Vol. 2 No. 1 (2026)

Case Studies

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

Published 25-02-2026

  • Ezra N. S. Lockhart

Ezra N. S. Lockhart
National University

Abstract

Emotionally Focused Therapy is commonly treated as treatment-as-usual for entrenched relational resentment and emotional disconnection, relying on attachment repair through empathic, emotion-oriented engagement. This case report offers a clinically and ethically grounded alternative by using Strategic Family Therapy, which emphasizes therapist-directed systemic pattern disruption rather than intrapsychic exploration or affective processing. The case involves a heterosexual couple in their early 40s, married 18 years, presenting with chronic resentment during an empty-nest transition. Across three 90-minute sessions, the therapist integrated radical honesty as a directive, systemic intervention with radical presence as a stabilizing stance. Interventions included direct systemic confrontation, therapist vulnerability, and strategic reframing, all deployed within Haley’s strategic model. Data from transcripts, therapist notes, and patient reflections were examined through thematic, narrative, and content-analytic methods. Radical honesty, operationalized through explicit therapist-driven challenge, disrupted ingrained avoidance sequences and generated relational accountability. Radical presence enabled the therapist to maintain ethical attunement while sustaining pressure without escalating hostility. The couple shifted from reciprocal blame to shared responsibility through structured disruption rather than insight or empathic attunement alone. This case demonstrates that, within SFT, radical honesty and presence function as deliberate tools of ethical disruption, supporting relational change where treatment-as-usual modalities may be insufficient.

Keywords

Marital Therapy, Family Therapy, Truth Disclosure, Psychotherapy, Time-Limited Psychotherapy, Emotions

Full text (HTML)

References

  1. Almeida, B., & Cunha, C. (2023). Time, resentment, and forgiveness: Impact on the well-being of older adults. Trends in Psychology, 1–20. https://doi.org/10.1007/s43076-023-00343-2
  2. American Association for Marriage and Family Therapy [AAMFT]. (2015). Code of ethics. https://www.aamft.org/AAMFT/Legal_Ethics/Code_of_Ethics.aspx
  3. Andersen, T. (1991). The reflecting team: Dialogues and dialogues about the dialogues. W. W. Norton.
  4. Anderson, C., & Erstling, S. S. (1983). Common problems in application. In R. F. Luber & C. Anderson (eds.), Family Therapy with Psychiatric Patients (pp. 121–137). Human Sciences Press.
  5. Angus, L. E., & Greenberg, L. S. (2011). Working with narrative in emotion-focused therapy: Changing stories, healing lives. American Psychological Association. https://doi.org/10.1037/12325-000
  6. Angus, L. E., & McLeod, J. (2004). The handbook of narrative and psychotherapy: Practice, theory, and research. Sage Publications.
  7. Asen, E. (2002). Outcome research in family therapy. Advances in Psychiatric Treatment, 8(3), 230–238. https://doi.org/10.1192/apt.8.3.230
  8. Barman, J. D., Maheshwari, S., & Varma, P. (2022). The conflicts and conflict management in stable middle-class marriages: An Indian perspective. The Family Journal. https://doi.org/10.1177/10664807221124231
  9. Bateson, G. (1972). Steps to an ecology of mind: Collected essays in anthropology, psychiatry, evolution, and epistemology. University of Chicago Press.
  10. Bobrow, E., & Ray, W. A. (2005). Strategic family therapy in the trenches. Journal of Systemic Therapies, 23(4), 28–42. https://doi.org/10.1521/jsyt.23.4.28.57840
  11. Bolton, G. (2010). Reflective practice: Writing and professional development (3rd ed.). SAGE Publications.
  12. Boscolo, L., Cecchin, G., Hoffman, L., & Penn, P. (1987). Milan systemic family therapy: Conversations in theory and practice. Basic Books.
  13. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
  14. Broderick, C. B. (1993). Understanding family process: Basics of family systems theory. Sage.
  15. Brown, J. M. (2012). The Milan principles of hypothesising, circularity and neutrality in dialogical family therapy: Extinction, evolution, eviction… or emergence? Australian and New Zealand Journal of Family Therapy, 31(3), 248–265. https://doi.org/10.1375/anft.31.3.248
  16. Brothers, B. J. (1993). Make love not war—or at least make meaning. Journal of Couples Therapy, 3(4), 1–6. https://doi.org/10.1300/J036v03n04_01
  17. Bruner, J. (1990). Acts of meaning. Harvard University Press.
  18. Carlson, C. I., Ross, S. G., & Stark, K. H. (2012). Bridging systemic research and practice: Evidence-based case study methods in couple and family psychology. Couple and Family Psychology: Research and Practice, 1(1), 48–60. https://doi.org/10.1037/a0027511
  19. Carr, A. (2019). Couple therapy, family therapy and systemic interventions for adult‐focused problems: The current evidence base. Journal of Family Therapy, 41(4), 492–536. https://doi.org/10.1111/1467-6427.12225
  20. Carr, A. (2025). Couple therapy and systemic interventions for adult‐focused problems: The evidence base. Journal of Family Therapy, 47(1), e12481. https://doi.org/10.1111/1467-6427.12481
  21. Daneshpour, M. (2024). Couples therapy and the challenges of building trust, fairness, and justice. Family Process, 1–15. https://doi.org/10.1111/famp.13072
  22. de Shazer, S. (1985) Keys to solutions in brief therapy. W. W. Norton.
  23. de Shazer, S. (1988) Clues: Investigating solutions in brief therapy. W. W. Norton.
  24. de Shazer, S., & Berg, I. K. (1997). ‘What works?’ Remarks on research aspects of solution‐focused brief therapy. Journal of Family Therapy, 19(2), 121–124.
  25. Dewey, J. (1938). Experience and education. Macmillan Company.
  26. Donkoh, S., & Mensah, J. (2023). Application of triangulation in qualitative research. Journal of Applied Biotechnology and Bioengineering, 10(1), 6–9. https://doi.org/10.15406/jabb.2023.10.00319
  27. Finlay, L. (2002). “Outing” the researcher: The provenance, process, and practice of reflexivity. Qualitative Health Research, 12(4), 531–545. https://doi.org/10.1177/104973202129120052
  28. Gagnier, J. J., Kienle, G., Altman, D. G., Moher, D., Sox, H., & Riley, D. (2013). The CARE guidelines: Consensus-based clinical case reporting guideline development. Journal of Clinical Epidemiology, 67(1), 46–51. https://doi.org/10.1016/j.jclinepi.2013.08.003
  29. Greenberg, L. S. (1988). Emotionally focused therapy for couples. Guilford Press.
  30. Greenberg, L. S. (2010). Emotion-focused therapy: A clinical synthesis. Focus, 8(1), 32–42. https://doi.org/10.1176/foc.8.1.foc32
  31. Haley, J. (1958). The art of psychoanalysis. Et Cetera, 15(3), 190–200.
  32. Haley, J. (1959). An interactional description of schizophrenia. Psychiatry, 22(4), 321–332. https://doi.org/10.1080/00332747.1959.11023187
  33. Haley, J. (1973). Uncommon therapy: The psychiatric techniques of Milton H. Erickson MD. W. W. Norton.
  34. Haley, J. (1984). Ordeal therapy. Jossey-Bass.
  35. Haley, J. (1993). Uncommon therapy: The psychiatric techniques of Milton H. Erickson, M.D. W. W. Norton.
  36. Haley, J., & Erickson, M. H. (1959). Hypnosis and therapeutic consent: Ethical implications in clinical practice. American Journal of Clinical Hypnosis, 2(2), 49–84.
  37. Hargaden, H., & Sills, C. (2014). Transactional analysis: A relational perspective. Routledge. https://doi.org/10.4324/9781315820279
  38. Harris, R. (1990). Language, Saussure and Wittgenstein: How to play games with words. Psychology Press.
  39. Hedges, F. (2005). An introduction to systemic therapy with individuals: A social constructionist approach. Palgrave Macmillan.
  40. Hintikka, J. (1979). Language-games. In E. Saarinen (ed.), Game-Theoretical Semantics: Essays on Semantics by Hintikka, Carlson, Peacocke, Rantala, and Saarinen (pp. 1–6). Springer Netherlands. https://doi.org/10.1007/978-1-4020-4108-2_1
  41. International Committee of Medical Journal Editors [ICMJE]. (2022). Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals. Retrieved from http://www.icmje.org/
  42. Jockers, M. L., & Thalken, R. (2020). Text analysis with R: For students of literature (2nd ed.). Springer. https://doi.org/10.1007/978-3-030-39643-5
  43. Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection (2nd ed.). Brunner-Routledge.
  44. Johnson, S. M., & Greenberg, L. S. (1985). Differential effects of experiential and problem-solving interventions in resolving marital conflict. Journal of Consulting and Clinical Psychology, 53(2), 175–184. https://doi.org/10.1037/0022-006X.53.2.175
  45. Johnson, S. M., & Greenberg, L. S. (1987). Emotionally focused marital therapy: An overview. Psychotherapy: Theory, Research, Practice, Training, 24(3S), 552–560. https://doi.org/10.1037/h0085753
  46. Kolb, D.A. (2015). Experiential learning: Experience as the source of learning and development (2nd ed.). Pearson.
  47. Krippendorff, K. (2018). Content analysis: An introduction to its methodology (4th ed.). Sage Publications.
  48. [Author]. (2024). Increasing transgender acceptance in religious families: A pilot study of manualized strategic family therapy. International Journal of Systemic Therapy, 36(1), 1–34. https://doi.org/10.1080/2692398X.2024.2408135
  49. [Author]. (2025a). Jay Haley’s ethical legacy: Bioethics, family therapy, and the AAMFT code. History and Philosophy of Medicine, 7(3), 15. https://doi.org/10.53388/HPM2025015
  50. [Author]. (2025b). Review of ‘Strategies of Psychotherapy.’ ScienceOpen. https://doi.org/10.14293/S2199-1006.1.SOR-UNCAT.BKNHO5.v1.RPIIEL
  51. [Author] (2025c). Jay Haley’s model of strategic family therapy: An epistemological inquiry. Philosophy, Psychiatry, & Psychology. Advanced online publication. https://doi.org/10.1353/ppp.0.a971258
  52. Lord, S. (2017). Mindfulness, intimacy, and presence: Moments of meeting in psychotherapy. In S. Lord (Ed.), Moments of Meeting in Psychoanalysis: Interaction and Change in the Therapeutic Encounter (pp. 358–374). Routledge. https://doi.org/10.4324/9781315389967
  53. McLeod, J. (2011). Qualitative research in counselling and psychotherapy (2nd ed.). Sage Publications.
  54. McNamee, S. (2016). The ethics of relational process: John Shotter’s radical presence. In Joint action (pp. 101–113). Routledge.
  55. McNamee, S. (2020). Radical presence: Alternatives to the therapeutic state. In D. Loewenthal, O. Ness, & B. Hardy (Eds.), Beyond the Therapeutic State (pp. 55–65). Routledge.
  56. McNamee, S. (2021). Radical presence: A relational alternative to mindfulness. In R. Aristegui, J. G. Campayo, P. Barriga (Eds.), Relational Mindfulness: Fundamentals and Applications (pp. 51–63). Routledge.
  57. McNamee, S., & Shawver, L. (2004). Therapy as social construction: Back to basics and forward toward challenging issues. In T. Strong, & D. Paré (Eds.), Furthering Talk: Advances in the Discursive Therapies (pp. 253–270). Springer.
  58. Minuchin, S. (1974). Families and family therapy. Harvard University Press.
  59. Minuchin, S. (2007). Jay Haley: My teacher. Family Process, 46(3), 413–414. https://doi.org/10.1111/j.1545-5300.2007.00220.x
  60. Morales, E. (2020). Mindfulness as an embodied relational resource in generative dialogue. In A. Arnold, K. Bodiford, P. Brett-MacLean, D. Dole, A. M. Estrada, F. L. Dugin, B. Milne, W. E. Raboin, P. Torres-Dávila, & C. F. Villar-Guhl (Eds.), Social Construction in Action (pp. 126–134). Taos Institute Publications.
  61. Perez, J. C., & Karney, B. R. (2025). Financial strain and couple relationships: Acknowledging the material challenges of couples living with low socioeconomic status. In N. C. Overall, J. A. Simpson, & J. A. Lavner (Eds.), Research Handbook on Couple and Family Relationships (pp. 298–313). Edward Elgar Publishing. https://doi.org/10.4337/9781035309269
  62. Roddy, M. K., Walsh, L. M., Rothman, K., Hatch, S. G., & Doss, B. D. (2020). Meta-analysis of couple therapy: Effects across outcomes, designs, timeframes, and other moderators. Journal of Consulting and Clinical Psychology, 88(7), 583–596. https://doi.org/10.1037/ccp0000493
  63. Roth, S., & Epston, D. (1998). Consulting the problem about the problematic relationship: An exercise for experiencing a relationship with an externalized problem. In M. F. Hoyt (Ed.), Constructive Therapies (Vol. 2; pp. 148–162). Guilford Press.
  64. Small, M. L., Brant, K., & Fekete, M. (2024). The avoidance of strong ties. American Sociological Review, 89(4), 615–649. https://doi.org/10.1177/00031224241263602
  65. Shotter, J. (2005). ‘Inside the moment of managing”: Wittgenstein and the everyday dynamics of our expressive-responsive activities. Organization Studies, 26(1), 113–135. https://doi.org/10.1177/0170840605049718
  66. Solovey, A. D., & Duncan, B. L. (1992). Ethics and strategic therapy: A proposed ethical direction. Journal of Marital and Family Therapy, 18(1), 53–61. https://doi.org/10.1111/j.1752-0606.1992.tb00914.x
  67. Spengler, P. M., Lee, N. A., Wiebe, S. A., & Wittenborn, A. K. (2024). A comprehensive meta-analysis on the efficacy of emotionally focused couple therapy. Couple and Family Psychology: Research and Practice, 13(2), 81–99.
  68. Stake, R. E. (1995). The art of case study research. Sage Publications.
  69. Stake, R. E. (2013). Qualitative research: Studying how things work. Guilford Press.
  70. Vetere, A., & Stratton, P. (2016). Interacting selves: Systemic solutions for personal and professional development in counselling and psychotherapy. Routledge.
  71. Villa, V. (2024). A joint endeavour: Working with couples. In E. Haynes (Ed.), A Transactional Analysis of Motherhood and Disturbances in the Maternal (1st ed., pp. 242–258). Routledge. https://doi.org/10.4324/9781003365822
  72. Vos, J., & van Rijn, B. (2021). The evidence-based conceptual model of transactional analysis: A focused review of the research literature. Transactional Analysis Journal, 51(2), 160–201. https://doi.org/10.1080/03621537.2021.1904364
  73. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. W. W. Norton.
  74. Williams, B. C. (2016). Radical honesty: Truth-telling as pedagogy for working through shame in academic spaces. In F. Tuitt, C. Haynes, & S. Stewart (Eds.), Race, Equity, and the Learning Environment: The Global Relevance of Critical and Inclusive Pedagogies in Higher Education (pp. 71–82). Routledge.
  75. Wilner, R. S., Breit, M., & Im, W. G. (1988). In defense of strategic therapy. Contemporary Family Therapy, 10(3), 169–182. https://doi.org/10.1007/BF00895619
  76. Wittenborn, A. K., Liu, T., Ridenour, T. A., Lachmar, E. M., Mitchell, E. A., & Seedall, R. B. (2018). Randomized controlled trial of emotionally focused couple therapy compared to treatment as usual for depression: Outcomes and mechanisms of change. Journal of Marital and Family Therapy, 45(3), 395–409. https://doi.org/10.1111/jmft.12350
  77. Zhu, J. (2018). "We're not cheaters": Polyamory, mixed-orientation marriage and the construction of radical honesty. Graduate Journal of Social Science, 14(10), 57–78.