As marital life begins, couples expect to have children because with the birth of a child life will move on to another path. In contrast, in the case
of infertility, the partners may face serious psychological problems [1]. For most people, children are the meaning of life and an important part of their identity. Multiple studies on infertile couples who yearn for biological neonates have shown that these couples experience tension in a deep distressed way [2]. Infertility causes harmful psychological effects [3], including reduced self-confidence, impaired self-image, and impaired male and female identities [4]. Some researchers believe that infertility is a challenging experience leading to problems in marital life [4].
Marital conflicts result from the disharmony of husband and wife needs and the way to meet
them, egocentrism, difference in requests, and irresponsible behavioral schemas for marital relationship and marriage [5]. The process of conflict starts when one side of the relationship feels that the other side is suppressing some of his/her favorite issues. Conflict occurs when something satisfied a side but leading to a kind of deprivation for the other side [6].
Therapists describe the conflict system as a kind of struggle to take over bases and sources of power which is revealed towards taking other points and increasing advantages. It is clear that both sides of the conflict aim to hurt the other side thwarted his tactics and finally put him/her out of the scene. Therefore, conflict is an indication of reaction to personal differences, and it can be sometimes so severe leading to anger, violence, hatred, disgust,   jealousy, physical and verbal misbehavior in couples, and reaction in a destructive and devastating way [7].
Recent studies showed that family therapy is very effective in various problems, including emotional, psychosomatic, and behavioral disorders [8]. According to the system theory, every member of the family communicates with others in order to maintain balance. Family therapy helps to reveal hidden patterns in the family and recognize them. All the therapists believe that not only the member of the family who has been labeled as patient and all problems of the family attributed to him/her need to be treated in the treatment process but also other members of the family should be taken into account in this process [9].
One of the systematic family approaches is structural therapy. The main idea of family therapy is that individual features can be best recognized when they are assessed in the interactive patterns of the family. From the family therapy point of view, before starting treatment and resolving the symptoms of the disease some changes should be made in the organization or structure of the family. Family structure is an invisible collection of special roles connecting members of the family. In this procedure, the emphasis is on the family as the whole and interactions among its subsystems. The most important criterion is the proper and effective performance of subsystems and clear borders based on roles, regulations, and power [10].
In structural couple therapy, the focus is generally on marital subsystem, border between them, sharing the tasks between couples, and relationship of other subsystems inside and outside the family, which if there is a specific disorder in any of these cases it is tried to assess, measure, and resolve the cases in order for couples to reconstruct their proper functions. Studies in this domain have demonstrated that structural family therapy significantly affects the decrease in marital conflicts and improvement of family performance [11].
However, another approach that can be effective in decreasing marital conflicts is the redecision approach. The reason for choosing this approach to be compared with structural family therapy is that this redecision emphasized that it is different from structural family therapy in decreasing marital conflicts. Redecision therapy is established based on Transactional Analysis Theory. Many of the interactive analysts also provide individual, marital, and family therapies and integrate other systems with transactional analysis for the treatment of couples and families [12].
Currently, transactional analysis has considerably changed, including Mary and Robert Goulding as the leaders of redecision therapy school who made basic changes in Berne’s classic transactional analysis approach. In order to function more effectively and efficiently, they blended the transactional analysis theory with the principles and techniques of Gestalt therapy, family therapy, psychodrama, and behavioral therapy. The aim of redecision therapy is to help people in the challenge with themselves in order to know their pseudovictim role, be aware of accountability and conduct their life, and impose necessary changes in life’s process [13].
In this type of treatment, clients are helped to fight with their previous beliefs regarding themselves, and clients are taught that they are free in their options in order to decide again about who they are and who they want to be [14]. Then, by adopting this approach in treatment, couples can decide to show new behaviors. Redecision therapy is based on the view that when people feel involved in a conflicting situation or they arrive at a point that becomes insoluble as the root of this conflict is in their childhood and it was insoluble at that time now they return to it. This return is usually beyond conscious awareness and with the answers which the individual gives to interview conditions usually will have an improper and ineffective state [15]. Studies have shown that the redecision approach has been effective in working with conflicting couples [16].
 
Objectives
The current study aimed to compare the effectiveness of structural couple therapy and redecision couple therapy in the reduction of marital conflicts among infertile couples. 
 
Materials and Methods
The present empirical semi-experimental study was carried out on two experimental groups receiving Minuchin’s structural and redecision therapies and a control group from a psychological point of view using a pretest and posttest design. The dependant variable was marital conflicts and associated dimensions. The statistical population of the study were all the infertile couples referring to Besat hospital of Sanandaj, Iran. A total of 36 study participants who met inclusion criteria were selected using convenient sampling and assigned to three groups. Semi-structured interviews and marital conflicts questionnaire were used for the selection of the subjects. Each of the experimental groups underwent 10 sessions of couple therapy.
The inclusion criteria were infertile couples with at least 3 years of marriage, living with each other and not leaving the home after an argument, having marital conflict scores of at least 150 and at most 186, no participation in any type of therapeutic intervention parallel with the interventions provided in this study, completing informed consent form for participation in the study, having at least diploma, and no addiction of spouses. The exclusion criteria were no participation in the treatment sessions for two successive sessions or three nonconsecutive sessions without any acceptable reason, failure to cooperate with the therapist, not doing the main assignments proposed by the therapist, and awareness that the subject did not meet the inclusion criteria of the experiment.
 
Marital conflicts questionnaire
This questionnaire is a reporting tool, includes 54 items which is developed by Boostanipoor and Sanai Zaker [17] in Iran and basically used for the identification of the nature and the number
of conflicts in the marital relationship. This questionnaire studies seven dimensions of marital conflicts, namely decreased cooperation, decreased sexual relationship, increasing emotional reactions, increasing children support, increasing personal relationships with one’s relatives, decreasing family relationships with spouse’s friends and relatives, separating financial affairs from each other, and decreasing effective relationship and marital conflicts. The scaling of the options is based on 1) Never, 2) Rarely, 3) Sometimes, and 5) Always. The items 3, 11, 14, 26, 30, 33, 45, 47, and 45 are numbered in reverse. Cronbach’s alpha for the whole questionnaire was reported as 0.71. This questionnaire has good and acceptable validity. The reliability of this tool was reported as 0.90 for the whole scale using the internal consistency method [18]. The reliability of this questionnaire in the present study was calculated at 0.93.
Descriptive statistic indices and multivariate analysis of covariance (MANCOVA) were used to analyze the data. In addition, the data were analyzed using SPSS software (version 22).

Session	Objective	Assignment
First session	Introducing and making a friendly relationship, expressing the objectives of the sessions, method therapy, and concept of marital conflicts and affliction	People are asked to write down their main conflict on a paper and state what they expect from the sessions.
Second session	The assignment of the previous session is checked. Communication and family subsystems are defined. Finally, the dominant status of the family is revised.	Members are asked to practice communication skills and write down the results of their practice.
Third session	By receiving feedback from previous sessions, the third session will be started. Then, the techniques of family therapy, such as adhesion, imitation, and restatement, were taught.	The assignment is to record the effects of family therapy techniques on the improvement of daily lives.
Fourth Session	By reviewing previous session assignments and giving feedback by group members, the fourth session will be started. Then, common interactional patterns and an available triangle around family problems are discussed.	Members are instructed to write their expectations from their spouses and put forward in the session and state cases which they think can lead to more cooperation of each spouse as a strategy.
Fifth session	This session is started with checking the assignments of the previous session. Moreover, reconstruction and family changing strategies are studied.	Participants are given the assignment to write two cases that cause reactions and state in the session.
Sixth session	The assignment of the previous session is checked. The manner and amount of communication of each member with his/her spouse are checked. The comparison of their relationships with their own family members is studied and taught.	Participants are asked to write some of their experiences that have brought them closer to their main family and caused them to stay away from their spouses and state in the session.
Seventh session	The assignment of the previous session is checked. Family relations with relatives and friends are discussed and studied.	Participants are instructed to write about strategies that balance the family relationship with spouse relatives and cause healthy relationships with friends.
Eighth session	The assignment of the previous session is checked. Considering that marital conflicts over sexual matters are more frequently about women and quality of the relationship, these cases are taught.	Participants are given the assignment to discuss the time and quality of having a sexual relationship with their spouses and follow what they agreed on.
Ninth session	The assignment of the previous session is checked. How to maintain coupled subsystems with the boarders of children subsystem will be discussed.	Participants are asked to write two cases that have led to attracting children support and state in the session.
Tenth session	The assignment of the previous session is checked. Proper financial management regarding concerns and turbulences are discussed.	Members discuss their experiences in this regard and reach an agreement with their spouses.

Session	Objective	Assignment
First session	Introduction and creating a friendly relationship; executing pretest; stating principles and regulations	Completing questionnaire; stating problems by the couples
Second session	Becoming familiar with marital conflict concepts and dimensions, its disadvantages and negative effects on the couples; discussing marital affliction	Studying pamphlet provided by the counselor for the next sessions
Third session	Familiarizing with the individual's personality structure or moods (i.e., parent, adult, and child); informing members of the process of character formation from Berne’s point of view	Studying pamphlet provided by the counselor
Fourth session	Explaining the redecision approach and naming its components, inhibitors, and propellants; learning about decisions made as the result of inhibitors and propellants	Writing inhibitors and propellants which parents remind of their spouses
Fifth session	Teaching to discover the drama of life; familiarizing with the concept and types of caress	Studying the pamphlet and making a list of caresses received in childhood
Sixth session	Explaining who to arrange an agreement; talking about personal responsibility with each member; assign responsibilities	Exchanging opinions about the agreement; writing cases which they expect to change during marital life
Seventh Session	Identifying family regulations and do’s and don’ts using cognitive techniques (i.e., cognitive controversy, conversation, and extreme questions) to understand initial decisions	Identifying defective beliefs and proposing realistic ones
Eighth session	Working on initial decisions using Gestalt therapy techniques (i.e., roleplaying, role inversion, and empty chair) in order to reconstruct the scenes coming to mind of the members from the past	Applying initial decisions using Gestalt therapy techniques; confronting with unfinished works through empty chair technique
Ninth Session	Discussing questions to review decisions (e.g., Do you want to review your initial decisions? Are these decisions useful for you and what new decisions do you want to make?)	Members are asked to specify weeks or days and act at least in an environment similar to home or workplace as if they are that person
Tenth decision	Holding a posttest; interviewing with participated couples; providing a plan based on their decisions regarding continuation of life	Talking about changes that are made during the treatment

Results
The mean scores of participants’ age in the structural couple therapy, redecision couple therapy, and control groups were reported as 28.8±7.9, 28.9±8.1, and 33.5±7 years, respectively. The duration averages of infertility in the structural couple therapy, redecision couple therapy, and control groups were 3.58, 4.25, and 5.08 years, respectively.
The results of Box’s M and Levene’s tests were evaluated in order to follow the defaults which are shown in the following tables. The results of Box’s M test are presented in Table 6 to study the assumption of the equality of covariance matrices of dependent variables. F gained for the variable of marital conflict components with (3034.31,72) degrees of freedom was not significant at 0.05 level, and the assumption of the equality of covariance matrices in  Box’s M test was rejected when the amount of F obtained for variables to be significant at 0.01 level; therefore, it was confirmed in the present study. Since Box’s M test was not significant, the term of homogeneity of variance-covariance matrices was properly observed. F amounts gained for the dimensions of the marital conflict components were not significant (P<0.05) in the posttest with degrees of freedom (df-33,2).
Lack of significance at Levene’s test indicated that the term of variance equality between the groups was observed, and the amount of error variance of dependent variables was equal at all groups; consequently, there was no significant difference between the error variances of the groups. Therefore, the assumption of homogeneity of error variances was observed, and MANCOVA can be used. Considering that the defaults using the MANCOVA were observed, Table 4 tabulates the results of Wilks’ Lambda to study the group effect.
As it can be observed in Table 4, the effect of the group is significant in the dimensions of marital conflict components at 0.001; consequently, the results indicated that it is significant at least among one of the components of the marital conflicts. The results of the MANCOVA are shown in Table 5.
As it can be observed in Table 5, in cooperation (F[2,25]=14.17), decreased sexual relationship (F[2,25]=28.53), increasing emotional reactions (F[2,25]=16.99), increasing personal relationships with one’s relatives (F[2,25]=24.02), decreasing family relationships with spouse’s friends and relatives (F[2,25]=21.81), separating financial affairs from each other (F[2,25]=18.70), and decreasing effective relationship (F[2,25]=28.53), there is a significant difference at 0.001 level. Furthermore, in increasing children support (F[2,25]=0.091), there was no significant difference between the two experimental groups and control group (P<0.05). There was a significant difference between the effectiveness of the Minuchin’s structural couple therapy, redecision couple therapy, and control groups in decreasing marital conflicts.
When Bonferroni adjustment was performed for a number of comparisons, the obtained results showed that there was a significant difference between the three groups regarding marital conflict components. A review of the means in Table 7 indicated that there was a significant difference between cooperation dimension in Minuchin’s structural therapy and redecision therapy groups with the control group at the significance level of < 0.01; however, there was not a significant difference between the two Minuchin’s structural therapy and redecision therapy groups (P≤0.05). A significant difference was observed regarding decreased sexual

Posttest		Pretest		Group	Variable
Mean	Standard deviation	Mean	Standard deviation
1.72	7.08	3.14	18.67	Minuchin’ structural therapy	Decreased cooperation
1.56	6.08	0.99	16.92	Redecision therapy
1.8	13.17	1.72	13.91	Control
2.28	10.17	3.01	17.75	Minuchin’ structural therapy	Decreased sexual relationship
1.08	6.08	1.90	18.17	Redecision therapy
1.11	14.17	1.77	14.67	Control
3.70	13.33	5.40	27.83	Minuchin’ structural therapy	Increasing emotional reactions
2.42	10.67	3.83	28.83	Redecision therapy
1.61	22.67	1.31	22.50	Control
0.99	5.41	1.72	5.58	Minuchin’ structural therapy	Increasing children support
0.58	5.16	0.99	5.41	Redecision therapy
1.15	5.56	1.08	5.91	Control
2.35	8.50	3.42	18.80	Minuchin’ structural therapy	Increasing personal relationships with one’s relatives
1.50	7.58	2.97	20.58	Redecision therapy
1.28	16.75	1.57	17.50	Control
2.14	8.67	3.98	18.33	Minuchin’ structural therapy	Decreasing family relationships with the spouse’s friends and relatives
2.12	7.83	2.60	20.08	Redecision therapy
1.24	15.58	1.29	15.75	Control
2.09	13.25	4.45	20.75	Minuchin’ structural therapy	Separating financial affairs from each other
2.02	8.50	3.08	23.42	Redecision therapy
1.52	19.17	1.35	18.75	Control
3.78	24.83	3.78	46.50	Minuchin’ structural therapy	Decreasing effective relationship
4.42	21.67	4.25	51.58	Redecision therapy
2.10	37.17	3.34	39.42	Control
11.61	91.25	13.05	173.92	Minuchin’ structural therapy	Marital conflicts
11.16	73.58	13.30	185	Redecision therapy
3.96	144.33	7	148.42	Control

Variable	Value	F	Question df.	Error df.	Sig.	Eta2
Marital conflict components	0.051	7.694	16	34	0.001	0.774

Eta squared	Sig.	F	Mean of squares	df	Sum squares	Source	Variable
0.53	0.001	14.175	34.301 2.210	2 25	68.602 60.500	Effect Error	Decreased cooperation
0.69	0.009	28.531	44.493 1.559	2 25	88.985 38.987	Effect Error	Decreased sexual relationship
0.58	0.001	16.995	94.015 5.532	2 25	188.029 138.299	Effect Error	Increasing emotional reactions
0.00	0.917	0.091	0.067 0.738	2 25	0.134 18.446	Effect Error	Increasing children support
0.66	0.001	24.016	53.204 0.215	2 25	106.48 55.384	Effect Error	Increasing personal relationships with ones’ relatives
0.64	0.001	21.806	35.607 1.633	2 25	71.213 40.823	Effect Error	Decreasing family relationships with the spouse’s friends and relatives
0.60	0.001	18.699	55.388 2.962	2 25	110.776 74.050	Effect Error	Separating financial affairs from each other
0.69	0.001	28.528	262.729 9.210	2 25	524.485 230.241	Effect Error	Decreasing effective relationship
0.250	0.001	68.140	6292.104 92.400	2 32	2592.208 2956.805	Effect Error	Marital conflicts

Sig.	Std. Error	Mean Difference (I-J)	(J) Group	(I) Group	Variable
1	0.880	0.125	Redecision therapy	Minuchin’ structural therapy	Decreased cooperation
0.001	1.33	*-6.88	Control
0.001	1.43	*-7	Control	Redecision therapy
0.001	0.703	*3.193	Redecision therapy	Minuchin’ structural therapy	Decreased sexual relationship
0.001	1.07	*-5.23	Control
0.001	1.15	*-8.48	Control	Redecision therapy
0.156	1.32	2.70	Redecision therapy	Minuchin’ structural therapy	Increasing emotional reactions
0.001	2	*-9.88	Control
0.001	2.16	*-12.58	Control	Redecision therapy
1	0.48	0.192	Redecision therapy	Minuchin’ structural therapy	Increasing children support
1	0.73	0.170	Control
1	0.73	-0.02	Control	Redecision therapy
1	0.72	0.554	Redecision therapy	Minuchin’ structural therapy	Increasing personal relationships with ones relatives
0.001	1.09	*-6.82	Control
0.001	1.17	*-7.38	Control	Redecision therapy
1	0.72	0.554	Redecision therapy	Minuchin’ structural therapy	Decreasing family relationships with the spouse’s friends and relatives
0.001	1.09	*-6.82	Control
0.001	1.17	*-7.38	Control	Redecision therapy
0.001	0.97	*3.99	Redecision	Minuchin’ structural therapy	Separating financial affairs from each other
0.005	1.47	*-5.23	Control
0.001	1.58	*-9.23	Control	Redecision therapy
0.056	1.71	4.30	Redecision therapy	Minuchin’ structural therapy	Decreasing effective relationship
0.001	2.59	*-16.70	Control
0.001	2.79	*-20.99	Control	Redecision therapy
0.001	4.24	*19.04	Redecision therapy	Minuchin’ structural therapy	Marital conflicts
0.001	5.40	*-56.24	Control
0.001	6.61	*-75.29	Control	Redecision therapy

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