is an ethic of nurturance, responsibility, and
care. Gilligan has developed the following three levels of care giving:
(a) care given is self-centered and self-protective, a coping strategy;
(b) care is given to win the approval of others; and (c) care for self
is seen as important and is practiced while still caring for others.

Gilligan's major work has been on young women and their struggle
with identity issues. These findings cannot be equated with midlife
women, however, the picture of the evolutional development of ”taking
care” that she proposes over the life course may be used to better

understand the psychological development of midlife women. As a woman

 

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24
moves through life and matures, she may change her level of care
activities. A woman may learn to distinguish between the activities of
helping and pleasing engaged in as a child and the activities of "taking
care" of the ”other” that are necessary to gain approval of others in
adulthood. As the transition from childhood caring to adulthood caring
requires a redefinition of care, so too may the transition to midlife
caring.
Transitions

When the last child leaves the home, a woman may experience a sense
of loss of what has been, an ending. Bridges (1980) emphasizes
transition as a process that begins with endings. As each transition is
an ending or loss, it is also an opportunity for new growth. The ending
of a transition has four phases: (a) disengagement, the need to separate
one's self from the main stream; (b) disidentification, when the
individual loses a means of self—definition as with the loss of major
roles; (c) disenchantment, the discovery that the world is no longer
real; and (d) disorientation and emptiness. The second stage of a
transition is often considered the ”neutral zone". The neutral zone is
the gap between the old and the new. It is necessary because it
provides perspective; when it has passed, a new sense of self will be
created. The final stage of the transition process is the new
beginning, the rebirth. New beginnings grow out of genuine inner
realignments rather then external shifts and are signaled by the feeling
of something different. Viewed in this context, the transition process
is seen as a loop in the life journey, a going out and away from the

main flow for a time and then coming around and back. Transitions alter

 

 

 

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roles, change relationships, change routines, and affect assumptions
(Schlossberg, 1986).

Levinson et al. (1978) defined transition as the boundary zone
between two psychological states of greater stability. Midlife
transitions may reactivate some developmental issues of adolescence.
The primary tasks of every transition period are to question and
reappraise the existing structure, to explore various possibilities for
change in self and the world, and to move toward commitment to the
critical choices that form the basis for a new life structure in the
ensuing stable period.

It is important to understand the transition process from the "old"
life stage to the "new" life stage and its effect on the self-in-
relation. At midlife a woman's value may be deeply imbedded in three
basic roles: daughter, wife, and mother. When her last child leaves
home, she is faced with choosing new role identities and relationships.
When women have invested heavily in the mother role and they no longer
have this major role as the focus of their lives, their sense of
identity may be threatened. Women in this situation may become
depressed and develop physical illness (Miller, 1976). Midlife
typically entails a reevaluation and renegotiation of many
relationships, especially the marital relationship and the maternal-
child relationship.

General Health Status

The definition of health status for this study includes both
subjective well-being and general physical health. This combination is
well supported. The World Health Organization in its definition of
health clearly integrates both the physical and psychological

 

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dimenSions. Health is ”a state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity" (Ware et
al., 1981, p.620) This definition has been widely used and is
especially applicable when respondents are basically healthy. This
section of the review of the literature examines general health status
of midlife women in transition. The emotional and physical health
issues will be presented in two separate sections.
Emetignel Health Status

The social roles of women, e.g. wife, mother, paid worker, may or
may not contribute to their health problems. Depner (1979) found women
with multiple roles were no less healthy. In fact, Verbrugge (1985)
pointed out that women in the United States with fewer roles presented
in the poorest health state. The role of wife has been found to
increase happiness and satisfaction slightly (Cleary & Mechanic, 1983);
when the quality of the marriage was taken into account, the effect of
the wife role is even greater, thus making for better health. However,
when the marriage is not a happy one and there is consistent negative
interaction with the husband, the health outcome for wives is often
depression (Brown, 1984).

A link has been established between stress and health. As early as
1967 Holmes and Raye established a link between stressful life events
and illness. For women, however, stress is not only due to the number
of events happening but also to daily chronic stresses in life, e.g.
role conflict, high household demands, and limited hours of leisure time
and sleep (Bird & Freemont, 1991; Kessler & McLeod, 1984).

Thomas (1990) studied predictors of health status in a

heterogeneous sample of 87 midlife women ranging in age from 39 to 60.

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The predictors of health status included optimistic disposition,
internal locus of control, education, income, employment outside the
home, moderate exercise, and sleeping 7-8 hours per night. The results
of the study found midlife is stressful for most women "particularly for
those experiencing major life changes concomitantly with a high
frequency of daily hassles" (p.69).

Black and Hill (1984) studied the well-being and satisfaction of
women in their middle years. The sample of 232 married woman ranging in
age from 46 to 61 completed a questionnaire. The questionnaire had been
developed to study the influences of selected variables on the well-
being of women who had experienced or who were anticipating the
experience of the empty nest. According to the data, 90% of the women
studied were ”generally quite happy". The researchers were not
surprised to discover these women were happy since their sample was
composed of well educated, economically stable, married women with
children. Our society values women who are successful in their roles as
wife and mother. Their findings were consistent with other researchers
(Axelson, 1960; Glenn 1975). It seems reasonable to assume that, during
this stage, women who can begin to explore new self-satisfying
alternatives of career and life styles after having fulfilled
childrearing obligations would be healthy. But not all women can do
this. How a woman chooses to invest her time when the last child leaves
home may be strongly related to age. The older she is, the less likely
she is to pursue outside interests particularly employment (Bradwick,
1980).

Mitchell and Helson (1990) advanced the hypothesis that the early

50s constitute the prime of life for women. In 1983 to look at this

28
question they conducted both a cross sectional and a longitudinal study.
They concluded that healthier women were women who had launched their
children, lived with partners, were autonomous, and balanced their
masculine, i.e. justice, and feminine, i.e. caring, voices. The
researchers felt this finding was consistent with Gilligan's (1982)
theory about the relational orientation attributed to women.

Finally looking for generativity, the trait Erikson (1959)
associated with the generative stage of adult development, Mitchell and
Helson (1990) found the women committed to people, careers, and
community service were the most psychologically healthy. The
researchers compared this to Gilligan's (1982) definition of ”mature
care” which incorporates care for others and care for self. While each
life stage has its problems, except for regrets related to their losses,
this cohort of 50 year old women identified this time in life as
”great".

According to data compiled over a generation ago by Glenn (1975)
from six U.S. National surveys comparing parental and postparental
families (N-1600), the postparental family stage of life for midlife '
women is somewhat happier than for those women who are the same age and
still have children in the home. The researchers found that marital
relationships were considerably more positive for postparental women.
Glenn hypothesized that as women reorder their relationships, they
initially look at the other important role in their lives, i.e. wife,
and that they may be happier because they reinvest some of the extra
time and energy they now have into this and other important roles.
“Life at home becomes simpler, and the energy that went to children is

redirected to the partner, work, and community or self-development"

29
(Mitchell & Helson, 1990, p. 453). Adelmann, Antonucci, Crohan, and
Coleman (1989) studied the psychological well-being of empty nest women
of different historical cohort groups and employment status. The sample
consisted of two different age cohorts: the first was born around the
turn of the century and the second cohort was born around 1920. The
effect of the loss of the mother role on psychological well-being was
hypothesized to be related to the cultural importance and socialized
expectations placed on the role. However, it was also felt that
positive job status at the time of the empty nest experience would
buffer any perceived status loss. The findings support cohort
membership and employment status as influencing a woman's well—being.
The consequences of an empty nest, i.e. loss of the mother role, may
depend more on life course and employment than on cohort membership.
However, cohort membership was found to be important for women born
around 1920. The strong orientation to the mother role for this group
was associated with "immobilization” at midlife.
He l t

As a woman's mental health for too long has been male defined, so
too have the issues which define her physical health. The health care
system in the United States is built upon the medical model and medical
care is provided to women mostly by men. Therefore men, not women,
determine the primary health issues to be addressed at midlife. To
date, for health care professionals the primary health concern for
midlife women is menopause. However, DeLorey (1990) interviewed 120
midlife women not one of whom thought menopause was a midlife concern.

Women undergo great personal change during the years which surround

menopause. Not all the changes which occur during this period are

30
negative. However, research continues to look for the negative. The
view that biology is destiny has narrowed the meaning of a woman's life
to her reproductive ability.

Brooks-Gunn and Kirsh (1984) identified health concerns for midlife
women. It has long been felt there is a connection between the
increased risks of heart disease and menopause. They saw heart disease
as a critical issue to be addressed by the health care system for two
reasons. The first was that most knowledge and treatment modalities are
based on research findings gathered on male subjects. The second was
that the social and cultural biases about women are so long standing as
possibly to have clouded some of the statistics related to mortality and
morbidity. In general, fewer diagnostic tests for heart problems are
done on women with the same symptoms as men (Fiebach, Viscole, &
Horwitz, 1990). The primary physical health concerns of midlife women
are cancer, heart disease, menopause, onset of chronic illness, and
substance abuse (Haynes, Levine, Scotch, Feinlab, & Kannell, I978;
Kopstein, 1978; Tishler, 1978; Wilsnack, 1984).

Role Theory

Human beings learn the rules of behavior through the process of
socialization. These rules become the norms which define role behavior.
”The cultural structure of a society, or of any social system within it
is comprised of norms, which are clustered in terms of time, place,
self, other, and function to form roles” (Bates & Harvey, 1975, p.92).
Therefore, the pattern specific, behavioral expression of a cluster of
internalized norms is role behavior.

Roles cluster together in terms of self and other to form statuses

which constitute a two person relationship. Statuses cluster together

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in terms of self and multiple others to form group positions. Social
positions are either achieved, based on what the person can do, or
ascribed, based on who the person is in terms of gender, age, or family
connections. Roles generally involve a complex combination of both
achieved and ascribed behavior sets. Finally, positions cluster
together to form group structures such as family and community.

The concepts of self, role expectations, and role performance are
central in role theory. The concept of self in role theory combines
fairly constant cultural norms with the psychological variations in the
individual personality. An organized system of role expectations is
cognitive and serves as a significant guide and standard for appropriate
conduct and behavior. Biddle and Thomas (1966) refer to the "shoulds"
and “oughts” that are internalized as norms, while those that are
overtly expressed are referred to as role demands.

The position a woman occupies changes over the course of the life
cycle. The individual's life cycle can be viewed by looking at how
roles, statuses, and positions are added to or deleted from behavior.
Middle age begins a major alteration in a women's participation in
society or an alteration in her expressed behavior relative to role,
status, and position. This alteration is heralded if she is a mother by
her children becoming adults and leaving home.

MM

Mother is an ascribed position with many individual and cultural
norms and demands. When children become adult and leave home, the
behaviors which surround the mother's role change. The central role
behavior involved in ”care taking” is altered. Initially, the child's

need to be cared for is great. Therefore, the mother may play out the

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role behaviors at her expense, neglecting herself for the sake of the
child.

When the child leaves home and his/her needs are not as great, a
mother may feel a tremendous loss of purpose, and, if she has
overinvested in the role, these feelings may be very acute. Even if she
is able to view this time in her life as open to change and personal
growth, the reordering of the relationship with her child is an awesome
task--one which requires her to discover who she is and how she sees her
future.

There is some empirical evidence that the role of mother
contributes to a woman's well-being (Barnett & Baruch, 1985; Veroff,
Douvan, & Kulka, 1981), although the results are mixed (McLanahan &
Adams, 1987). Research has indicated the mother role, combined with
others, brings both feelings of enhancement and feelings of conflict
(Tiedje et al., 1990). The role of mother is made especially difficult
in our society because there is the unrealistic expectation that one can
shape a child in a chosen way (Lopata, 1971).

Mothers bear the primary responsibility for child care and feel
responsible for parenting failures. Whereas multiple roles may feed
positively into a woman's sense of well-being, problems with the mother
role often may not be compensated for by other roles (Veroff et al.,
1981).

Summary

The uniqueness of the female experience expressed in "...a woman is
never not a woman..." (Erikson, 1968, p.290) combined with the social
expectation for women to ”take care" of relationships places them at

risk for health problems at midlife. The event of launching the last

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child from home is a transition and transitional changes are times of
disequilibrium and uncertainty. Because the transitional period
surrounding the physical launching of the last child from the nest is
tied to strong affectional bonds, it is an integral part of the self-
definition. The fear of what may be the outcome of the change and the
individual's possible failure to achieve a comfortable adaptation to the
new situation contribute to feelings of increased stress. When stress
reaches intense levels, feelings of inadequacy and depression are the
outcome. Therefore, to assess accurately a midlife woman's health
status, both mental and physical health aspects of her varied life
experience must be included.

This study builds on Gilligan's (1982) theory of changing care
activities as women mature. It is based on the premise that midlife
represents a time when a woman's need to balance her separate self and
her connected self converge. How a woman reorders her relationships,
how she seeks expression for her separate self and her connected self,

and her subsequent state of health are the issues of study to follow.

CHAPTER III
METHODOLOGY

This study used a descriptive correlational design and is intended
to provide information that will guide the care and counsel of midlife
women and further research ventures. This chapter includes the
following: (a) criteria for sample, (b) procedure, (c) data collection,
(d) instrumentation, (e) proposed data analysis, and (f) limitations.

Criteria for Sample

Criteria for participation in this study were (a) women in marriage
relationships and (b) women whose last child had left home within the
last 24 months, i.e. gone off to college, gotten married, moved into an
apartment and not returned to live permanently at home. Vacations,
holidays, and weekend returns did not count. This time period was
selected to provide ease in attaining a sample.

The sample size for this study was projected to be 130 women, i.e.
at least 10 per variable. The 13 variables and the measures that will
be used in this study are displayed in Figure 2.

The criteria for this study were selected in order to gather
information from women during the time period when two transitions
coexist: the individual's midlife age transition and the family
transition of the last child leaving the home. It was thought being
married was another relationship that might require reordering during
this time. This was to be controlled for by omitting from the sample

currently divorced, widowed, and never married mothers.

34

35

 

Variable Classes

Measures

 

Independent variable
Self in Relation

Dependent Variable: Health Status
Emotional Health Status

Physical Health Status

Contextual Variables
Activities of Preparation for
Transition
Social Support

Marital Relationships
Parental Relationships
Posttransition Care for Self

 

The Relationship Self Inventory (RSI)
1. Separate Self (SS)
2. Connected Self (CS)
3. Primacy of Other Care (POC)
4. Self and Other Care
(Pearson et al., 1985)

Health Insurance Study - General Well-
Being Scale (HIS-GWB) (Ware,
et al., 1975)

Perceived Health Status (Spreitzer and
Snyder, 1974)

Use of Health Care Services (Price,
1974)

Reported Health Behaviors (Price, 1993)

Pretransitional Index (Price, 1993)

Social Suppot Index - Adapted from the
PRQ (Brandt and Weinert, 1981)
Marital Relationship Index (Price, 1993)
Parental Relationship Index (Price, 1993)
Posttransition Self Care (Price, 1993)

 

Figure 2

Classes of psychosocial variables and instruments used to measure them

36
Procedure

Requests for women to participate in this research took several
forms. The first attempt to recruit women was to ask friends and
coworkers if they knew women who met the criteria and would be
interested in being part of the study. This approach was purposeful and
the women recruited were self-selected.

The second approach involved placing advertisements in newsletters
distributed by health care corporations, churches, businesses, and
public schools. Both employees and volunteers of these organizations
were targeted as possible respondents. The newsletter requests included
the two key criteria questions and a phone number to which to respond if
eligible and interested in participation. Requests were also made at
regular meetings of women's groups and local health care clinics. One
large grocery store chain was contacted; the managers agreed to place
notices which introduced the researcher and included the criteria for
study participation in the pay envelopes of all women employees between
40-60 years of age. If interested the employees were asked to contact
the personnel office and leave their name and address. These names and
addresses were then forwarded to the researcher.

The remainder of the women were recruited by a type of snowballing.
Several local high schools were contacted and a request for a list of
names of the June 1993 graduating seniors was made. The schools felt
the only way they could provide this was to provide a list that was
already public record so a copy of the commencement program was given to
the researcher. Unless otherwise directed by a friend or an
acquaintance who might have known the students on the list and knew who

were last children leaving a two parent household, the researcher

37
arbitrarily selected a name from the list and began phone canvassing.
The phone call consisted of a personal introduction to the mother and
explanation for the call followed by several questions.
1. Do you meet the criteria?
2. Would you like to participate?
3. Do you know other mothers of students in the graduating class who
also meet the criteria?
4. Do you have other family members or friends who might meet the
criteria?

Usually within the first 10-15 phone calls a potential respondent
was found. After one participant who met the criteria was found, the
network spread quickly. This technique was used with one private and
six public high schools.

Another way of recruiting women for the study was to include in the
questionnaire a self-addressed stamped postcard to be given to a friend
or relative who was thought to meet the study criteria and would be
interested. Because the postcard return rate for the first one hundred
questionnaires that were sent was so poor, the last 92 questionnaires
did not include the postcard. There were 148 questionnaires returned
(see Table 1). Phone calls to the homes of 1993 high school graduates
and direct contact provided over 50% of the participants.

The techniques used to obtain a sample were broad in scope and
encompassed a wide range of populations. The sample was obtained from a
variety of sources in an attempt to sample a diverse group of
individuals. This was intentional in the hope that a close

approximation of the general population would be achieved.

38

 

 

Table 1. Sourees of Study Eopplation

Source ' Number Percent
Phone calls/high school 40 27
Direct contact 37 25
Newsletters 29 20
Women's meetings 12 8
Local business 12 8
Health care clinics ll 7
Postcard .1 _§
TOTALS 148 100

 

Data Collection Procedures

Following approval of the research proposal by the University
Committee on Research Involving Human Subjects (UCRIHS), each person who
answered both questions "yes" and who agreed to participate in the study
was sent a questionnaire. The average time to complete the
questionnaire was expected to be 30 minutes. Included in the packet
were a $2.00 bill and a self-addressed stamped envelope for return of
the completed questionnaire. It was hoped the $2.00 would serve as
incentive to complete the questionnaire and also as token payment for
the woman's time and contribution to the research project. The
completed questionnaires were received between June 1993 and December

1993.

39
Instrumentation

A summary of the instruments used to measure the constructs
identified in this study is presented in Figure 2. These were combined
to form a questionnaire composed of three sections. The two major
sections are those related to the primary independent and dependent
variables, i.e. The Relationship Self Inventory measuring the self-in-
relation and instruments used to measure the health indicators. The
health measures include The Health Insurance Study General Well-Being
Questionnaire and measures designed by the researcher to evaluate a
woman's physical health status. The next section consists of questions
related to the contextual variables which have no direct bearing on the
hypotheses. The remaining questions are designed to gather information
of general demographics.

Each portion of the instrument will be described including
instrument development, reasons for use in this study, and planned
scoring techniques.

1 e f v nt r

The first portion of the questionnaire, (see Appendix A) The
Relationship Self Inventory (RSI) (Pearson et al., 1985), was designed
to measure the theoretical construct self-in-relation. The items
included in this questionnaire clustered into four scales. They are
the: (a) Separate Self (SS), (b) Connected Self (CS), (c) Primacy of
Other Care (POC), and (d) Self and Other Care (SOC).

The Relationship Self Inventory was designed to validate the
theories proposed by Miller (1976) and Gilligan (1982). Gilligan's
methodology for studying female development was to use semistructured

interviews on a small sample compiling her data in long and in-depth

40
narrative results. The researchers who developed the Relationship Self
Inventory believe the self-in-relation to be a real and robust
phenomenon which can also be measured by more traditional psychometric
means.

The survey instrument consists of 60 items and the responses were
on a five point Likert scale with responses ranging from "not like me at
all" (1) to "very much like me” (5). Pearson et al. (1985) tested this
instrument on 930 women and 228 men. The alphas for internal
reliability, the mean scores, and the standard deviations for this study
for all four scales parallel those obtained by Pearson et al. when
testing the instrument during development (see Table 2).

The Relationship Self Inventory (RSI) was used in this study to
operationalize the self-in-relation. In scoring the RS1 a summed score
for each scale was used. High scores on the Separate Self scale
determine the degree to which a woman would describe herself as being
more separate or independent of others. 'High scores on the Connected
Self scale are indicative of how important interconnections with others
are for women. High scores on the Primacy of Other Care scale provide a
measure of the degree to which a woman is more often apt to place the
needs of others before her own. Finally, high scores on the Self and
Other Care scale allow for a measure of the woman's ability to care
equally for herself while still caring for others.
health Stetge

The second section of the questionnaire (see Appendix B) measures
the construct health status. This measure is a combination of (a) the
Health Insurance Study General Well-Being Scale (Ware et al., 1979), a

22 item instrument developed to measure emotional health status, and (b)

41
a sixitem measure of physical health status designed by the researcher
for use in this study. The physical health status measure has three
scales: (a) perceived health status, (b) use of health care services,
and (c) positive and negative reported health behaviors.
Intercorrelations between the indicators of emotional and physical
health are presented in Table 3.

Following the presentation of the two subscales, the construction
and scoring of the health status variable for this study will be
discussed.

Emetjonel health etatgs, The Health Insurance Study-General Nell-
Being (HIS-GWB) form A, was used to measure emotional health status in
this study (Ware et al., 1979). The HIS-GWB was developed to be used in
the Rand Health Insurance Study and was designed to investigate
physical, mental, social, and general health perceptions of the health
status on a general population of adults, 14 and older in the United
States. For this study the HIS-GWB was the operational definition of
emotional health status and used the Health Insurance Study's broad
definition of health that included complete physical, mental, and social
well-being not just the absence of disease. This definition adapted
from the World Health Organization has expanded the definition of mental
health to include positive states. This demonstrates an interest in the
quality of life as the ability to achieve optimal functioning (Offer &
Sabshin, 1974).

The HIS-GWB was selected because of its reliability, acceptance in
the field, and ease of administration. The questionnaire is composed of
22 items and includes six scales designed to measure anxiety,

depression, positive well-being, self-control, general health, and

42

Table 2. m aris n f e St n a d Dev“ ti ns nd r nb '
l h f ea a . n ri e D ta on Rel ti ns ’

Self-Inventory

 

 

Pearson et al. (1985) Price (1994)
Relationship Self N=320; Age 30-78 N=145; Age 39-62
Inventory Scale

Mean SD Alpha Mean 50 Alpha
Separate Self 2.5 .51 .77 2.4 .42 .76
Connected Self 4.1 .56 .76 4.2 .47 .73
Primacy of Other Care 3.2 .53 .68 3.4 .51 .70
Self and Other Care 3.8 .54 .78 3.8 .45 .76

 

 

Table 3. Interegrpelations Between Emptipnel Heelth Measure and
Phyejeel Health Meesgpe

 

 

Variable: Emotional Health Variable: Physical Health
Total Perceived Use of Positive Negative
Physical Health Health Care Health Health
Health Status Services Behaviors Behaviors
Emotional Health .41* .48* .15* .18* -.06 ,
Less Anxiety .24* .30* .07 .12 -.05
Less Depression .17* .20* .04 .07 -.14*
Self Control .23* .29* .08 .11 -.03
Well-Being .31* .35* .12 .15* -.08
General Health .55* .61* .29* .21* .04
Vitality .37* .48* .11 .17* -.OO

 

*p<.05

43
vitality (Dupuy, 1972, 1973). Scoring for the HIS-GWB was done by
reversing items 1, 4, 5, 7, 10, 11, 12, 16, 19, 20, 21, and 22 and then
summing all scores to achieve a total score. Therefore, each subscale
as well as the total scale was viewed as a positive scale and a high
score on each subscale and the total scale was indicative of a favorable
mental health status. This technique allowed the researcher to view
each subscale knowing that high scores meant positive health outcomes,
i.e. less anxiety and less depression.

The overall reliability and validity measures for the HIS-GWB were
determined after being tested on 8,000 subjects (Ware et al., 1979).
Reliability was estimated using test/retest and internal consistency
reliability. Internal-consistency reliability coefficients for the HIS-
GWB Total were above 0.90, the mean was 104.18, and the standard
deviation was 15.68. Intercorrelations among the subscales were
significant in this study (see Table 4).

Ehyeieel_hee1th_§tetget For purposes of this study, physical
health was measured using three indicators. Items found in the physical
health measure can be found in Appendix B. These were questions H1, a
woman's perception of her health; questions H2-H4, her use of health
care services; and question H5, her reported negative and positive
health behaviors. While it is understood there are disadvantages to
self-reported health status, it has not been determined that the reports
of health care providers are any better (Eisenberg, 1979).

Physical health measures were combined and scored as follows. The
physical health measure had a total weight of nine which was a summed
score of the three subscales. Possible responses to H1, the item

measuring self-reported health perception, had a range of 1-4, therefore

44
it was 4/9ths of the total physical measure. Each response to the three
items in the subscale use of health care services could receive a score
of O or 1 with the highest total possible summed score being 3 and
carrying a weight of 3/9ths. The weight assigned the subscale for
reported health behaviors was 2/9ths. The negative behaviors were
assigned the following values: use of cigarettes-l/3, use of
alcohol-1/3, use of caffeine-1/3 summing to a total of one. The
positive behaviors were assigned the following values: time spent
sleeping-1/3, time spent exercising-1/3, and quality rating of
nutritional intake-1/3 summing to a total of one. When summing for the
total physical health score positive, behaviors were added to and
negative behaviors were subtracted from the physical health score.

A single item measure of health status based on individual health
perception has been used on both early adult and aging populations.
Because there is an association between general health rating scores
(the single-item measure) and other measures of health status and
health/illness behavior, it was decided to use a single item measure of
health status (Henley & Davis, 1967; Madow, 1967). For this study the
item asks for a perception of health status in the last 24 months with a
range of choices on a Likert scale from excellent (1) to poor (4)..

The information retrieved from the use of health care services
scale included: the number of upper respiratory illnesses, trips to the
physician's office, and if hospitalization for any reason had been
required in the last 2 years. These data were obtained because it was
thought that by using a multidimensional approach to physical health a

better overall picture of health status would be obtained.

45

For the scale of reported health behaviors, the woman was asked to
check a response of increased, decreased, or stayed the same to a list
of both positive and negative health behaviors. This was a single item
(H5a-f) with six behaviors listed. Negative behaviors included use of
cigarettes, alcohol, and caffeine while positive behaviors were time
spent sleeping, exercising, and maintaining a quality diet. These items
were chosen because they have been shown to be significant in
determining health status (Brooks et al., 1979). There was a
restricted range of responses on this variable accounting for the low
correlations. The correlations among the physical health indicators are
presented in Table 5.

tepetrgetjoh of the health etatue measpre. To construct an overall
measure of health for this study, emotional and physical health factors
were combined in the health status scale. When necessary to make the
scales positive, the items were reversed. To interpret this scale,
higher scores meant better health.

The emotional health scale and the physical health scale were
designed to parallel each other with equal importance and value. To do
this the raw scores of both measures were converted to 2 scores and then
combined to create the health status score.

Seleeteg tonteztuel Variables

This section of the questionnaire (see Appendix C) is made up of
five indices that were developed by the researcher for all of the
contextual variables except social support (see Figure 2). The items
included in each index were selected after a careful study of the
available literature. Each index looked at a different variable which

might play a part in the transition process at midlife for women. These

46

Table 4. Dependent yeriahle Intercorrelations for Emotional heelth
(a)(Price,.1994)

 

I. Emotional Health Scale 1 2 3 4 5 6 7

 

 

 

 

2. Less Anxiety .80*

3. Less Depression .75* .56*

4. Self-Control .82* .60* .72*

5. Well-Being .86* .57* .65* .70

6. General Health .55* .29* .18 .28* .33*

7. Vitality .77* .47* .43* .49* .62* .54*

(a) present study

* P<.05

Table 5. e n t i e nter rr la ions f r Ph i l e lth
(Price, 1994)

1. Physical Health Scale 1 2 3 4

2. Total Physical Health

3. Perceived Health Status .78*

4. Use of Health Care Services .82* .33*

5. Behaviors: Positive .25* .15 .09

6. Behaviors: Negative -.10 .10 -.O3 .14*

 

*P<.05

47
indices were (a) the pretransition--reflections relative to the time
before the last child left home, (b) social support--relationships with
friends and support individuals, (c) the marital relationship--a
perception of the marital relationship that is reality based
facilitating rebalancing, (d) the parental relationship--a perception of
the parent/child relationship that is reality based facilitating
rebalancing, and (e) the posttransition--rebalancing of role
relationships with others and self.

r t ans' 'on i x. The pretransition index was made up of five
items which gathered information about preparatory activities a woman
might use to "get ready" for the leaving of her last child from home.
The pretransition index included the following activities: reading,
taking classes, counseling, and sharing concerns with friends and
spouse. The five questions required yes or no responses allowing for a
possible score of 0-5. The score was summed over the responses. The
higher the score, the more the mother had prepared for the launching of
her last child from home.

0 'al r ' de . The measure of social support used in this
study was adapted from the Personal Resource Questionnaire. Brandt and
Weinert (1981) developed a two-part social support measure which they
tested on 149 adults. Part two contained 25 items that included five
subscales. These subscales encompassed five dimensions of social
support: (a) intimacy, (b) social integration, (c) worth, (d)
assistance, and (e) nurturance. A seven point Likert scale measured
the items from ”strongly agree" (7) to "strongly disagree" (1). For the
purposes of this study, one item from each of the seven subscales was

selected arbitrarily to create an abbreviated version of the PRQ part 2

48

social support scale. The abbreviated version of the PRQ part 2
included all of the dimensions of social support believed by the
original developers to be important. Sample items include "There is
someone I feel close to who makes me feel secure” and "There is little
opportunity in my life to be giving and caring to another person." The
scores on this index were summed and a high score is indicative of a
high level of social support. Cronbach's alpha for this index was .60.

r' r i hi i . The sample selection for this study
included only married women. This was done because it was thought the
husband/wife relationship would require rebalancing as well as the
mother/child relationship at this life transition. Questions M1-M2 made
up the Marital Relationship Index. Each item on this scale had three
possible responses, each looking at the degree of change expected by the
wife in the relationship. The range of responses were from ”getting
better" (I) to "getting worse" (3). Two factors were thought to
influence health: the direction the relationship shifted as well as the
accuracy with which the woman could predict the direction of the shift.
When scoring this index, crosstabs were done between the expected
direction of change for the marital relationship (M1) and the reported
change in the relationship (M2). Crosstab placement allowed for group
assignment. If a woman predicted accurately the direction of change in
the marital relationship, her score was 3. If a woman's prediction was
not accurate, but the change in the relationship was positive, the
researcher assumed she was pleasantly surprised and scored a 2.
However, if a woman's prediction of the change in marital relationship

was neither accurate nor positive, the researcher assumed she was

49
disappointed and her score was a 1. Higher scores on this scale are
expected to correspond to a better health status.

P t r l on hi ' . The Parental Relationship Index was
developed to measure the degree of understanding a mother has about the
quality of her relationship with her child. Like the Marital
Relationship Index, health outcomes were expected to be influenced by
both the direction of the relationship change and the woman's ability to
predict accurately the change. The value here was for her to know the
relationships in her life. The expectation was that the greater a
mother's understanding, the better her adjustment and, therefore, the
better her overall health. The items for this measure were P1-P2. Each
item had three responses ranging from “getting better" to "getting
worse". The responses for the Parental Relationship Index were
calculated in the same manner as the Marital Relationship Index.

Epsttrehejtigh self-care, Investigation of posttransition self-
care was done by asking women if time given to the last child at home
and others in the past would now be given to herself. It was expected
that women who were satisfied with the transition would spend more time
taking care of themselves and this self-care would contribute to a
better health status. The item was on a five point Likert scale from “a
great deal" (1) to "not at all" (5). When scoring this item was
reversed, so that a high score indicated a greater level of self-
orientation.

Analysis of Data

To determine scale reliability and internal consistency, Cronbach's

alpha for this sample was computed on the independent variable self-in-

relation (see Table 2). Intercorrelations between indicators of the

5O
dependent variable, health status, were computed (see Table 3). The
results for emotional health are presented in Table 4 and for physical
health Table 5.

Descriptive statistics were then used to determine frequency
distributions, and to calculate mean scores and standard deviations for
the following: the independent variable self-in-relation (see Table 2);
the contextual variables: pretransition index, social support, marital
relationship index, parental relationship index, posttransition self-
care (see Table 6); and the dependent variable health status (see Table
7). Pearson Product Moment correlation coefficients were used to
determine the degree of association between the independent variable
self-in-relation and the dependent variable health status. Correlations
were also done using the contextual variables (pretransition index, the
social support index, and posttransition self-care), and the dependent
variable health status.

All of the calculations used a one-tailed test of significance. A
level of .05 was accepted as significant. The one-tailed test and .05
significance levels were appropriate because the expected direction of
the relationship is stated in the hypothesis. Analysis of variance was
done to determine if differences existed between a women's self-in-
relation orientation and her health and her ability to predict
accurately the direction of change in close relationships with husband

and child after the transition.

51

 

 

Table 6. s r' iv t t' t' f r m l ' on xt

Variable N Range Mean SD
Pre Transition Index 140 0-4 1.76 .83
Social Support Index 145 3.4-7.0 5.85 .80
Marital Relationship 144 1-3 2.60 .69
Parental Relationship 144 1-3 2.58 .66
Post Transition Self-Care 145 4-10 7.35 1.45

 

Table 7. Descriptive Stetistics for Sample:

Health lndieators

 

 

Variable Range Mean SD
Health Status -5.72-3.50 .00 1.68
Emotional Health -2.72-2.03 .00 1.00
Less Anxiety 11-29 21.12 3.91
Less Depression 7-18 15.03 1.98
Self Control 7-18 14.49 2.48
Well-Being 8-23 16.49 3.15
General Health 7-18 14.17 2.13
Vitality 5—17 12.50 2.30
Physical Health -3.72-1.65 .00 1.00
Perceived Health Status 1-4 3.32 .69
Use of Health Care Services 0-3 1.91 .72
Reported Health Behaviors
Positive 0-1 .72 .15
Negative O-.78 .35 .19

 

N-l45

52

Limitations
The convenience sample used in this study limited generalizability.
No effort was made to select women of low socioeconomic status or
minority groups whose developmental processes may be different from
the primarily white sample participants. However, some women from
these groups may appear due to the technique of snowballing.
This sample excludes midlife women who are divorced, have never
been married, and who are not mothers.
The instruments used in this study were not all developed for use

with midlife women.

CHAPTER IV
RESULTS

This research sought to determine if a correlation existed between
a midlife woman's self-in-relation orientation and her emotional and/or
physical health. In the first section of this chapter the data relating
to sample description including size, geographic location, age,
educational level, family income, employment status, and family
composition will be discussed. The next section will discuss the three
research hypotheses and how the data relate to each. Finally, selected
questions relating to the contextual variables and the possible impact
they have on this midlife transition will be explored.

‘ Sample Description

A variety of ways were used to find women who met the criteria and
were willing to participate in the study. The following sample
description provides a picture of the women who comprise this sample.
W1:

From June 1993 to December 1993 a total of 192 questionnaires were
sent to women who stated they met the criteria for inclusion in the
study: (a) living in a marriage relationship, and (b) had their last
child leave home within the last 24 months. Within the 6 month period a
total of 148 questionnaires were returned, a return rate of 77%. Of the
total number returned, 133 were from women who had launched their last
child from home within the previous 24 months. Twelve completed the
entire questionnaire, however, their last child had left home prior to
the 24 month time period allowed by the sample criteria. The range for

this group was 26 to 72 months. The remaining three questionnaires were

53

54
returned only partially completed, therefore they could not be included
in the study sample. The 12 completed questionnaires which did not fall
within the established time parameters were grouped together and scored
separately. Because their mean and standard deviation scores were not
statistically different from the sample of the 133 who met the time
criteria, the decision was made to add the 12 to make a total of 145
questionnaires which were analyzed for this study.
r hi '0

The majority of this sample (132) was recruited from Michigan.
However, six other states were represented: Idaho (4), Rhode Island
(3), North Dakota (2), Montana (2) California (1), Massachusetts (1).
The majority of the sample lived in small urban communities. The
exceptions were one woman who lived in North Dakota and the two women
who lived outside Billings, Montana, in rural areas.
Age

The mean age of the sample was 49.9 years. The range of ages was
from 39-62 years.
Eggeetippel Level

Only a small proportion (3%) of the sample had not finished high
school, while 28% had high school diplomas, but no college.
Approximately one third (33%) indicated they had some college, 36% had
completed college, and some had postgraduate degrees. The group may
have been more highly educated because the community in Michigan where
most of the sample was drawn has access to a large university and two
community colleges. For a breakdown of the sample by educational level,

income, employment status, and occupation, see Table 8.

55

Table 8. Samele.£harasteristics

 

 

 

 

 

Percent

EDUCATION
Less than High School 2.8
High School 28.3
Vocational 17.2
Community College 15.9
Bachelor of Science Degree 17.2
Master of Science of Master of Art 16.6
Professional 2,0
100.0

INCOME

Under $14,999 .7
515,000-529,999 4.8
530,000-549,999 11.0
551,000-599,999 62.8
Over $100,000 15.2
Missing Data 5,5
100.0

EMPLOYMENT
Employed 90
Unemployed _19
100

OCCUPATION
Business and Office 43.4
Education 15.2
Health Occupations 14.5
Service Occupations 6.2
Homemaker 4.8
Sales 4.8
Other lltl

p...
O
O
O

 

56
F i i n 0

When asked about their total household income, 63% reported the
$50-99,999 range and 15% reported above $100,000. Therefore, over 75%
of the participants reported annual household incomes above $50,000.
We

Working women comprise 90% of the sample. Of this group, 71% were
employed more then 30 hours a week. Thirty seven of the working women
reported increasing by 26% the number of hours they spent working after
the last child left home. To the question 017, "Do you consider your
employment to be? Just a job" (1), "A very important part of who you
are?“ (2), or "A career you love?" (3), working women in the study
selected responses two and three 75% of the time. Of the 10% of the
sample who identified themselves as not working, 9% stated they were
unemployed and 1% reported they were retired. More then half (64%) of
the respondents were employed in business and office staff positions.
Care had been taken to recruit a sample from a variety of work places.
However, the researcher feared a high preponderance of caring
professions (e.g., nursing, social work) might skew the overall results
because women who choose these careers may be more care oriented or need
to be more connected than others. Therefore, to have more than 50% of
the sample representative of traditional service, but not caring
careers, provides diversity to the overall results.

Of the 145 women in the sample, 58 reported they spent time in
volunteer activities before their last child left home. Fourteen spent
more then 10 hours a week in volunteer activities, and 44 spent less
then 10 hours a week in volunteer activities. Of those who volunteered

before their child left home, after their child left home 12 increased

57
time Spent, 9 decreased time spent, and the remainder, 37, reported no
change in time spent on volunteer activities.
W

The majority of the sample (84%) were socialized in either two
parent family structures (N-BO) or two parent working families (N-42).

A total of 32 women (22%) had been divorced at least once and were now
remarried.

The mean number of children in each family was 2.5 with a range of
1-7. Family size was ”just right" for 72% of the sample and ”too many”
for 5%. A total of 23% would have liked more children.

For this sample, the breakdown by sex of last children leaving home
was 57% girls and 43% boys. When answering question 07 ”number of
children now living", several women chose to include in that number the
children of second spouses by their former marriages when the women felt
responsible for and cared about these children. Supporting this care ‘
orientation, 52% of the total sample felt a “great deal" of commitment
to the mothering role with 37% admitting to "quite a bit' of commitment.
Seventy-one percent of the women admitted experiencing “some” to “a
great deal” of difficulty letting their last child go.

Hypothesis Testing

The following section will address the research hypotheses and will
be organized in the following manner. First, the hypothesis will be
stated. A discussion will follow of how the hypothesis was tested and
findings presented. Finally a statement of support or rejection of the

hypothesis based on the data will be made.

58
hypotheeie One

The first hypothesis is: The more balanced a woman's
separate/objective self with her connected/relational self at midlife,
the better her health.

To operationalize the concept balance, a difference score was
calculated by subtracting separate self scores from connected self
scores for each woman. This score then became the balance index. Based
on the balance index score, individuals were placed into three groups
with approximately 1/3 of the research sample in each group. Group one
consisted of those women who had a high separate self and a low
connected self orientation. The women in group two, those whose scores
clustered around the group mean, were thought to be those individuals
who would be most balanced or have equal or nearly equal expressions of
the traits separate self and connected self. Group three were women who
had high connected self and low separate self orientation. One way
analysis of variance, followed by multiple comparisons of group means,
were used to determine if there were differences among the three groups
of women on the measures of emotional and physical health status. No
differences were found (see Table 9).

To further test this hypothesis, a second approach was used.

Scores on the variables separate self and connected self were used to
divide the respondents into two groups, those above and below the mean.
The women were placed into one of four groups based on where their
scores fell on the two measures. Group A included women with scores
that were above the mean on both measures. Group B was comprised of
women who were above the mean on the separate self measure but below the

mean on connected self. The women in group C scored high on connected

59
self and low on separate self, and group D had scores below the mean on
both measures (see Table 10). Two groups with similar score directions
were thought to reflect a balanced self. They were groups with high
separate self/high connected self (A) and low connected self/low
separate self (0). One way analysis of variance was done to determine
if there were differences among these four groups on each of the health
indicators. No significant differences were found (see Table 11).

Therefore, after trying two different approaches to operationalize
the construct balance between the variables separate self and connected
self and finding no identifiable differences when related to health
status, hypothesis one could not be supported.

Hypgtheejs Twp

The second hypothesis is: The higher a woman's commitment to the
primacy of other care, the more deficient her health status at midlife.l

To test the second hypothesis, zero-correlations were computed
between the primacy of other care scale and the health indicators. The
results of this analysis are presented in Table 12.

Several significant correlations were found. Scores on a woman's
overall health status were negatively correlated with primacy of other
care. When health status was broken down into emotional and physical
health components, a woman's overall emotional health was found to be
negatively affected by the effect of primacy of other care. The effect
of primacy of other care is seen in her loss of vitality and a decreased
sense of well-being. A negative correlation was also found between

reported positive health behaviors and her primacy of other score.

60

Table 9. l d' to l

 

Balancing Index Groups

Group 1 Group 2 Group 3

 

Health Variables N-47 N-50 N-48 F Ratio
Health Status -.14 .09 .05

(1.49) (1.72) (1.82) .2603
Emotional Health -.17 -.01 .18

( .98) (1.01) ( .99) 1.4333
Physical Health .03 .10 -.13

( .92) (1.02) (1.06) .6241

 

NOTE: There were no statistically significant differences between the
groups.

Table 10. Distpipptipn pf 155 Eertjejpapte Aceopgihg tp lypolggy pf

1 nd ow Sc r s n Se arate nd Conn te Sel Scale

 

Separate Self

 

Connected Self High Low

High A Q
"‘28 N845

Low B D
".43 N-29

 

N-l45

61

Table 11. Mean: and (S. . f r alt di at rs i i
WW T 10

 

 

 

Health Variables ' Group A Group B Group C Group D F

N=28 N-43 N245 N-29 Ratio
Health Status -.10 .03 -.16 .30

(1.81) (1.73) (1.54) (1.71) .4847
Emotional Health -.14 .13 -.15 .18

(1.12) ( .92) ( .95) (1.06) 1.0360
Physical Health .04 -.O9 -.02 .12

(1.03) (1.08) ( .99) ( .89) .2754

 

NOTE: There were no significant differences between the groups

 

 

Table 12. l n e w W ma ' Heal St d
e lf- t S r s

Health Variable SS CS POC SOC
Health Status -.00 .09 -.15* .15
Emotional Health -.02 .20* -.14* .20*
Less Anxiety .06 .15* -.11 .15*
Less Depression -.02 .14* -.07 .12
Self-Control .01 .18* -.13 .16*
Well-Being .01 .20* -.17* .18*
General Health -.14* .10 .01 .12
Vitality -.O6 .11 - 16* 16*
Physical Health .02 -.06 -.11 .06
Perceived Health Status -.01 -.O4 -.O9 .03

Use of Health Care Services .03 -.O3 -.06 .03
Reported Health Behaviors (Positive) .05 -.22* -.19* .07
(Negative) -.01 -.06 -.02 -.O7

 

N=145; *p<.05

SS-Separate Self
CS-Connected Self
POC-Primacy of Other
SOC-Self Other Care

62
These correlations were modest in magnitude; however, because they were
found to be statistically significant, hypothesis two was supported.
$291M

The third hypothesis is: The higher a woman's commitment to self
and other care, the better her health status at midlife.

Correlations were done between the self and other care scale and
the health status variable. Table 12 presents the zero-order
correlations. The overall health status of the sample was not
significantly correlated with the self and other care scale. The
physical health scale did not correlate significantly with the self and
other scale. But as expected, the emotional health of the women in the
study was most affected by the self and other scale. Significant
correlations were found on the emotional health scale and the subscales
of anxiety, self-control, well-being, and vitality. These correlations
were small to moderate; however, they do demonstrate a relation between
emotional health and the ability for a woman to give care to herself as
well as others. Therefore, hypothesis three was supported.

Post Hoc Exploratory Analysis of Selected Variables

Analysis was undertaken to address the question of possible
relationships between each of the contextual variables and the health
status of midlife mothers who have launched their last child from the
home. Table 13 displays the correlations that were found between the
variables.

Although a number of significant correlations appear, they are
small in magnitude. Five questions of particular interest to the

researcher were formulated as ways to organize the exploratory analysis.

63
1122mm
Among the women in the sample, is there a relationship between
involvement in activities to prepare for the separation from her last
child and her health status?

Self-control was the only health indicator that was found to be
significantly correlated with the pretransition index (see Table 13).
Self-control was found to be negatively related to activities done to
prepare for the separation. It might be that feelings of being out of
control push the need to be involved in activities which help a woman
feel she can gain control over a life event that is often surrounded by
conflicting feelings. None of the other health status variables were
found to be significantly related to the pretransition index.

mm

For this sample, does the perceived amount of social support provided
during the transition of launching the last child from home relate
positively to a woman's health?

The social support index was significantly related to only one
health measure-—the emotional health scale for well-being (see Table
13). Because a greater degree of correlation was expected, further
analyses were undertaken. In these analyses, the individual items of
the social support scale were correlated with the health indicators.

Out of 24 correlations, two significant relations were found. The first
was "I can't count on my relatives and friends to help me with problems"
(SS3) which was correlated with the physical health status variable
(r-.23). This item had been recorded. Therefore, the higher the score
the more important social support. This finding was consistent with the
expected outcome.

The other item “I spend time with others who have the same

interests that I do" (SS4) correlated positively with the emotional

64

 

 

Table 13. r ' e lt u
Centextualmm
Health Variables PRETRAN SOCIAL POSTINX
INDEX SUPPORT
Health Status -.09 .06 .08
Emotional Health -.09 .09 .14*
Less Anxiety - 13 -.03 .08
Less Depression -.05 -.01 .17*
Self-Control - 18* .12 .11
Well-Being -.01 .19* .23*
General Health -.06 .09 .02
Vitality .02 .01 .00
Physical Health .06 .02 -.OO
Perceived Health Status .06 -.02 -.04
Use of Health Care
Services — 08 .06 .01
Reported Health
Behaviors (Positive) .01 .01 .19*
(Negative) -.12 .06 .06

 

N=145; *p<.05
Pretran Index
Pretransition Index
Social Support Index

Posttran-Post Transition Self Care

65
health status variable (r-.21). Again this might be expected (Surrey,
1991) because emotional growth for women is through connections.

911.151.1111.}

Does a woman's ability to predict with accuracy the direction of marital
relationship change at the time her last child leaves home impact her
health status significantly?

It was thought that accurate prediction of the direction of change
in the relationship would be positively reflected in health indicators
(see Table 14). To look at this relationship, the variable "marital
index" was used to create three groups: (a) those for whom the marriage
was less positive than expected following the transition (b) those for
whom the marriage was more positive than expected (c) those who
accurately predicted how the marriage would be following the transition.

To analyze the relationship between these two variables, oneway
anovas were done with each of the health indicators to determine if
differences could be found between the groups (see Table 14). The
health indicators which had group differences that were statistically
significant were health status, emotional health, less depression, self-
control, well-being, physical health, perceived health status, and use
of health care services. Differences were found between women in group
one, those who did not accurately predict the relationship change and
were assumed to be disappointed, and between groups two and three.
Group two, included the women who did not predict accurately but erred
in a negative direction so were assumed to be pleasantly surprised with
the outcome. Group three included the women who possessed a realistic
understanding of where the relationship stands. The one exception to

this was the measure of health perception where only groups one and

three were found to be different.

Table 14.

Aeegracv of the Meritel Relationship

Opeway ANOVA Analysis of Marital Index of Self-Perceived

 

Means and Standard Deviations

 

Group 1 Group 2 Group 3 F
N-14 N-27 N-103 Ratio
Health Status -1.42 .30 .10
(2.68) (1.45) (1.47) 6.0715*
Emotional Health -.78 .18 .05
(1.28) ( .99) ( .92) 5.1229*
Anxiety 19.50 21.30 21.27
(5.08) (3.88) (3.75) 1.3032
Depression 13.36 15.22 15.20
(2.68) (1.67) (1.86) 5.8849*
Self Control 12.36 14.74 14.69
(3.30) (2.58) (2.20) 6.0546*
Well-Being 13.43 17.04 16.74
(3.63) (3.04) (2.91) 8.0286*
General Health 13.71 14.56 14.13
(2.58) (2.10) (2.08) .7780
Vitality 11.57 13.07 12.49
(2.28) (2.09) (2.33) 2.0073
Physical Health -.64 .12 .05
(1.58) ( .92) ( .90) 3.2944*
Perceived Health Status 2.86 3.33 3.38
(1.03) ( .62) ( .63) 3.7024*
Use of Health 1.57 2.07 1.91
Care Services ( .93) ( .82) ( .64) 2.2999*
Reported Health Behaviors
Positive .79 .70 .72
( .16) ( .20) ( .14) .7680
Negative .34 .36 .35
( .14) ( .20) ( .20) .0480

 

Group 1-(marriage less positive than expected)
Group 2-(marriage more positive than expected)
Group 3-(those who predicted accurately)

67
u io
Does a woman's ability to predict with accuracy the direction of
parental relationship change at the time of separation impact her health
status significantly? '

For this analysis the variable "parental index" was created. To
create this index three groups: (a) those women who found their parental
relationship to be less positive than they had expected, (b) those woman
who found the parental relationship to be more positive than they had
expected, and (c) those woman who had accurately predicted the direction
the relationship would take when the child left home (see Table 15).

Oneway anovas were done to look at differences that might exist
between those women who could predict accurately the direction of the
change in mother-child relationships and those who were assumed to be
disappointed with the relationship outcome or who were assumed to be
pleasantly surprised by the changes in the relationship since the last
child had left home (see Table 15). Significant differences existed
between those women in group one and women in both groups two and three.
The health indicator related to emotional health that was found to be
significantly different between women in group one and women in groups
two and three was less depression. Perceived health status was the
physical health difference found to be significantly different between
groups two and three. It appeared that if a woman could accurately
predict the direction her parental relationship would take after her
child left home or if the relationship got better than she predicted it
would, her health status was better. However, women who were unable to
predict accurately and who were assumed by the researcher to be

disappointed with the change in the relationship were less healthy.

Women who could predict accurately or who were assumed by the researcher

68

 

 

Table 15. e a NO A l f a nd f Se f- ' d
1
Means and Standard Deviations
Group 1 Group 2 Group 3 F
N-l4 N=3O N=100 Ratio
Health Status -.82 -.18 .17
(1.56) (1.78) (1.64) 2.3863
Emotional Health -.53 -.10 .10
( .99) (1.03) ( .98) 2.7291
Less Anxiety 20.36 21.00 21.26
(4.55) (3.76) (3.91) .3389
Less Depression 13.79 15.30 15.13
(2.89) (1.74) (1.86) 3.2578*
Self Control 13.00 14.33 14.74
(3.11) (2.23) (2.41) 3.1725*
Well—Being 14.86 16.30 16.77
(3.84) (2.82) (3.12) 2.3563
General Health 13.07 14.00 14.35
(2.37) (2.38) (1.99) 2.3542
Vitality 12.14 11.83 12.75
(1.61) (2.91) (2.15) 2.0396
Physical Health -.29 -.07 .07
( .98) ( .99) (1.00) .8712
Perceived Health Status 3.07 3.10 3.43
( .62) ( .71) ( .07) 3.8704*
Use of Health 1.79 2.00 1.90
Care Services ( .80) ( .69) ( .72) .4510
Reported Health Behaviors
Positive .71 .74 .72
( .13) ( .20) ( .14) .4719
Negative .29 .33 .36
( .19) ( .22) ( .19) .9663

 

Group 1-(parental relationship less positive than expected)
Group 2-(parental relationship more positive than expected)

Group 3-(those who predicted accurately)

69
to be pleased with the change in the relationship were less depressed
and perceived their health as better.

Differences were also found between groups one and three on the
subscale self-control. Women who could predict the direction of change
in the relationship had greater self control then those who could not
predict accurately or whose prediction was less positive then expected.
MELT:

In this sample, is there a relationship between a woman's health and
increased time spent on self-care activities by mothers after their last
child leaves home?

This question was answered by looking at only one item PC4 (see

Table 16).

Table 16. ggpreletipne Between A Women's health Stetue ape her
Ihvelvement In Posttraheitjon Self-tare

 

 

 

Health Variable Increased Time Spent on Self
Health Status .08
Emotional Health .14*
Less Anxiety .08
Less Depression .17*
Self-Control .11
Well—Being .23*
General Health .02
Vitality .00
Physical Health ' -.OO
Perceived Health Status -.04
Use of Health Care Services - .01
Reported Health Behaviors (Positive .19*

(Negative) .06

 

70
Thirteen correlations were done between this item and the health
indicators and four were found to be significant. It appears, in
general, a mother's health status is improved after her last child
leaves home if she devotes time and attention to herself. Positive
correlations were found to exist between a mother's emotional health,
her sense of well-being and practicing positive health behaviors. She

was also found to be less depressed.

CHAPTER V
DISCUSSION

This study looked at the health status of upper middle class,
middle aged women who had launched their last child from home and how
they relate to others as evidenced by their expression of their separate
self and their connected self. Also examined were a woman's health and
a series of contextual variables: (a) involvement in activities to
prepare for separation from her last child leaving home, (b) the amount
of social support she perceives during the transition, (c) her ability
to predict direction of change in her marital relationship, (d) her
ability to predict directional change in her parental relationship, and
(e) the increased time she spends in self-care activities after her
child leaves home. The sample was chosen to superimpose two transition
points (a) midlife, a time of reflection and reclaiming of the self and
(b) the task of reordering the primary relationship of mother and child.

The literature reviewed prior to this research identified two

different schools of thought about this period in a woman's life.
Strong evidence can be found in support of a unidirectional pathway that
is nongender specific for adult development (Erikson, 1959; Levinson et
al., 1978). This single pathway places individuation and separation at
the heart of growth and emotional health.

Franz and White (1985) expanded the single pathway theory of adult
development to a double helix model. Their model included both
individuation (separate self) and communion (connected self). They

disagreed with contemporary feminist theorists (Gilligan 1982; Surrey

71

72
1991) instead proposing an adult theory of development that applies to
both genders.

Gilligan (1982) took exception to the earlier thinking (Erikson,
1959; Levinson et al., 1978) and has proposed a theory that is not only
gender specific, but which suggests there is strength and value to the
female path of adult development. She saw emotional health as achieved
through the expression of both a separate self and a connected self and
believed this expression took the form of caring for self and others.

Surrey (1991) moved Gilligan's theory a step further and proposed a
self-in-relation hypothesis that stated to grow and be healthy a woman
did not need to disconnect. All growth for women is achieved through
connections.

Both Gilligan and Surrey have used qualitative methods for their
research designs and have only small samples on which to base their
findings. The Relationship Self Inventory (RSI) measures Gilligan's
(1982) levels of care as four different expressions of the self-in-
relation (Surrey, 1991). These expressions were seen in how separate a
woman saw herself from others, i.e. her separate self, how connected she
felt to others, i.e. her connected self, how much others' needs took
precedence over her own, i.e. primacy of other care, and how she managed
to care for herself as well as care for others, i.e. self and other
care.

This study used the RSI on a sample of 145 married women to
determine if a woman's self-in-relation orientation indeed correlated
with her health status. The sample selected for this study was
experiencing a life transition event, i.e. last child leaving home, and

was involved in relationship changes.

73

It seems appropriate to apply Gilligan's model developed when
working with adolescent girls to midlife women because during both
periods in a woman's life the process of self-expression is examined.
Gilligan determined that at adolescence a young girl disconnects with
the self_and disavows knowledge of her own self-needs. If at
adolescence her self-voice is lost or "goes underground” (Gilligan,
1990) and only her caring voice is expressed, then at midlife, because
the taking care needs for women as mothers are lessened, perhaps the
self-voice again emerges.

It is not surprising to learn that there are two times of

crisis in a woman's life: when she enters that social role in

adolescence, and when it abandons her at around fifty.

Perhaps one day, we will have changed society enough so women

are never asked to submerge a true self. Until then, those

early years are the best guide to the person we can become in

that last third of life. (Steinem, 1992, p.89)

Midlife is a time to focus on self--to reconnect to the self. How
a midlife woman does this is of import for younger women as she is a
role model for the future. How she does this is also important for
health care providers since both her emotional and physical health may
be negatively affected depending on her ability to accomplish this
transition with ease.

Discussion of the Research Findings

Discussion of the findings of this study will include: (a) a
critical look at the sample, (b) reviewing the outcome of the tested
hypotheses, (c) a commentary related to the post hoc analysis of data,
and (d) conclusions drawn by the researcher on the findings of this

research. The format for this discussion will be patterned after the

presentation of data analysis in Chapter IV.

74
W

A sample that is as highly educated and affluent as this one does
not lend itself to generalization to other populations. The findings
seem to reflect a very self-actualized (Maslow, 1970) group of women
with knowledge and resources at their disposal to care for themselves
and others.

Age and cultural identity may have contributed to the findings of
this study. Neither were controlled and allowing for a younger or older
population and/or a sample reflecting known cultural diversity might
have produced very different results.

The high percentage of working women in this study may contribute
to differences in expressions of separate and connected selves because
the very act of working provides opportunity for an increased number of
connected strands and relationships. Working women may see themselves
as more connected than nonworking women. Because they have fewer roles,
nonworking women may have a poorer health status (Verbrugge 1985). The
possibility that this is the case with this sample is strengthened by
the fact that those women who worked felt much self-worth and value in
their role as worker.

The 84% of the sample who were raised in two parent families may
contribute to the feelings of high sense of connection. The need to
take care of relationships and to sacrifice self to maintain
relationships may also be reflected in the long standing marriages of
78% of the women in the sample.

Why did almost 25% of the women in the sample see the number of
children in their lives as not enough? Perhaps the wish to have had

more children is a reflection of past generational norms or really a

75
wish to do it over--better, and may have been an expression of the
reflective nature of midlife for women.
hypptheeee Testjhg

Three hypotheses were proposed and two of the three were supported
by the findings of the study. The first hypothesis which correlated
health indices with a balanced separate and connected self may not have
been supported due to the fact that the measures were not sensitive
enough and/or the sample size not large enough, or diverse enough to
discern a difference. The construct balance as developed for this
research proposed equal amounts of the two personality traits separate
self and connected self as an indicator of a state of health. However,
the construct may not be balance in equal amounts but rather balance in
terms of what is comfortable for the individual women. It is not clear
how much self-expression and how much connected expression is needed to
provide an inner harmony.

The second hypothesis which related a woman's commitment to others
to the detriment of her health was found to be supported. A woman's
identity develops in the context of connections and she judges herself
by a standard of responsibility and care. The dynamic here is the
primacy of which others. Which other is not clearly delineated in the
Relationship Self Inventory. Will a mother place her children's primacy
of other needs before her own more then she would someone else? In
future studies, specific others would need to be identified and
controlled.

Hypothesis three relating to self and other care was supported

because women who cared for themselves as well as others were found to

76
be healthier with more self-control, a better sense of well-being, low
anxiety and more vitality.

These findings are only specific to the sample under study. A
different sample, a different transition period, a more narrowly defined
period of time around the transition event might provide more
information and greater understanding to the question of individuation
and connectedness for women in our society.

W118;

The following discussion is related to the post hoc analysis of
selected questions of interest to the researcher. What if any
relationship existed between the contextual variables and the health
indicators for the sample population?

Qgeetieh_1. Among the women in the sample, is there a relationship
between involvement in activities to prepare for the separation from her
last child and her health status?

Anticipated transitions are usually rehearsed and planned
(Schlossberg, 1986). However, when looking for preparatory activity in
this sample of women, little was found. A normal and expected role
transition is not stressful or crisis-ridden and, conversely, only
events which upset the sequence and rhythm of the expected life cycle
lead to difficulties (Neugarten, 1979). Though expected, this is one of
those events in life where there are feelings of great conflict because
of the strong affectional bonds between mother and child and because of
the identification with the mother role and the part this plays in self-
definition. Perhaps because this sample was well educated, the women
did not see the need to prepare for the event prior to launching. This

might be due to the value of their education and affluence; they may

think they should look forward and be happy about this adventure for

77
their child as well as for themselves. But they might be denying
feelings of loss and sadness. Maybe it is not socially acceptable to
admit to others you have concerns or "can't handle” the separation. We
prize independence and self-control; to need others is evidence of a
weakness, a flaw, (Thomas, 1990).

Qgeetiph_zt For this sample, does the perceived amount of social
support provided during the transition of launching the last child from
home relate positively to a woman's health?

Question two explored the relationship of social support to a
woman's health during this transitional period. Gilligan (1982)
espoused that connections with others increase feelings of well-being
and knowing someone cares reduces stress. If this is true, then at
times of change reaching out to others for support would be likely.
This was supported but with only a weak correlation for the subscale
well-being.

The researcher believed that social support would play a much
greater role at this time in a woman's life. Perhaps the fact the
social support scale was used in an abbreviated form, even though
inclusive of the constructs believed to be important by the developers,
lessened its sensitivity. The decision to use an abbreviated version
was made in consideration of respondent time and would be reconsidered
for further use of the instrument. When applying transition theory to
this variable, perhaps this transition is of such magnitude that the

process of disengagement and the need to pull away from others and into

one's self is the phenomenon occurring here (Bridges, 1980).

78

Queetieh_3t Does a woman's ability to predict with accuracy the
direction of the marital relationship change at the time her last child
leaves home impact her health status significantly?

The third question dealt with change in the marital relationship
and a realistic understanding of the true nature of the relationship.
The marital index was created to look at differences between groups of
women and their ability to predict direction change. The sample was
poorly distributed on this variable. Few (N-7) women reported their
marriages had ”gotten worse" since their last child left home (see Table
14).

Glenn (1975) found a positive effect on the wife's marital
happiness when the children leave home. It would be important to see
longitudinal data on this sample to determine if two things happen in
the postparental phase.

1. If the marriage relationship is seen as "better", is that “better“
sustained?

2. As women reorder relationships, if the wife role is placed second
to caring for herself, does the husband's perception of ”better”
decrease?

Brown (1984) found women in unhappy marriages experience more
depression. The women in this sample who did not accurately predict the
direction of change in their marriage relationship were more depressed,
more out of control, and had a lesser sense of well-being. Those women
who predicted their marriage relationship change accurately experienced
overall better emotional and physical health.

Midlife can be a tumultuous time for marriage relationships. The

middle years are a time when marriages dissolve (Smith & Moen, 1988).

More and more midlife couples will experience divorce before they

79
experience widowhood (Glick, 1984). A woman who has a realistic
understanding of where the relationship is probably will make it through
the transition at midlife in better health.

Qgeetion 4. Does a woman's ability to predict with accuracy the
direction of the parental relationship change at the time of separation
impact her health status significantly?

Only a small number (N-5) of mothers in the sample reported the
relationship with their last child at home was bad, i.e. “got worse“ and
“gotten worse" (see Table 15). This finding may reflect the particular
sample or it may speak to the importance of the mother role. This
relationship carries with it a great deal of responsibility because
mothers in our society are considered to be most responsible for how
their children turn out (Veroff et al., 1981). If a mother is launching
a child who has not met expectations, the mother may be faced with guilt
and anxiety.

‘Parental relationships for this study were dealt with in the same
manner as the marital relationship by creating a new variable: the
parental index. In this study, being able to predict accurately the
direction of change in the relationship reflected positively on a
women's physical health perception, her sense of self-control, and
significantly less mental depression.

The researcher was surprised to find fewer significant differences
between the health indicators and the parental index than with the
marital index. Believing this to be the primary relationship, the
reverse was expected. It may be the importance of this relationship is

so close to a woman's core that she tends to be less realistic about the

level of intimacy shared.

80

Questjpn 5. In this sample, is there a relationship between a
woman's health and increased time spent on self-care activities by
mothers after their last child leaves home?

Question five explored relationships between a woman's health and
time devoted to activities for self (see Table 16). Responses to this
question would indicate a relationship exists between the time and
energy a woman spends on herself after her last child leaves home, and
her health status. Women in this sample who spent more time on self-
care activities also had more positive health indicators. Maybe the
increased time she spends on positive health behaviors such as
exercising leads to the physiological body responses which bring about
feelings of well-being and improved body image both of which contribute
to improved emotional health. The positive correlation between less

depression and time spent on self-care may reflect feelings related to a

parenting job well done.

CHAPTER VI
SUMMARY AND IMPLICATIONS

This chapter will be organized in three sections. First a summary
of the study will be presented. The second section will be devoted to
implications for existing theory, proposed research, and practice
issues. A short conclusion follows.

Summary

This research looked at the possible relationship between a
mother's health status during her midlife transition and her self-in-
relation. This was a descriptive study of a self-selected sample of 145
married women. These women had launched their last child from home and
agreed to complete a questionnaire designed to study the expression of
their self-in-relation at a time in their lives when relationships are
being reordered. When children no longer have intense caring needs,
more time which could be devoted to self is available to women. The
reflective nature of midlife provides the background for this
introspection. The researcher believed balanced expressions of self and
other care would prove to be healthy.

Data were collected from June 1993 to December 1993. The study
used a survey questionnaire which included the following instruments (a)
Relationship Self Inventory, (RSI) (b) the Health Insurance Study
General Well-Being Scale (HIS-GWB), and (c) physical health measures
created by the researcher.

Three hypotheses were proposed for this study. The first looked at
the health of midlife women and the balanced expression of her separate

and connected self. No support could be found for this hypothesis.

81

82
However, the second and third hypotheses were supported. These
hypotheses proposed a direction for the self-in-relation against the
scales of primacy of other and self and other care. These findings help
demonstrate that when a woman is involved in giving to others to the
exclusion of her own self, her health will suffer. When she is able to
give freely to herself as well as to others and is able to view her
activity of self-care as positive, her overall health is better. To
summarize the findings related to the proposed hypotheses, it appears
for this sample that a balanced self, i.e. equal expressions of separate
and connected self, is not related to health status at midlife.
However, overinvestment in meeting the care needs of others could be
health damaging, while self-care coupled with the care of others appears
to be related to health.

The results of this study are consistent with the earlier work of
life course researchers who determined that transition is a time to
reassess the self (Neugarten, 1979). Using a quantitative measure of
Gilligan's (1982) female development theory, the Relationship Self
Inventory, this research supports the use of this instrument to assess
the four expressions of the self-in—relation for some women.

Implications

Theory, research, and practice implications will be presented.
Ibsen:

The theory base used to investigate the health status of midlife
women at a time of transition integrated the theories of Franz and White
(1985), Gilligan (1982), and Surrey (1991). The integration was
accomplished by applying the Franz and White double helix model of

83
nongender specific adult development to Gilligan's female caring "voice"
model and used Surrey's definition of self-in-relation.

By applying the view of adult development proposed by Franz and
White (1985) to the more narrow gender specific approach to female
development as proposed by Gilligan, (1982) and Surrey (1992) (a sample
of midlife married women) this researcher believed gains could be made
in understanding the self-in-relation of midlife women and how the
expression of self at midlife may have a bearing on their health status.
It was thought the Franz and White model had application here because of
its broader appeal to adult development. The fact that Gilligan's
theory is gender specific and her results specific to adolescent girls
limits its application. However, Gilligan's work with adolescent girls
has implications for this study because both adolescent girls and
midlife women are experiencing transitions related to caring. Gilligan
believes adolescent girls are taking on the caring roles which the
researcher believes midlife women are letting go. The self-in-relation
construct emphasizes the shift from separation to connection and assumes
a woman does not need to disconnect to grow. Surrey (1991) believes all
self-growth takes place through connection. The application of this
theory to the health of midlife women pushes for greater knowledge and
understanding of female development.

Midlife women have one third of their lives ahead of them and face
a life transition point when launching their last child from home. The
more information that can be gleaned regarding the process of change
that life course transitions bring as well as study of the impact of
that change on the health status of midlife women, the more we might

help create an environment of healthy transitions for midlife women that

84
supports and strengthens self growth. That quest was the impetus of
this inquiry.

While not conclusive, the data obtained in this study support
theories of Gilligan (1982) and Surrey (1991) that growth for women is
achieved through connections. The findings that identify women with
high expressions of connected self to be in better health than women who
express high separate self contribute to the existing theory base that
believes self-expression for women can and does occur through
connections. The findings related to primacy of other care lend support
to Gilligan's assertion that a source of psychological stress for women
is the need to give up a relationship with self for the sake of
relationships with others. However, support for the reestablishment of
a relationship with self at midlife may be seen in the women whose major
orientation at this time was self and other care. This group was
healthy and comfortable expressing self through connection.

This study is a first step in determining if shifts in the self in
relation are gender specific as proposed by Gilligan (1982) or gender
neutral as proposed by Franz and White (1985). This question will
require much more study and will only be understood by using as a sample
midlife men in transition. Because of the way the data were collected
for this study, it was not possible to determine if individual shifts in
the self-in-relation occur over time as proposed by Davis and Jones
(1992). Logic supports the notion that shifts do occur over time. Are
there gender specific patterns of shifts? This question gives the
gender issue as viewed by the two theories a different twist. Only much

study and interest in the question will help humankind gain insight.

85
8:531:11

Replication of this research with a sample that is more
representative of the population as a whole would provide greater
generalizability. The racial, ethnic, religious, educational and
economic variables need greater variability. A sample of just
professional care givers, i.e. nurses, might prove interesting in light
of the fact that female care givers may do better at this time in their
lives. They may have established greater skills in connecting because
over their life course they have connected both personally and
professionally. Therefore, they may be more adept both in reaching out
to new connections and adjusting comfortably to the relationships that
are changing. Perhaps a study of the coping strategies for care givers
would provide insights into health care practice directions.

Other studies might include women who have never had children using
an age marker as the definition of midlife. Or women who have a large
number of children and this is the last one versus women who have only
one or two children might be compared. Another question of interest may
be how a mother launches her first child. Maybe by the time the last
one leaves, the majority of the anticipatory preparation has taken place
and a cross section sample would not demonstrate the separation process.
It would be valuable to look at women who have never been married but
who have children, women who are divorced at the time the last child
leaves home, and women who are widowed at the time the last child leaves
home.

A research question could be related to working versus nonworking

mothers, and working mothers happy in their jobs and those who are not.

86
The relationship with working, the life transition of launching the last
child, and health has much to be explored.

To replicate the study with the fathers would permit looking at
gender differences in separate and connected orientations which would
shed light on family function. Another way to look at gender
differences would be to study just mothers and daughters in this process
and just mothers and sons.

If this research could be done again, it would be most helpful to
Ruse multiple time points. The sample could be followed over time before
the child leaves home, at the time of separation, and a follow up when
the transition process is complete. Shifts in the separate and
connected self could be plotted over time for each individual.

The entire midlife time frame for women is rich with research
needs. While the topic of health, midlife women, and the psychological
self have not suffered from a lack of research, much of the research has
dealt with the loss of biological function, i.e. menopause, and has left
women with the view that this time is negative and the doorway to old
age. Further research into the many factors that contribute to a
midlife woman's health status is necessary to help clarify the role the
expression of separate self may play at this life transition.

The instruments used in this study were a combination of
established methods and newly developed measures created by the
researcher. The Relationship Self Inventory (RSI) (Pearson et al.,
1985) and the Health Insurance Study (HIS-GWB) (Ware et al., 1979)
proved to be reliable and user friendly instruments. The RSI is a
quantitative measure of Gilligan's (1982) theory and has application in

many areas of female development. This researcher would use this

87

measure to see if changes occur over time in the expressions of separate

and connected self and.if the health of women is affected based on the

changes.

Although the data gathered for this study were both quantitative
and qualitative in nature, only the quantitative findings were analyzed.
In the future, the remaining data will be reviewed and further analysis
will be conducted to understand more of this transition as experienced
by the midlife women in this sample.

If this study were to be repeated, other ways to conceptualize the
concept of balance might be considered, e.g. using The Self Other Care
scale as the measure of a balance state.

The following is a list of other suggestions that might be
considered for changes in the questionnaire.

1. The various measures used in this study to create the physical
health scales were selected from the literature. There are other
questions, i.e. seat belt use, that might be included and which
might provide greater insight.

2. Because self-control was so often significant as a finding, a
standardized measure for self-control should be added.

3. A different measure of social support could be found, however, if
the PRQ part two (Brandt & Weinert, 1981) is used, other questions
might be selected or the complete PRQ part two should be used.

4. The measures of both marital and parental relationships could be
conceived as Likert scales with a greater range of choices. By
using these measures as continuous variables, correlational

directions could guide analysis.

88

5. Questions should be directed at the perception of the marriage
relationship by the women at the time they complete the
questionnaire. This would provide a relative starting point and be
more meaningful when asking ”getting better” and "getting worse”
questions.

6. Question development to provide further inquiry into the role
changes posttransition is needed to determine just how self-care
contributes to health.

7. A scale to measure feelings of guilt might help to understand what
is the emotional cost of giving time to self. The concepts of
grief and loss might also have application to this changing
relationship.

mm
Health professionals have the opportunity to assess the expression

of the self-in-relation and the possible impact that expression might

have on the health status of the client when midlife women use-the
health care system. They need only be made aware. In the future,
findings from this research study might be used to educate physicians
and nurses regarding the relationship between a midlife woman's health
status and the experience of launching the last child from home. A clue
to her ability to make this transition with ease may be found in her
self-in-relation orientation. A history form might be created for use
in health care settings that includes a list of expected life course
transition events. This tool might help to anticipate those events
which may negatively or positively influence a women's health and

provide direction of care and counsel for the female client.

89

The need to find and make available various activities to prepare
for this transition will help a women feel in control and is important
to maintaining her health. Helping women understand the process of
transition and providing individual attention or group support may be
helpful. This could be accomplished by speaking to health professionals
to heighten their understanding and awareness and to lay groups of woman
to provide anticipatory guidance and support. By disseminating this
information to the community at large, health care professionals are
both promoting health and preventing illness.

The health care profession is dominated largely by women. It is
appropriate that female health professionals act as role models and work
to dispel the myths about women in midlife. Health professionals need
to empower women and help them find strength in their connections.

Conclusion

The cross sectional design of this research allowed for only a
single snapshot in the lives of well educated, economically stable,
midlife women. Greater understanding will be gained only as
longitudinal studies are done on more diverse samples of both men and
women to determine how changes over time in the self-in-relation

orientation are expressed.

Appendix A

9O

RELATIONSHIP INVENTORY (RSI)

READ EACH OF THE STATEMENTS BELOW AND DECIDE HOW EACH ONE
DESCRIBES YOU. USING THE RATING SCALE OF 1- "NOT LIKE ME AT ALL"

TO_§_-

"VERY MUCH LIKE ME," CHOOSE THE MOST APPROPRIATE RESPONSE.

 

Not like
me at all

(1)

(2)

(3)

(4)

Very much
like me

(5)

 

l. I oftentty to act on the beliefthat
self-interest is one of the worst

 

 

 

 

 

3 I cannot choose to help someone
else if it will hinder my

self-development _

 

 

 

5. In making decisions, I can neglect

my own values in order to keep a

elanonship

 

 

 

I Itry to curb my anger for fear of

 

g others .

 

 

9. Lovmg is like a contract: lfltS

provisions are not met, you wouldn't

 

eye the person anymore

Y the notion of ”an eye for
5,5 a tooth for a tooth" """""""""

 

 

[11. Iwanttoleamto stand onmy

own two feet.

 

 

 

 

 

 

 

91

 

Not like Very much
me at all like me

 

 

(I) H , e (2) w (3) (4) +_ (5)
12 Ibehevethatone of the most ‘ ~

», , rtant things that parents can
each their children IS hevvto . p p ’

  
   

 

 

 

 

15. Activities of care that I perform
expand to both me and others.

 

16 em mm to do upsets gtiifi..;i;_;*:§5%;
other We 1w tom ammo

 

see if I really warn to do It

 

 

7. I do not want others to be

 

18 I am guided by the principle of } tgff 55323}?7:535???€355??fo;:3157i5i.f‘5ifiilffii'i? .?f§?l;5§i1§5?'§;§£fi5TI :1?
. ‘f g others as I want to be j,jg;_gigfgggigi-j;:.;:};L;;,iigi2.3;?3:11;: .
gated - 9

     

 

or myself and mine, and let others

lf9..1beheve that 1 have to look out
shift for themselves.

 

 

20 Bemg unselfish With 318a --

   

 

21. When a fiiend traps me With
idemands and negotiation has not
worked, I am likely to end the

fi'iendship

 

 

 

   

olved With someone else

 

3. Sometimes I have to accept
someone else if I am to do
e things that are important in my
own life.

  
  
 

 

 

 

 

 

 

 

92

 

Not like
me at all

Very much
like me

 

24 In order to continue a

 

, j 0.) .

Q). ,.

“2(3). w

l (4),, _

. (5?.

 

n shaped more by the persons I
care about than by what I do and

 

 

 

Relationships are a central part

[if my identity

 

 

29. When someone otfers to do
something for me, I should accept

 

 

 

................

 

31. HI amreallysurethatwhatl
todoisfighgldoitevenifit

psets other people.

 

 

2 Before i can be sure I really care
' ' 'fto know mytme f ,3 _ H

 

 

 

 

 

 

.................

 

 

 

 

 

 

93

 

Not like
me at all

(1)

(2)

(3)

Very much
like me

(5)

 

 

35. Even though it's dificult, I have
teamed to say no to others when I

eed to take care ofmyseIf.

 

{.6 Ihketoseemyselfas

  
  

L1,.fends

, connected wrthanetworkof

 

 

are part ofwho I am.

37. Those about whom I care deeply

 

1,8 I accept my oblrgatrons and

 

 

39. I believe that I must care for
elf because others are not
esponsible for me.

 

 

jigo The people whom I kipefare
ii are who seem to be in close
'fna-l relationships.

  
 

vvvvvvvvvvv

 

 

  
 

nsibility for the efi‘ect my

1. It rs necessary for me to take

 

 

actions have on others

 

..........................

 

 

If 'I'he feelings of others are not

 

levantwhendecrdrngwhatrsrrght fl __ _

 

 

5. I make decisions based upon

I believe rs best for me and

 

,. gifee my

 

 

 

7. I beheve that in order to survive
must concentrate more on taking

  

 

 

 

 

 

 

 

94

 

Not like
me at all

(I).

(2? e

<3)

Very much
like me

 

 

 

48 The best way to help someone is 1:36; ,2 y _ 1:; ,2; f ,

(4), ,

__ (.5? _ I

 

I49 Doing things for others makes

me happy.

 

50 All you really need to do to help 7 5’65.}{fii9.53:5: '5 ,; 33-: f [Se-i;

someone is to love them

 

51. I deserve the love of others as
much as they deserve my love.

 

 

S2 Yeu've got to look out for
:jourself or the demands of y .
circumstances and of other people

.6 . eat; YOU up

   
  

 

o the opinions of others when I am
certain I am correct.

53. I cannot afl‘ord to give attention

 

 

54. “80mm does 9°

 

 

g for

 

 

55 Caring about other people is

Important to me.

 

56 If other people are going to

 

Wlfice somethlng they Wanthf my

 

 

.When I make a decrsron it's

' 57portant to use my values to make
e right decision.

 

  
 

58 I try to approach relationships
i the same organization and
eflicrency as I approach my work

 

 

 

' important to me to understand my
own motives.

59. IfI am to help another person it

 

60. I like to acqmre many
acquaintances and fi1ends

 

 

 

 

 

 

 

 

Appendix B

95
ANXIETY SCALE ('HIS-GWB)

THE NEXT QUESTIONS ARE ABOUT HOW YOU FEEL AND HOW THINGS
HAVE BEEN GOING WITH YOU. FOR EACH QUESTION CIRCLE A NUMBER
FOR THE ANSWER WHICH BEST APPLIES TO YOU.

2. Have you been bothered by nervousness or your "nerves" (during the past 12

months)?
1. El Extremely so - to the point where I could not work or take care of things
2. CI Very much so
3. U Quite a bit
4. CI Some - enough to bother me
5. C] A little
6. Cl Not at all
6. Have you been under or felt you were under any strain, stress or pressure (during
the past 12 months)?
1. D Yes - almost more than I could stand orbear
2. Cl Yes - quite a bit of pressure
3. Cl Yes - some - more than usual
4. D Yes - some but about normal
5. Cl Yes - a little
6. CI Not at all
9. Have you been anxious, worried or upset (during the past 12 months)?
1. Cl Extremely so - to the point of being sick or almost sick
2. [:1 Very much so
3. D Quite a bit
4. [I Some - enough to bother me
5. U A little
6. [I Not at all
12. Did you feel relaxed, at ease or high-strung, tight, or keyed-up (during the past 12
months)?
1. Cl Felt relaxed and at ease the whole 12 months
2. Cl Felt relaxed and at case most of the time - seldom or never felt high-strung
3. D Generally felt relaxed but at times felt fairly high strung
4. Cl Generally felt high-strung but at times felt fairly relaxed
5. Cl Felt high-strung, tight or keyed-up most of the time - seldom or never felt
relaxed
6. Cl Felt high-strung, tight or keyed-up the whole 12 months

15.

96

' Were you generally tense or did you feel any tension (during the past 12 months)?

. CI Yes - extremely tense, most or all of the time

. D Yes - very tense most ofthe time

. CI Not generally tense, but did feel fairly tense several times
. CI I felt a little tense a few times

. El My general tension level was quite low

. C]

l
2
3
4
5
6 I never felt tense or any tension at all

97

DEPRESSION SCALE (HIS-GWB)

8. Have you felt depressed (during the past 12 months)?

QMFPNP
DUDDDU

13.

Yes - to the point that I felt like taking my life

Yes - to the point that I did not care about anything
Yes - very depressed almost every day
Yes - quite depressed several times
Yes - a little depressed now and then
No - never felt depressed at all

wondered if anything was worthwhile (during the past 12 months)?

Alittle

9999NH
DDDUDD

Not at all

Extremely so- to the point that I have just about given up
Very much so

Quite a bit

Some - enough to bother me

Have you felt so sad, discouraged, hopeless or had so many problems that you

 

All of the Most of A good Some of A little of None of
time the time bit of the the time the time the time
time
(1) (2) (3) (4) (5) (6)

 

 

17. Have you felt

downhearted and blue

(during the past 12
onths)?

 

 

 

 

 

 

 

 

98

SELF-CONCEPT SCALE (HIS-GWB)

7. Have you been in firm control of your behavior, thoughts, emotions, or feelings

(during the past 12 months)?
1. Cl Yes, definitely so
2. Cl Yes, for the most part
3. U Generally so
4. CI Not too well
5. E] No, and I am somewhat disturbed
6. C] No, andIamverydisturbed

 

11. Have you had any reason to wonder if you were losing your mind, or losing
control over the way you act, talk, think, feel or of your memory (during the past 12
months)?
1. U Not at all
2. U Only a little
3. El Some - but not enough to be concerned or worried about
4. Cl Some and I have been a little concerned
5. CI Some and I am quite concerned
6. Cl Yes, very much so and I am very concerned
All of the Most of A good Some of A little of None of
time the time bit of the the time the time the time
time
(1) (2) (3) (4) (5) (6)

 

21. Have you been
feeling emotionally
Fable and sure of

 

ourself (during the past
12 months)?

 

 

 

 

 

 

 

 

last 12

99

POSITIVE WELL-BEING SCALE (I-IIS-GWB)

How have you been feeling in general (during the past 12 months)?

1. CI In excellent Spirits

2. C] In very good spirits

3. D In good spirits mostly

4. Cl I have been up and down in spirits a lot

5. C] In low spirits mostly

6. [I In very low spirits

How happy, satisfied, or pleased have you been with your personal life (during the
months)?

1. Cl Extremely happy - could not have been more satisfied or pleased

2. Cl Very happy most of the time

3. CI Generally satisfied - pleased

4 [:1 Sometimes fairly satisfied, sometimes fairly unhappy

5. El Generally dissatisfied, unhappy

6. Cl Very dissatisfied or unhappy most or all of the time

 

All of the Most of A good Some of A little of None of
time the time bit of the the time the time the time
time

(1) (2) (3) (4) (5) (6)

 

 

19. Has your daily life
full of things that
ere interesting to you
(during the past 12
months)?

 

Cheerfirl lighthearted

lifdunng thexpastvii’

 

 

 

 

 

 

 

 

 

100

GENERAL HEALTH SCALE (HIS-GWB)

3. How often were you bothered by any illness, bodily disorder, aches or pains
(during the past 12 months? _

l. [3 Every day

2. CI Almost every day

3. D About halfofthe time

4. Cl Now and then, but less than half of the time

5. Cl Rarely

6. D None of the time
10. Did you feel healthy enough to carry out the things you like to do or had to do
(during the last 12 months)?

1. CI Yes, definitely so

2. C] For the most part

3. CI Health problems limited me in some important ways

4. C] I was only healthy enough to take care of myself

5. CI I needed some help in taking care of myself

6. U I needed someone to help me most or all of the time
14. Have you been concerned, worried or had any fears about your health (during the
past 12 months)?

1. Cl Extremely so

2. CI Very much so

3. Cl Quite a bit

4. Cl Some, but not a lot

5. CI Practically never

6. El Not at all

101

wmuwxmfimmmm)

4. How much energy, pep, or vitality did you have or feel (during the past 12
months)? _

Very firll ofenergy - lots ofpep

Fairly energetic most of the time

My energy level varied quite a bit

Generally low in energy, pep

Very low in energy or pep most of the time

mmfiwwfi

ou feel active, vigorous or dull, sluggish (during the past 12 months)?
Very active, vigorous every day

Mostly active, vigorous - never really dull, sluggish

Fairly active, vigorous - seldom dull, sluggish

Fairly dull, sluggish - seldom active, vigorous

Mostly dull, sluggish - never really active, vigorous

Very dull, sluggish every day

9MPPNf
008000

16.

99:59.”?
E-
'~<

DDDDDD

 

All of the Most of A good Some of A little of None of
time the time bit of the the time the time the time

<1) (2)”. <3) 14) (”(6)

 

18 Have‘j'mu felt

 

 

   
  

ma (dunngthe

 

 

 

 

 

 

 

 

 

 

 

102

PHYSICAL HEALTH STATUS

THIS SECTION OF THE QUESTIONS ARE CENTERED ON YOUR PHYSICAL
HEALTH IN THE LAST 12 MONTHS.

H1.

H3.

How do you think your health has been in the last 24 months (choose one):
1. Cl Excellent

2. Cl Good

3. Cl Fair

4. [:1 Poor

Have you been hospitalized in the past 24 months?
1. D No

2. D Yes

If Yes, how many days? (write in):

 

Have you had more visits to the doctor's ofice or clinic in the last 24 months than

you think is average for you in the years previous?

H4b.

1.1:] Yes
2C1 No

Is this above your average in years previous for a 24-month period?
1. El Yes
2. C] No

Since your last child lefi home has your (check one for each):

 

Increased Decreased Stayed Does Not

 

HSa. Use of cigarettes

 

 

piss-rose orifijffj

vvvvvvvvvvvvvvvvvvvvvvvvvvvvvv

- .‘I'ul>'-‘~..|:'-‘-I-V-‘n’ui-V- '-‘- , l,-.',‘v‘ .'.'~ 4.1..“ , var-.92... / . . 4’ '.‘~ r':'.‘~':'.‘t ~‘1' ............................... ' .................. 1.” if. .'.’.'. .‘.'.~- I. . U... ’1‘.‘.‘.'.‘."1 , ‘ig', ,‘,"." ,‘f. t , ,‘.’. , .l. ff... .‘Cu’u' ‘a‘f. ~'o','y..'.’, y'...'.‘...'.','V'.'.'. “'3.

 

 

llfISc Use of cafi‘eine

 

 

........................................................................................................................................
....................................................................

5d Time spent sleeping

 

 

IHSe Tune spent exercrsrng

 

31'. .‘.‘.’ ‘.'.‘. .'.’.‘.'-'.‘.'.',‘-‘.'.‘. .'.' .l. .‘I‘.',':‘T':’L'I‘I -':':';‘:'.'I‘.‘.' ‘.‘.'.’ t3 '.:.:"‘y'-:.;.’.'.:v:,' .:.“V" ‘.:.U‘.:.;~".:.

 

 

 

 

 

 

Appendix C

103

PRE TRANSITION INDEX

THE FOLLOWING QUESTIONS ASK YOU TO REFLECT ON THE TIME IN YOUR
LIFE BEEQRE YOUR LAST CHILD LEFI‘ HOME. ANSWER EACH BY PLACING
AND ”X" IN THE RESPONSE BOX THAT EXPRESSES/MQSIEXERESSES YOU.

AC1. During the time before your child left home did you do any of the following to
" get ready” for the separation? (Select as many choices as apply.)
ACla. Read books:
1. D Yes
2. C] No
AC1b. Attend classes related to adjustment, coping, dealing with changing relationships
and adult children:
1. D Yes
2. C] No
AClc. Seek professional counseling:
1. Cl Yes
2. CI No
ACld. Discuss your feelings and concerns with female fiiends:
1. D Yes
2. C] No
ACle. Discuss your feelings and concerns with your spouse:
1. [:1 Yes
2. CI No

SOCIAL SUPPORT INDEX

104

THE FOLLOWING QUESTIONS DEAL WITH FRIENDS AND SUPPORT PEOPLE
OUTSIDE OF FAMILY MEMBERS AND THE CONTRIBUTION THEY MAKE TO
YOUR LIFE. CHECK ONE FOR EACH.

 

Strongly
Disagree

(1)

Disagree

(2)

Some-
what
Disagree
(3)

Neutral

(4)

Some-

what

Agree
(5)

Agree

(6)

Strongly
Agree

(7)

 

881. There
is someone I
feel close to

ho makes
me feel

 

 

 

 

 

 

 

 

 

 

 

105

 

Strongly Disagree Some- Neutral Some- Agree Strongly
Disagree what what Agree
Disagree Agree
(1) . (2) (3) (4) (5) (6) (7)

 

SSS. There
is little '
opportunity
in my life to
e giving and

caring to
another
person.

 

 

 

 

 

 

 

 

 

106

MARITAL RELATIONSHIP INDEX

THE NEXT SEVERAL QUESTIONS DEAL WITH YOUR RELATIONSHIP WITH
YOUR HUSBAND AND YOUR LAST CHILD TO LEAVE HOME. SELECT THE
RESPONSE THAT BEST REPRESENTS THE QUALITY OF THE RELATTONSHIP.

Ml. Before your last child left home, did you expect your marital relationship would:
1. U Get better
2. CI Stay the same
3. U Get worse

M2. Since your last child left home, would you say your marital relationship has:
1. Cl Gotten better
2. C] Stayed the same
3. CI Gotten worse

1 0 7
PARENTAL RELATTONSHIP INDEX

Pl. Before your last child left home, did you expect your parental relationship with
that child would:

1. U Get better

2. D Stay the same

3. [I Get worse

P2. Since your last child left home, would you say your parental relationship with that
child has:

1. Cl Gotten better

2. Cl Stayed the same

3. D Gotten worse

108

POST TRANSITION SELF CARE

THIS SECTION OF THE QUESTIONNAIRE ASKS YOU TO REFLECT ON WHAT
LIFE AND RELATIONSHIPS HAVE BEEN LIKE SINCE YOUR LAST CHILD LEFT

HOME.
CHECK ONE FOR EACH.

 

AGreat QuiteA Some Just A NotAt
Deal Bit Little All

 

 

   

 

 

 

 

 

 

 

 

Appendix D

109

Dear Midlife Woman:

This letter is by way of introduction of myself and the midlife
transition study. I am a registered nurse and a PhD student at Michigan
State University in the College of Human Ecology, Department of Family
and Child Ecology. 1 am interested in studying the changing nature of
women's relationships during their middle years and the effect these
changes have on their health.

Midlife women have one third of their lives ahead of them and the
information you provide will help me gain insight relative to how women
see themselves during this time.

I very much appreciate your willingness to participate in my study, and
to give approximately thirty minutes of your time to complete the
enclosed questionnaire. A self-addressed and stamped envelope is
provided to return the questionnaire along with a small token ($2.00) of
my appreciation for your participation. All information obtained will
be confidential, your name removed and data reported in aggregate and
identified by code number only.

You will also find in this packet of material a postcard addressed to me
and containing the qualifying questions for participation in the study.
I would very much appreciate your cooperation in helping me to locate
other women whom meet the criteria to be included in this research
project. If you know anyone who you think would take the time to fill
out the questionnaire please give them the postcard to send to me and I
will send them a questionnaire.

Even after receiving this questionnaire, you are free to discontinue
participation in the research project at any time simply by not
returning the instrument. However, you indicate your voluntary
agreement to participate by completing and returning this questionnaire.

Included on this form are my address and phone number. Please, if you
have any questions or need any additional information do not hesitate to
call or write.

Thanks again,

Elizabeth Price, R.N.'

110

CONSENT FORM

"Yes" answers to the following two questions are necessary to be a

participant in this study.

I.
2.

ARE YOU PRESENTLY IN A MARRIAGE RELATIONSHIP? YES NO

HAS YOUR LAST CHILD LEFT HOME WITHIN THE PAST
24 MONTHS (gone off to college, gotten married,
moved into an apartment) and NOT RETQRNEQ TQ

LIIE PERMANENTL! (vacations, holidays, and
weekends do not count)? YES NO

You have answered yes to both questions and have previously

indicated a desire to take part in my research project. If you still

wish to participate in the study please sign you name in the space

provided below and complete the questionnaire.

INAME
ADDRESS

Thank you.

 

 

 

Ill

MIDLIFE WOMEN IN TRANSITION

MICHIGAN STATE UNIVERSITY
COLLEGE OF HUMAN ECOLOGY
DEPARTMENT OF FAMILY AND CHILD ECOLOGY

Respondent ID

 

STATEMENT OF CONFIDENTIALITY:

'I‘his questionnaire is confidential and completely voluntary. If you should come to any
Cluestion that you do not wish to answer, skip it and go on to the next question.

1 12
INSTRUCTIONS

Please read each question carefirlly and follow all the instructions. Ifthere are no
instructions, always answer the next question.

Some questions ask you to write in numbers or fill in other information. However,
most questions ask you to select the response that is mos]; like you and to place an ”X” in
the appropriate box.

 

 

EXAMPLE QUESTION:
Very Pretty Somewhat Not Very Not At
True True True True All True
(.1) (2) (3) (4) (5)
I enjoy walking in the rain.

 

 

 

 

 

 

 

 

Please use a pencil or pen to complete this questionnaire. Begin on the top of the
next page. Again, I want to express my appreciation for you willingness to share this
information with me.

PLEASE RETURN YOUR COMPLETED QUESTIONNAIRE IN THE
ENVELOPE PROVIDED TO:

Midlife Transition Study
c/o Elizabeth Price

2545 St. Joe Highway
Grand Ledge, MI 48837

113

THE FOLLOWING QUESTIONS ASK YOU TO REFLECT ON THE TIME IN YOUR
LIFE BEEQRE YOUR LAST CHILD LEFT HOME. ANSWER EACH BY PLACING
AN "X" IN THE RESPONSE BOX THAT EXPRESSES/MQSIEXEBESSES YOU.

AC1. During the time before your child left home did you do any of the following to
" get ready" for the separation? (Select as many choices as apply.)
ACIa. Read books:
1. [I Yes
2. 1:] No
AC1b. Attend classes related to adjustment, coping, dealing with changing relationships
and adult children:
1. 1:] Yes
2. C] No
Seek professional counseling:
1. [I Yes
2. I] No
Discuss your feelings and concerns with female fiiends:
1. Cl Yes
2. [:1 No
Discuss your feelings and concerns with your spouse:
1. [:1 Yes
2. C] No
Other (write in):

AC1e.

ACId.

AC1e.

 

 

A Great Quite A Some Just A 1 Not At
Deal Bit Little All
( 1) (2) (3) (4) (5)

 

AC2. During the time preceding
your last child leaving home, to
what degree did you think your
adjustment to this change in
relationship would be difficult?

AC3 To what degree did you , . .
commit yourselfto the activities of = 1 ._ 3:7 i ' ‘ ' ' ' '
Enothenng? , _- ~ f '
AC4. To what degree has it been
difficult for you to "let go” of the
active parenting role as your
child/children have grown to
adults?

 

 

 

 

 

 

 

 

 

 

 

114

 

Important
(1)

Quite
Important
(2)

Important
(3)

A Little
Important
(4)

Not
Important
(5)

 

AC5. During the time your
child/children were growing
p, how important do you

' being a "mother" was
0 you?

 

 

 

 

 

 

 

 

THE FOLLOWING QUESTIONS DEAL WITH FRIENDS AND SUPPORT PEOPLE
OUTSIDE OF FAMILY MEMBERS AND THE CONTRIBUTION THEY MAKE TO
YOUR LIFE. CHECK ONE FOR EACH.

 

 

 

Strongly Disagree Some- Neutral Some- Agree Strongly
Disagree what what Agree
Disagree Agree
(1) (2) (3) (4) (5) (6) (7)
SS1. There
is someoneI

eel close to

 

 

 

 

 

 

 

 

 

 

 

 

115

 

Strongly
Disagree

(1)

Disagree

(2)

Some-
what
Disagree
(3)

Neutral

(4)

Some-
what

(5)

Agree

(6)

Strongly
Agree

(7)

 

SS4. .I spend
time with

have the
same _

pthers who '

interests... ,4

 

SSS. There
is little
opportunity
in my life to
be giving and
caring to
another
person.

 

 

 

 

 

 

 

 

 

THE NEXT SEVERAL QUESTIONS DEAL WITH YOUR RELATTONSHIP WITH
YOUR HUSBAND AND YOUR LAST CHILD TO LEAVE HOME. SELECT THE
RESPONSE THAT BEST REPRESENTS THE QUALITY OF THE RELATIONSHIP.

M1.
1.1:] Getbetter
2. U Staythe same
3. Cl Getworse
M2.
1.1:] Gottenbetter
2. El Stayed the same
3. Cl Gottenworse
Pl.
that child would:

LEI

Get better

2. El Stay the same

3. [I Get worse

Before your last child left home, did you expect your marital relationship would:

Since your last child left home, would you say your marital relationship has:

Before your last child lefi home, did you expect your parental relationship with

 

116

P2. ' Since your last child left home, would you say your parental relationship with that
child has:

1. Cl Gotten better

2. CI Stayed the same

3. Cl Gotten worse

THE FOLLOWING QUESTIONS TELL SOMETHING ABOUT YOUR LIFE
COURSE AND FAMILY HISTORY.

Dl. Your date of birth: / /
month day year

 

D2. What was your approximate total household income during the last year (choose
one):

1. C] under $14,999

2. Cl $15,000 - $29,999

3. Cl $30,000 - $49,999

4. D $50,000 - $99,999

5. [:1 over $100,000

D3. What was the highest grade or class you completed in school (choose one):
Less than 12 years

High school graduate or equivalent

Vocational/special training

Community college degree

Bachelors degree

Masters degree

Professional degree: PhD, MD, JD

NQVPPN!‘
DDUUDUD

D4. What is your occupation? (write in):

 

D5. Have you ever been divorced?
1. Cl Yes
2. C] No

D6. Number of children born alive (write in):
D7. Number of children now living (write in):
D8. Have you had a child who died?

1.1:] Yes
2C1 No

D9.

D9a.

D10.

D11.

D12.

D13.

D13a. When your last child left home what were your feelings? (write in):

117

Approximately how many months has it been since your last child left home?
(write in):

 

Was your last child to leave home a:
1. El Girl
2. CI Boy

Do you think the number of children you had was (choose one):
1. I] Just right

2. [:1 Too many

3. El Not enough

Have you experienced or are you experiencing menopause?
1. Cl No

 

 

2. 1:] Yes
If yes, Surgical: Age (year):
Biological: Age (year):

 

 

Were you sterilized as a means of birth control earlier in your life?
1. D No

2. E] Yes

Ifyes, Age: Year:

Before your last child left home, how harmonious was your relationship?
1. El Not at all harmonious

2. [:1 Somewhat harmonious

3. Cl Harmonious

4. CI Very harmonious

 

 

 

 

D13b. What were your thoughts? (write in):

 

 

 

 

D14. ‘

D15.
one):

D15a.

118

Are you presently (choose one):

1. CI Employed

2. 1:1 Retired

3. 1:] Disabled

4. [:1 Not employed outside the home

If employed, how many hours a week do you work outside your home (choose

1. U LessthanlO
2. B 10-20

3. 1:1 20-30

4. Cl Morethan30
5.1:! Other (write in):

 

If you are a vohmteer, how many hours a week do you spend in volunteer

activities (choose one): -

D16.
one):

Dl6a.
one):

1. CI Lessthan 10

2. 1:1 10—20

3. 1:] 20-30

4. Cl Morethan30
5. D Other (write in):

 

Since your last child left home has the time you've spent as an employee (choose

1. Cl Increased
2. Cl Decreased
3. Cl Stayed the same
4. U Does not apply

Since your last child left home, has the time you've spend as a volunteer (choose

1. CI Increased
2. Cl Decreased
3. Cl Stayed the same
4. 1:] Does not apply

 

119

IF YOU ARE EMPLOYED AS A PAID WORKER OUTSIDE THE HOME ANSWER
TIE NEXT QUESTION. IF YOU ARE NQI EMPLOYED OUTSIDE TIE HOME
PLEASE CONTINUE WITH QUESTION D18.

D17. Do you consider your employment to be (select as many statements as
appropriate):

1. 1:] Just a job (paycheck)

2. Cl A very important part of who you are

3. Cl A career you love.
D18. Is your mother living?

1. D Yes

2. C] No

If No, when did she die? Year:

 

D19. Is your husband retired?
1. C] No
2. Cl Yes
If Yes, when did he retire? Year:

 

D20. When you were growing up was your family constellation (choose one):
1. CI Traditional - Father bread winner, Mother homemaker
2. CI Single parent/working mother
3. 13 Both parents working
4. CI Other (write in):

 

THIS SECTION OF TIE QUESTIONNAIRE ASKS YOU TO REFLECT ON WHAT
LIFE AND RELATIONSHIPS HAVE BEEN LIKE SINCE YOUR LAST CIIILD LEFT
HOME. CIECK ONE FOR EACH.

 

A Great Quite A Some Just A Not At
Deal Bit Little All
(1) (2) (3) (4) (5)

 

ECI. To what extent do you think
your role is changing with your
child/children as they begin their
[lives on their own?

cz'rwhatem tame

 

 

 

 

 

 

 

 

 

 

 

120 .

 

A Great
Deal

(1)

Quite A
Bit
(2)

Some

(3)

Just A
Little
(4)

Not At

(5)

 

 

PC3. To what extent would you

like your relationship with your

child to remain the same as it was
fore he/she left home?

 

 
  

 

 

 

 

 

 

.C48mceyour lastibhirdqireai j' :_-;:.rié;:i:éf;:;;;.;:_7:-:-i; 5363+ ' ‘ ‘ '* "
devotedmoretimetoyourself ‘ I ~. w . .
(lengthsfleasiyesfikstoifl<fllA :97 v

 

PCS.
1. Cl Time of endings

Time for uncertainty

Time for self growth

9:559.“
DDDD

Time of emptiness - lost

Time to build new relationships

How do you view this post parental time in your life (choose one):

THIS SECTION OF TIE QUESTIONS ARE CENTERED ON YOUR PHYSICAL
IEALTH IN THE LAST 24 MONTHS.

H1.
1. Cl Excellent
2. 1:] Good
3. [:1 Fair
4. Cl Poor

HZa.
1. Cl No
2. [:1 Yes

Iers, how many days? (write in):

Have you been hospitalized in the past 24 months?

 

How do you think you health has been in the last 24 months (choose one):

H2b. Ifyour answer to HZa. is Yes, what were you hospitalized for? (write in):

 

 

 

 

121

H3. Have you had more visits to the doctor's ofice or clinic in the last 24 months than
you think is average for you in the years previous?

1. CI Yes

2. CI No

H4a. How many colds or upper respiratory infections have you had in the last 24
months? (write in):

H4b. Is the number of colds or upper respiratory infections that you have had above

your average in years previous for a 24-month period?
1. CI Yes
2. D No

H5. Since your last child left home has your (check one for each):

 

Increased Decreased Stayed Does Not
The Same Apply

(1) (2) (3) (4)

 

 

H5a.Useofcigarettes _ .. ._.. ..... .
HSbUseof alcohol

 

HSc. Use of cafiene

 

HSdTnnespentslee mg

 

H5e. Time spent exercising

 

 

 

 

 

 

(I-ISeralrnrofnumuonalmtake

 

 

THE NEXT QUESTIONS ARE ABOUT HOW YOU FEEL AND HOW
T'IIINGHAVEBEEN GOING WITH YOU. FOR EACH QUESTION PLACE AN ”X"
IN TIE RESPONSE BOX FOR TIE ANSWER THAT BEST APPLES TO YOU.

1. How have you been feeling in general (during the past 12 months)? -
In excellent spirits

In very good spirits

In good spirits mostly

I have been up and down in spirits a lot

In low spirits mostly

In very low spirits

99:59.5)!"
DECIDED

122

2. Have you been bothered by nervousness or your "nerves" (during the past 12

months)? '

l. [:1 Extremely so - to the point where I could not work or take care of things

2. CI Very much so

3. CI Quite a bit

4. 1:] Some - enough to bother me

5. C! A little

6. El Not at all
3. How ofien were you bothered by any illness, bodily disorder, aches or pains
(during the past 12 months?

1. Cl Every day

2. CI Almost every day

3. 1:] About halfofthe time

4. C] Now and then, but less than halfof the time

5. 1:1 Rarely

6. U None of the time
4. Ho ow much energy, pep, or vitality did you have or feel (during the past 12
months)?

1.1:] Veryfullofenergy-lotsofpep

2. El Fairly energetic most of the time

3. U My energy level varied quite a bit

4. 1] Generally low in energy, pep

5. CI Very low in energy or pep most ofthe time

6. D Drained, sapped
5. How happy, satisfied, or pleased have you been with your personal life (during the
last 12 months)?

1. CI Extremely happy - could not have been more satisfied or pleased

2. Cl Very happy most of the time

3. 1:] Generally satisfied - pleased

4 Cl Sometimes fairly satisfied, sometimes fairly unhappy

5. Cl Generally dissatisfied, unhappy

6. Cl Very dissatisfied or unhappy most or all of the time
6. Have you been under or felt you were under any strain, stress or pressure (during
the past 12 months)?

1.1:! Yes- almost morethanl could stand orbear

2. El Yes - quite a bit ofpressure

3. Cl Yes- some-morethanusual

4. D Yes - some but about normal

5. C] Yes - a little

6. El Not at all

 

123

7. Have you been in firm control of your behavior, thoughts, emotions, or feelings
(during the past 12 months)?

Yes, definitely so

Yes, for the most part

Generally so

Not too well

No, and I am somewhat disturbed
No, and I am very disturbed

8. Have you felt depressed (during the past 12 months)?

1.0
2.0
3.0
4.0
50
6.0
10
20
3.0
40
5.0
6.0

Yes - to the point that I felt like taking my life ’
Yes - to the point that I did not care about anything

Yes - very depressed almost every day

Yes - quite depressed several times

Yes - a little depressed now and then

No - never felt depressed at all i

 

9. Have you been anxious, worried or upset (during the past 12 months)?

99:59.”?

10.
(during

P‘MPPNHEQ
000000

000000

Extremely so - to the point of being sick or almost sick
Very much so

Quite a bit

Some - enough to bother me

A little

Not at all

<1 you feel healthy enough to carry out the things you like to do or had to do
e last 12 months)?

Yes, definitely so

For the most part

Health problems limited me in some important ways
I was only healthy enough to take care of myself

I needed some help in taldng care of myself

I needed someone to help me most or all of the time

11. Have you had any reason to wonder if you were losing your mind, or losing
control over the way you act, talk, think, feel or of your memory (during the past 12

months)?

99:59.“?

000000

Not at all

Only a little

Some - but not enough to be concerned or worried about
Some and I have been a little concerned

Some and I am quite concerned

Yes, very much so and I am very concerned

124

12. Did you feel relaxed, at ease or high-strung, tight, or keyed-up (during the past 12

months)?

Felt relaxed and at ease the whole 12 months

Felt relaxed and at ease most of the time - seldom or never felt high-strung

Generally felt relaxed but at times felt fairly high strung

Generally felt high-strung but at times felt fairly relaxed

Felt high-strung, tight or keyed-up most of the time - seldom or never felt
relaxed

Felt high-strung, tight or keyed-up the whole 12 months

.V'PP’N!"
00000

9
El

13. Have you felt so sad, discouraged, hopeless or had so many problems that you
wondered if anything was worthwhile (during the past 12 months)?

1. 0 Extremely so — to the point that I have just about given up
2. 0 Very much so

3. 0 Quite abit

4. 0 Some - enough to bother me

5. 0 A little

6. 0 Not at all

14. Have you been concerned, worried or had any fears about your health (during the
past 12 months)?

Extremely so

Very much so

Quite a bit

Some, but not a lot

Practically never

Not at all

ewewwr
000000

15.

9

ewewwrg
000000

e you generally tense or did you feel any tension (during the past 12 months)?
Yes - extremely tense, most or all of the time

Yes - very tense most ofthe time

Not generally tense, but did feel fairly tense several times

I felt a little tense a few times

My general tension level was quite low

I never felt tense or any tension at all

16. °

9..
~<

ou feel active, vigorous or dull, sluggish (during the past 12 months)?
Very active, vigorous every day

Mostly active, vigorous - never really dull, sluggish

Fairly active, vigorous - seldom dull, sluggish

Fairly dull, sluggish - seldom active, vigorous

Mostly dull, sluggish - never really active, vigorous

Very dull, sluggish every day

ewewwrg
000000

 

125

All of Most of A good Some of little None of
time the time bit of the the time the time the time
time

. Have you felt
and blue
the past 12

. Has your daily life
firll of things that
interesting to you

the past 12

Have you been
emotionally
and sure of
(during the past

 

126

READ EACH OF TIE STATEMENTS BELOW AND DECIDE HOW EACH ONE
DESCRIBES YOU. USING TIE RATING SCALE OF 1 - "NOT LIKE ME AT ALL"

TO 5 - "VERY MUCH LIKE ME, " CHOOSE TIE MOST APPROPRIATE
RESPONSE.

 

Not like Very much
me at all like me

(1) (2) (3) (4) (5)

 

1. I oftentryto act on the belief
t self-interest is one of the worst
problems facing society

 

 

  

2ggggeaA‘c1ose friend rs someone who ............. ;3i:tfiii???Li‘ii'ff";

55' 377.! .. . :< :5" -: '-: ~ j .- . t ‘ ' ‘- ‘ - .. ;. " : _ .~ .
~. ‘ ' . ' 1:3" ' 37:30. -'-:~: .1 ‘i Tut-4:1. ‘3 ' . 3"::;;;-'._.3
need 1t -:’.3. .i:?:*¥:‘;r;':3=vi'~3:1.LES: £.-:'~‘i:i.v.l‘l 5:1 ?:i :35 :3:-':-:" :»;" .i:7:':~:1:‘ ‘4 :i. .3: 23.11. 1133-5325 :23 ‘21 " .';',~,.;:- 3:3: .?;'. 3:-'.-":~'. {:3.~-:T ._ 1': «.1:»‘:?:‘;-'

.........................

 

 

3. I cannot choose to help someone
else if it will hinder my
self-development

 

 

 

‘5. In making decisions, I can
neglect my own values in order to
keep a relatronshrp

 

 

 

7. Itryto curbmyangerforfearof
hurtrng others.

 

 

 

9. Lovrng rs like a contract: rfrts
rovisions are not met, you wouldn't
love the person anymore

 

 

 

11. Iwant to learn to stand on my
own two feet.

 

 

 

 

 

 

 

127

 

Not like
me at all

Very much
like me

 

 

13. I try not to thrnk about the
eelings of others when there rs a
principle at stake.

147“ I ““9”? 40., month: ether: 5*,

     

 

 

    

 

15. Actrvrtres of care that I perform

expand to both me and others. .

16 Ifwhat I: want 1'. O (10 upsets jigfizizf'izge s:;:é‘s;.;:e:;:‘s::;'j.;:;;i:5:*:g_..,:z:z-;: {35{31-}?231:;if}?iff:g}7§:gf§§§;.iIii.rEEI,.‘_§:§I§.g:i'§;}:.{53§ffEZ-f'ffiffzjji :j{;;g3£§f}5_57.{fi:}f'?gf'gf°i;gf3f; ;,g::;:;.;.g.;;.g-.I

other people If. 1 f :: agamto

seerfI really want to do it ”
7. I do not want others to be

 

..............................

   

 

 

 

 

 

 

19 I beheve that I have to look out
for myself and mine, and let others
shift for themselves.

 

20 ‘‘‘‘‘‘ Berng unselfish wrth ers rs

  

 

21. When a fiend traps me with
Emands and negotiation has not

 

orked, I am likely to end the
endship.“

2 Ifeel

 

   
   

”01"“ With someone else.,;;,;_;;;_, a? 51:7:
23. Sometimes I have to accept
urting someone else if I am to do
e things that are important in my
own life.

 

 

 

 

 

 

 

 

 

128

 

Not like

-meatall

Very much
like me

 

 

24.111 order to continue a

   

OW.

relationship it has to let both of us

K4,),

‘5). .

 

   
 

n shaped more by the persons I
care about than by what I do and

accomplish.

5.1 feel that my development has

 

  

6 People who don‘t work hard to {if
' . J mPhshrespectablegoal3 Gatl‘t _ :97 '

 

[27. Relationships are a central part

of my identity.

 

  
  

.8 I often keep quiet rather than
hurt someOne’s feelings, even if it
eans giving a false impresswn

 

29. When someone offers to do
something for me, I should accept
the ofl‘er even if I really want
sometlung else.

 

 

30 The worst thing that could ,,

 

........................

 
 

 

antto doisfighLIdoitevenifit
psets other people

El IfI amreallysurethatwhatl I

 

 

2 Before I can be sure! really

 

 

 

 

 

 

 

 

 

 

 

129

 

Not like Very much
me at all like me

(1) (2) (3) (4) (5)

 

35. Even though it's difficult, I have
learned to say no to others when I
need to take care of myself

36, 1 llke to see myselfas ‘ 3i-i-i7gfigiiiéfifilirifai Eiiiiigifigfiie?)5f

 

 

 

   

 

37. Those about whom I care
deeply are part of who I am

 

 

 

39. I believe that I must care for
myself because others are not
responsrble for me

 

 

 

I It IS necessary for me to take
responsibility for the efi‘ect my
actions have on others

 

 

 

43. The feelmgs of others are not
elevant when dec1d1ng what 18 right i . . I ..

 

 

 

5 Imake declswns based upon 1 1 H 1 1 1
hat I believe 13 best for me and

 

    

 

7. I beheve that m order to survive
must concentrate more on taking

 

 

 

 

 

 

 

130

 

Not like Very much
me at all like me

 

 

   

 

49. Doing thmgs 1f1or others makes

lmehPPPY . . .. ..x . ,. ,. .. . . - -. . .
ISO All you really need to do to help x?{55153531;}???{112-7iiisié
30mm is to love -.i:.. :1111'4-4... , 71 Effigi'g. .1. ,4 ,4... .. :,,..,.,,.. ..:-:;. .. .4: -. iiiT1111§51¥§1151
51. I deserve the love of others as
much as they deserve my love.

52 H You“ got to 109k 9‘” for“

 

 

   

 

 

 

 
 
 

 

 

eat you up

53. I cannot afi'ord to give attention

0 the opinions of others when I am

certain I am correct.

54 33011180118 does som‘for ......................

 

 

...............................

      

 

155. Canng about other people 1s
important to me.

 

 

 

57. When I make a decrsron rt'
important to use my values to make
e right decislon

 

 

 

5119 If I am to help another person it
is important to me to understand my
own motlves

 

 

 

 

 

 

 

 

 

 

131

THE REMAINDER OF THE QUESTIONS ARE OPEN ENDED AND ALLOW YOU
TO RELATE IN YOUR OWN WORDS HOW YOU HAVE FELT AND WHAT THE
EXPERIENCE HAS BEEN LIKE FOR YOU.

0E1. How have you spent time on yourself since your last child left home? (write in):

 

 

 

 

0E2. How has the balance of time spent caring for yourself versus caring for others
changed since your last child left home? (write in):

 

 

 

 

0E3. What kinds of things do you do just for yourself now that your last child has left
the home? (write in):

 

 

 

 

0E4. Think back when you were in your early twenties. What was the dream you had
for your life then? (write in):

 

 

 

 

 

132

0E5. You have on the average one third of your life left to live. What would you say
is your dream for your future? (write in):

 

 

 

 

 

 

0E6. Please share with me any comments regarding this time in your life and/or any
comments about the questionnaire (write in):

 

 

 

 

 

 

Thank you for taking the time to contribute to this research project.

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