Women's power bases may reflect social and cultural gender inequities. They may be financially vulnerable and subsequently or concurrently psychologically weaker. Power outcomes for women in household and childcare tasks favored male partners, in particular those who were in non-depressed couples. Power processes were also less constructive and more problematic in such couples compared with non-depressed couples (Byrne and Carr, 2000, page 422). With respect to power bases, the lack of economic power is associated with depression for women. Isabelle was a stay-at-home wife/mother, while Kyle worked. Overtly and implicitly, Kyle asserted his right as breadwinner and man-of-the-house. This is consistent with other research connecting economic disadvantages within marriage to depression. Men and women who rely on passive-aggressive behaviors are also distinctly associated with depression. Isabelle's over spicing could possibly have been a passive-aggressive response to Kyle greater power in the relationship. In terms of power processes, depression was related when women who perceive frequent demands from their husbands where the husbands would subsequently withdraw. How often did Kyle really need to work late or was working late a way to avoid Isabelle's demands? Relative to power outcomes, depression is more common when women perceived partner under or non-involvement in household and childcare tasks, and when both partners were dissatisfied in this sharing or non-sharing or these responsibilities. (Byrne and Carr, 2000, page 424). "The findings on passive aggression and husband-demand-wife-withdraw as characteristic of depressed wives, when considered in conjunction with the findings on poor power outcomes for depressed wives, are consistent with strategic therapists' theories on the role of depression in managing marital power imbalances (Coyne, 1986; Haley, 1963; Price, 1991). However, these results are also consistent with a stress and coping formulation in which withdrawal and passive aggression are coping strategies used to manage the stressful demands that may be perceived to exceed depressed female partners' personal resources"(Byrne and Carr, 2000, page 424-25)
Influences upon a couple and for each partner may come from gender stereotypes perpetuated by layers of models. While social influences, especially economic ones affect the couple and each partner, there can be significant differences in male versus female expectations in addressing depression and anxiety, much less even acknowledging them. These expectations may be significant by themselves and/or have important reciprocal influences on the functioning of the partners. They may have impact on the development of depression as well. Gender roles can define expectations differently for men versus women (Fincham et al., 1997, page 351). Women tend to be more highly rated than men on helpfulness, kindness, and compassion. They seek and practice greater devotion and show more emotional support to others. Family and cultural training causes gender roles to be internalized. That may include women placing greater emphasis on the care of others whether or not personal needs are being met. Sacrifice to save a relationship is a common expectation, which coincides with women being seen as more relationship oriented than men. More willing to self-disclose, women tend to take greater responsibility for the relationship quality. When the relationship is troubled, women have a strong tendency to feel and take greater responsibility. They may feel at fault if things do not work out or anticipate others blaming them for failure. Rating emotions as more importantly than men, women also talk more about emotions and personal problems.
"In response to marital discord, then, women may be particularly likely to use emotion-focused coping, focus on the difficulty they are having, and blame themselves for marital problems, placing themselves at greater risk of depression (Nolen-Hoeksema, 1987). Such observations might lead one to hypothesize a relatively stronger prospective effect of marital discord on depressive symptomatology for women than for men" (Fincham et al., 1997, page 351-52). Since depression and anxiety are significantly related, it is not surprising that Lundren et al (1980, page 238) found that stability and gratification in a solid rewarding marriage was a critical factor for low anxiety in wives. For husbands, however, how they evaluated themselves was more important than relational variables (or how their wives perceived them) on emotional functioning. Since women may be more relationship oriented than men and hold a greater sense of responsibility for dealing with relationship problems, they may also be more vulnerable to relationship stresses than men. While men may be more prone to respond in a dismissive style to partner issues, women may be less likely to or proficient at deflecting negative emotional distress with relationship conflict. This would be consistent with other research of women's greater vulnerability to depression in unsatisfactory relationships. Poor marital satisfaction tends to lead to depression more so for women, while depression tends to lead to poorer marital satisfaction for men. "…men may respond to their own depression by denigrating their relationships or by withdrawing from relationships to a greater extent than is true for women. This would account for the greater effect of depression on marital satisfaction among men than among women" (Fincham et al., 1997, page 355-56). The male gender role emphasizes activity and overt displays of anger- even retaliation for wrongs. Men have greater tendency to get or make others change with direct influence strategies such as rewards, coercion, asserting expertise, and intimidation. They are expected to be calm in crises and not back down when confronted. Such internalized role expectations can result in men perceiving interpersonal conflict as a competition to win. Being seen as withdrawing or trying to withdraw from conflict is not acceptable. An unfortunate consequence of various combinations of these tendencies can be a lessened likelihood to take responsibility for relationship problems. Men become more likely to minimize the importance of partners' grievances. They are become more prone to distract selves and others from negative feelings or to leave problematic situations to avoid blame or to calm down. Kyle did all these things in his marriage with Isabelle. These behaviors can manifest in times of intense emotional distress and complicate what would otherwise be shared bonding experiences.
Serrano and Lima (2006, page 592) examined the effects of miscarriage and repeated miscarriages on couples. Women reported higher levels of suffering than men. There are often different social expectations for men versus women. Miscarriage is an emotional and social negative experience for both partners. For women, however it may also be a physical event with considerable complications and trauma. While men experience deep loss after miscarriage, they are often hesitant to openly express grief. They may suppress their own feelings to support the partner-mother. Loss and depression may become loss and depression for both partners… and experienced alone. It may be more intense for men if they feel forced to deny their feelings. This is a significant qualifier to the commonly found following assertion. "Thus, men may be relatively less likely to become dysphoric in response to marital problems and more prone to withdraw from and denigrate the relationship when they are dysphoric. Such a pattern seems consistent with a relatively stronger effect of depression on marital satisfaction for men than for women. (Fincham et al., 1997, page 351-52). Research is fairly consistent in finding gender differences in depression, anxiety, and marital and other intimate relationships. However, while men may self-report or behaviorally show emotions more or less intensely, their internal experience may be just as intense or even more intense given potential adherence to gender roles expectations that are in conflict with having or showing emotional/psychological distress. The therapist may find that Kyle is in deep distress and profoundly depressed and anxious, but unable to express those feelings because of a "man code." The therapist must be aware of not seeing women and men in terms of stereotypes however validated by research. The therapist should continue to see clients as individuals who may benefit (or not) from his/her exploration of how stereotypes may be relevant.
The therapist should be aware of other potential gender differences that may be relevant to an individual's and the couple's experience of depression and anxiety. The quality of intimacy between partners affects interactions with one partner who is depressed. Marriage has been found to have positive health benefits, but the benefit may not be the same for both partners. It "may depend on the degree of intimacy in the relationship… husbands with the lowest levels of depression had emotionally independent wives, and wives with the lowest levels of depression felt like they were important to their husbands. In other words, concordance of well-being was different for husbands and wives" (Stimpson et al., 2005, page 387). Women tend to have greater mediating and moderating skills in conflict communication along with significantly higher levels of constructive communication, demand-withdrawal, and avoidance. Women are more likely to express demands, while men are more likely to withdraw during problem solving discussions. This may be because "differences in conflict communication behaviors arise from differences in the consequences of engaging in conflicts- considering the effects of the social structure within which men and women are embedded rather than from intrinsic sex differences in the way that men and women communicate (Vogel & Karney, 2002) (Heene et al., 2005, page 431). Later discussion will further examine the effect of communication characteristics on depression, anxiety, and the relationship. Attachment style, which may be a major contributor to relationship functionality also has relevant gender differences. Women relative to men report significantly higher levels of anxious-ambivalent and avoidant attachment. Men compared to men report significantly higher levels of secure attachment style.
The therapist should be aware of that "…the correlations between attachment style, depressive symptoms, and marital adjustment were stronger and more consistent in the female sample, with mediating and moderating effects of attachment style for women only; these results are partially consistent with prior findings (e.g. Mikulincer et al., 2002). Other studies nevertheless reported that ambivalent attachment style ratings had stronger associations with men's marital satisfaction than women's (e.g. Feeney, 1999a, 1999b; Simpson, 1990) or that depressive symptoms and marital adjustment are generally associated for both men and women (e.g., Mikulincer et al.). Overall, wives seem more sensitive than husbands to their relationships (Bradbury et al., 1996), and previous studies have demonstrated that women tend to put more effort into maintaining romantic relationships than do men (Scott & Cordova, 2002). Because traditional female gender roles encourage women to take responsibility for maintaining relationships (Surra & Longstreth, 1990), and because of the different problems faced by males and females in close relationships, this may in turn engender sex differences in conflict communication, attributional activity, and attachment styles (e.g. Bradbury et al.; Scott & Cordova; Vogel & Karney) (Heene et al., 2005, page 432). Attachment considerations in depression and anxiety will be further discussed later in this book. Any and all of these considerations and more may be relevant for the therapist to explore with a couple such as Kyle and Isabelle.