Review: Case Report: Treating Marital Resentment with Radical Honesty in Strategic Family Therapy {under peer review}

 

Reviewer: Dr. Fernan Torreno

 

Completed: 23-03-2026 21:27

 

Recommendation: Resubmit for Review

 

 

	Yes	No	N/A
Is the research question clearly defined?	+
Are the methods appropriate and sufficiently detailed?		+
Is the data analysis robust and replicable?		+
Are the conclusions supported by the results?		+
Is the manuscript well organised and clearly written?		+
Are tables, figures, and supplementary material informative and necessary?	+
Is the abstract an accurate summary of the study?	+
Does the manuscript contribute meaningfully to the field?		+
Is it relevant to the field of mental health or related disciplines that are connected to the scope of the Journal?	+
Are ethical approvals and participant consents adequately described?	+
Have competing interests, funding, and data availability been transparently declared?	+

 

Comments for the authors:

 

This manuscript addresses a clinically relevant topic and the paper’s central aim is identifiable: to present a strategic family therapy case in which “radical honesty” is used to address longstanding marital resentment in a brief couples treatment. The abstract is broadly consistent with the paper, and the manuscript is clearly within the general scope of mental health and psychotherapy case reporting. The inclusion of ethics, consent, funding, competing interests, and data availability statements is also a strength.

At the same time, in its current form the manuscript does not yet meet the level of methodological and evidentiary rigor expected for publication as a clinical case report. The main concern is that the manuscript repeatedly makes efficacy-like claims from a single uncontrolled case while the data sources are limited to therapist-generated material, patient reflections, and therapist-led interpretation. The paper explicitly states that no formal pre/post measures were administered and that standardized outcome metrics were not used, while also acknowledging the absence of objective benchmarking, quantitative generalizability, and reliability metrics. Those admissions are important, but they substantially limit the strength of the conclusions.

A second major concern is that the analysis is not sufficiently replicable. The manuscript states that coding involved NVivo plus a custom Python pipeline using spaCy and pandas, but it does not provide enough operational detail to allow a reviewer to understand what exactly was coded, how codes were generated, how disagreements or ambiguities were resolved, what the codebook contained, what the unit of analysis was, or how the automated and manual outputs were integrated. The paper says a codebook was developed and that outputs were cross-referenced and validated, but the analytic workflow remains too high-level for reproducibility.

Third, the paper often reads as an advocacy piece for the author’s preferred model rather than a balanced case report. The framing contrasts Strategic Family Therapy with Emotionally Focused Therapy in a way that can sound polemical, and the conclusion extends beyond the evidence presented by asserting that the case demonstrates the value of this approach where treatment-as-usual modalities may be insufficient. For a single-case design without independent outcome assessment, this is too strong. The argument would be more credible if the authors limited claims to feasibility, clinical plausibility, and hypothesis generation.

Fourth, there is a substantial risk of interpretive bias because the therapist is also the investigator, coder, and primary narrator of change. The manuscript does mention reflexivity, journaling, peer consultation, and audit trail strategies, which is appropriate, but those steps do not adequately substitute for independent assessment. Given that the reported outcomes are closely aligned with the author’s theoretical commitments, stronger safeguards against confirmation bias are needed or, at minimum, the paper should discuss this limitation more directly and prominently.

Fifth, the manuscript would benefit from substantial tightening and reorganization. There is considerable repetition across the introduction, theoretical foundation, analytic commentary, outcomes, and conclusion. Some passages are rhetorically forceful but not analytically necessary. In several places, the manuscript shifts from case description into philosophical defense of therapist authority and “ethical disruption,” which dilutes the clinical reporting focus. The paper would be much stronger if shortened and reorganized around standard case-report structure: presenting problem, assessment, intervention, data sources, analytic procedure, outcomes, limitations, and cautious implications. The duplication in the back matter should also be corrected; the data availability statement appears twice, and “Disclosure Statement Funding” appears to reflect a formatting/editing error.

More specifically, I encourage the authors to revise in the following ways:

Reframe the manuscript as a case report, not as proof of efficacy.

Replace causal or comparative claims with more cautious language. This case can illustrate how the intervention was implemented and what changes were observed, but it cannot establish superiority, effectiveness, or insufficiency of alternative approaches.

Strengthen the methods section substantially.

The authors should specify:

the full analytic sequence step by step,

the unit of analysis,

how thematic, content, and narrative analyses were combined,

the contents and development of the codebook,

what the Python/NVivo workflow actually produced,

whether any independent reviewer examined transcripts or codes,

how contradictions were resolved in practice rather than in principle.

As written, the methods are described, but not in enough detail to be meaningfully reproducible.

Temper the conclusions.

The results currently consist mainly of selected quotations, therapist observations, and post-session reflections, with no formal outcome measurement. Conclusions should therefore be limited to observed within-case change and possible mechanisms, not broad claims about strategic family therapy or radical honesty as a clinically validated model.

Address bias and dual-role issues more directly.

Because the therapist is also the researcher, the manuscript should explicitly discuss how this dual role may have shaped intervention delivery, coding, interpretation, and outcome assessment.

Reduce rhetorical overstatement and theoretical defensiveness.

Several sections read more like a defense of a philosophical position than a clinical case analysis. Condensing those passages would improve clarity and credibility.

Clarify the novelty claim.

The manuscript argues that it contributes “early empirical groundwork,” but a single case without independent outcome measurement is better positioned as exploratory or hypothesis-generating. The contribution should be stated more modestly.

Edit carefully for language and formatting problems.

I noted repetitive sections, some awkward or grammatically incorrect sentences, table numbering confusion, duplicated statements, and minor typographic issues. These should all be corrected before the manuscript is reconsidered.

 

In summary, the topic is relevant and the case may have value as a descriptive clinical illustration. However, the manuscript currently overinterprets a single uncontrolled case, lacks sufficient analytic transparency for replication, and is written in a way that often exceeds the evidence presented. With major revision, especially a much more restrained interpretation and a clearer methods/reporting structure, the paper could become more suitable for review.