Solution-Focused Marathon Sessions

Nova Southeastern University NSUWorks

CAHSS Faculty Articles Faculty Scholarship

3-2010

Michael D. Reiter Nova Southeastern University, [email protected]

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NSUWorks Citation Reiter, M. D. (2010). Solution-Focused Marathon Sessions. Journal of Systemic Therapies, 29 (1), 33-49. https://doi.org/10.1521/jsyt.2010.29.1.33

This Article is brought to you for free and open access by the Faculty Scholarship at NSUWorks. It has been accepted for inclusion in CAHSS Faculty Articles by an authorized administrator of NSUWorks. For more information, please contact [email protected]. Solution-FocusedJournal of Systemic Therapies,Marathon Vol. 29, No. 1, 2010, pp. 33–49 33

SOLUTION-FOCUSED MARATHON SESSIONS MICHAEL D. REITER, PH.D. Nova Southeastern University

Solution-focused therapy has been around for approximately 20 years. It has been used in a variety of contexts including schools, agencies, and private practice and with a wide range of clients including children, adolescents, couples, and families. The current article addresses how solution-focused therapy can be used in a marathon session format. The paper addresses how solution-focused therapy makes sense, in some circumstances, being conducted in a marathon-session format. The article details how various aspects of solution-focused therapy are amenable to the unique context of marathon sessions and what some contraindications are for this format. A case example is provided to exemplify the benefits of this unique format.

Solution-focused brief therapy (SFBT) has been around for over 20 years. Developed by Steve de Shazer, Insoo Kim Berg, and colleagues (de Shazer et al., 1986), it has been used in a variety of contexts including schools, agencies, and private practice and with a wide range of clients including children, adolescents, couples, and families. This approach attempts to shift client’s focus from what is not working and the problems of life to what has worked, and then build upon these strengths and resources to move toward solutions. This article addresses how solution-focused therapy can be used in an extended-time format. Solution-focused marathon sessions (SFMS) enable therapists and clients to engage in an extensive and intense interaction, allowing unique opportunities for a switch from a problem- focused story to solutions. The present article focuses on How are various aspects of solution-focused therapy, such as the miracle question, exceptions, and the use of therapeutic letters used in SFMS? With the use of a case example, we hope to demonstrate this unique format.

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33 34 Reiter

SOLUTION-FOCUSED MARATHON SESSIONS

Psychotherapy tends to be conducted in one hour blocks. Managed care companies have shifted from reimbursing for a 60-minute hourly session to 50 minutes or even 45 minutes. However, this timeframe for how long a therapist meets with a client is arbitrary. By maintaining a standard one-hour session, the therapy might be limited. Shapiro (2000) explained, “Discus- sion regarding the expansion of the time frame in treatment is important because clinicians lock into a certain time schema that may be uncreative and not optimally responsive to a patient’s problems” (p. 18). The author has developed a format of contacting clients that alters the time schema while continuing to use the standard principles of solution-focused therapy. This approach is used primarily with couples and families in crisis. Solution-focusd marathon sessions tend to last four hours. After an initial joining stage, the therapist focuses on the clients’ concerns. Although solution-focused therapists may veer away from problem-talk or quickly shift to solution-talk, in SFMS more time is spent discussing each par- ticipant’s perspective. Since the clients that this format is most useful for are usually in crisis—a couple who are contemplating divorce and giving their marriage one last chance, or a family dealing with intergenerational conflict—this initial time is used in hearing and validating each person’s concerns. This segment of the SFMS usually lasts about 30 minutes to two hours, depending on how much previous open discussion occurred in the couple or family. Approximately halfway through the session, the miracle question is asked. Before the clients provide answers to the miracle question, a break of about 10–15 minutes occurs. (The break might be longer if used for a lunch or dinner break.) After the break, the SFMS shifts into the details of the miracle picture. This part of the session usually lasts approximately 30 minutes to one hour as the miracle is broken down into small goals. The next 30 minutes to one hour are spent fleshing out the exceptions to their miracle picture. The last ten minutes of the session are used to present a task, usually the First Session Formula Task (FSFT). Approximately three days after the SFMS, the therapist sends the couple a therapeutic letter, detailing what occurred during the session as well as comments and ques- tions designed as interventions. Subsequent marathon sessions, if there are any, are used to discuss follow-up from the first session as well as highlighting the outcomes of the Solution-Focused Marathon 35

FSFT, the components of the miracle, as well as other exceptions. The subsequent sessions might also be used as a forum for participants to continue to discuss areas of concern they have that might not have been brought up in the first marathon session or areas that seem not to be progressing.

SFBT COUPLES THERAPY

SFMS tend to be used primarily with couples, especially those who are contemplating separation or ending their relationship. SFBT is very appropri- ate for work with couples, even high conflict couples, as it helps the two individuals to focus on what they want out of their relationship. It can be used for premarital counseling (Murray & Murray, 2004), couples groups (Nelson & Kelly, 2001), divorce prevention (Weiner-Davis, 1992) or for any other type of couple issue. The Divorce Busting® work of Michele Weiner-Davis might be the most famous application of solution-oriented work with couples. Her work includes an average of four to six sessions designed for each partner to focus on what is working in the relationship and doing more of that. Her focus is on keeping the couple together so that they do not divorce. One of the primary differences, besides length of sessions, of the current application of SFMS and Weiner-Davis’ work is that SFMS is not focused on keeping the couple from divorcing, dissolving the relationship. In fact SFMS might also be used to help couples to end their relationship in a productive fashion, particularly if they have children together. However, attempting to prevent divorce can fit nicely within a SFMS format. Hoyt and Berg (2000) explained the relationship between the problems that couples have and how SFBT can be useful to them: “A ‘problem’ arises and a couple seeks therapy (intervention) when the partners view their situation in such a way that they do not have access to what is needed to achieve what they consider reasonable satisfaction” (p. 144). In work with couples, as well as for individuals and families, the same three general rules of SFBT hold. First, if it is not working, do something different. Second, if it isn’t broke, don’t fix it. Third, once you know what works, do more of it. These rules do not need to be overtly explained, but will demonstrate themselves in therapy. For the first SFMS, the conversation starts around finding out about the first rule, what has not been working for the client(s). When working with 36 Reiter couples and families during marathon sessions, this portion of the session allows each individual to feel heard by not only the therapist, but hope- fully the spouse and/or other family members. During this in-depth discussion of what is not working, the therapist begins to explore what is working—what is not problematic—in the client’s life. This addresses the second rule about not changing patterns that are working. After the break in the SFMS, the therapist then focuses the clients around issues of the third rule; finding the exceptions to their complaints and then trying to find out how the client may start engaging in more exception times. For subsequent SFMS, time is mainly spent on rules two and three, where conversation centers on what clients have done differently and for those behaviors that are working for them, how they can do more. However, time may be also spent in further exploring aspects of their lives that are still not working and moving the conversation toward exceptions. One of the biggest deviations of a SFMS from a typical SFBT session is the extra focus on problem-talk. Having a future focus is a key for these clients, as the past will probably be mired in complaints. However, many couples come to therapy as a last resort and have many built-up frustra- tions and complaints they would like to vent. The goals of SFBT focus on what clients want to have happen in their future. Often, with high conflict couples and families, people have built up a wall because they have not received the acknowledgement of their concerns. Allowing a significant space in a solution-focused therapy session allows this process to occur.

THERAPEUTIC LETTERS

Bacigalupe (2003) explained, “Brief therapy demands that therapists focus on creating a context for change in every interaction with their clients” (p. 1). These interactions may be before therapy ever starts, via the telephone and the intake process, during actual sessions, and between sessions. Between sessions the interaction can happen via the use of therapeutic letters. These letters not only summarize what has already occurred in therapy, but they can act as a means of promoting the therapeutic process (Pyle, 2006). Letters can help to shift a client’s focus from the past to the present and the future. Bacigalupe (1996) stated, “Writing in systemic therapy can help clients to distance themselves from problem-saturated descriptions, mobilize multiple meanings and voices and facilitate the re- Solution-Focused Marathon 37 storying of their dilemmas” (p. 372). Therapeutic letters have been used quite effectively in postmodern oriented therapies, and perhaps the narrative therapy camp has used them to the greatest extent (Epston, 1994; White & Epston, 1990; White, 1995). Solution-focused therapists have also extensively used letters in their therapeutic practice (see Alexander et al., 2008; Nunnally & Lipchik, 1989; Shilts & Ray, 1991). Alexander et al. (2008) explained the purpose of solution- focused letters, “Written to enhance the positive aspects of face-to-face therapy, letters summarize meetings, link people and events, contain meta- phoric language, and help turn ideas into interventions” (p. 59). These letters are not merely summaries of sessions, but act as a catalyst to continue therapeutic change by getting clients to focus on their preferred outcomes and what they might do to get there. Therapeutic letters written by the therapist can be delivered to the client during or at the end of a session, or sent to the client at some point after a meeting. One important aspect of solution-focused letters is that they match where the client is at in the therapeutic process (Shilts & Ray, 1991). Letters try to focus on changing where the client is stuck to where they might no longer be restrained. These authors explained, “The letter provides the therapist the opportunity to punctuate the system and interrupt the repetitive cycles that keep the client from changing” (p. 94). Since the length of time and intensity of Solution-Focused Marathon Ses- sions may be overwhelming in remembering all that took place, therapeutic letters can be used to good advantge. The letters can be used to help re-orient the client to the primary areas of exploration during the session. Therapeutic letters written after a SFMS tend to follow the following format:

(a) Where the client is now (based on the discourse of the session) (b) Where the client came from (focusing around the problem-talk) (c) Exceptions (d) Miracle picture (e) Hopes/Goals (f) Scales (if the solution-focused therapist utilized them (g) Client agency (how they have been proactive in trying to solve their problem) and (h) Focus on the future (what they might think about or do to help them reach their goals). This last portion usually includes any tasks the therapist might have given them. 38 Reiter

BRIEF THERAPY, EXTENDED SESSION Single-Session Therapies The use of a SFMS might only occur once with the clients, and as such, therapists who use this format should be prepared to have this one session, albeit a marathon session, be all that a client may need. Perhaps the first modern therapist to have used a single-session toward a productive out- come was Sigmund Freud (Talmon, 1990). However intentional it might be, many clients find that they get all the necessary gains they need with one meeting. In outpatient therapy settings, it is very common to have single-session meetings with clients (Rosenbaum, Hoyt, & Talmon, 1990). Given that the modal number of sessions a client will go to a particular therapist is one (Miller, Duncan, & Hubble, 1997), therapists will quite often only meet with a client for that all-important single session. Utilizing that first, and perhaps only, session is extremely important. Rosenbaum, Hoyt, and Talmon (1990) and Talmon (1990) provided several guidelines for therapists to enhance a single-session therapy.

First, expect change. Next, view each encounter as a whole, complete in itself. Third, do not rush or try to be brilliant. Focus on strengths and abilities as opposed to pathology. The real change occurs out in the real world, when clients live their lives. Next, focus on pivot chords to contextualize problems into a greater pattern where new opportunities/perspectives open up for clients. For example, a therapist could highlight that the couple was able to not engage in a pattern of defensiveness and attacking while talking to each other in session and use that occurrence as a foundation for future positive interchange between the two. Large problems do not necessarily need large solutions. And, lastly, termination can, and should, be a good thing. Thus, there are definitive actions therapists can engage in to try to enhance the effectiveness of their first, and perhaps last, meeting with a client.

Therapists can come into therapy with a mind-set designed to enhance immediate change. Hoyt (1994) explained that the rationale for single- session solutions is for the client to have some shift in understanding. Thera- pists and clients usually do not go into an encounter thinking that it will be Solution-Focused Marathon 39 only one session, but they can go into it with the openness to see how they can make the most use of the session, regardless of the length. Hoyt (1994) explained that in successful single-session solutions, the client changes patterns that have been self-limiting. Further, clients view themselves differently, especially in how they are constructing stories about themselves from constricting stories to stories of possibilities. By contracting for an extended length of time to meet with each other, therapist and client make a statement to each other about the importance of the SFMS and come into it with expectations of change. There is a difference for a client in com- mitting for a one-time one-hour session rather than a four-hour session. Clients seem to expect significant change from attending a single SFMS. Brief therapy can be as brief as five minute sessions or potentially a single marathon session of 10 hours. However long the session, the goal is the same: to help the client as quickly as possible (Hoyt, 2000). Some modali- ties may be more apt to utilize a single-session for effectiveness. Solution- focused brief therapy seems to be one of these approaches that can have very good results in just a single session (see Iveson, 2002 and Perkins, 2006).

Marathon Sessions Given that the modal number of therapy sessions clients come to is one, it would seem imperative to utilize that first session to its utmost possibilities. Engaging in a marathon session helps to do this as it is a way to get as much work in as possible during the time that the client and therapist interact. Marathon sessions have primarily been used in the group therapy format (Stranger & Harris, 2005; Weigel, 2002). They had their heyday during the 1960s and 70s and have gone somewhat out of favor in today’s therapeutic world (Weigel, 2002). These sessions usually lasted over two to three days. Traditionally in group therapy, the marathon approach was used for extended continuous periods (whole days), where participants received little or no sleep. Part of this was to fatigue the individual to get past their defenses and allow them to have a true encounter with others (Weigel, 2002). Stranger and Harris (2005) explained how the use of marathon sessions has been helpful. Although they discuss them in terms of group therapy, it seems the same holds for couples and family therapy. They say, “The basic principle being that time- extended contact (as opposed to the usual 1.5 hours per week) allows for the 40 Reiter enhancement of therapeutic factors and provides the opportunity to capital- ize on these factors to further clients’ therapeutic goals” (pp. 146–147). In psychoanalytic literature, extended time of sessions tends to be discussed as double sessions (Cohen, 1980; Shapiro, 2000). Cohen provided five goals for the double session (not all applicable when considered out- side the realm of psychoanalytic therapy). The first goal is the accelera- tion of the removal of certain defenses, such as blocking, denial, obsessive trends, phobias, intellectualization, and isolation. Second, help break down ritualistic behavior patterns. Third, double sessions provide an opportunity to work through conflicts in the dependence-separation dimension. Fourth, provide a positive holistic experience in an interpersonal situation. Fifth, double sessions provide adequate time within one session to make periodic assessments of the status of the analysis. Family therapy has periodically utilized extended time in session with clients. James Framo may be the most notable of using this format. Framo (1992) conducted family-of-origin (FOO) sessions where he would bring in the family members of a client or couple he was working with. These FOO sessions were originally four hours in length. After discussion with a family therapist who was utilizing his model but had made a modifica- tion to the format, Framo switched to have two hours on Friday night and then two hours on a Saturday morning. If the four-hour session was held on one day, then there was a break of a few hours in the middle. Framo found that the break between these sessions provided several benefits to the therapy including having the family risk more in the first session (knowing there will be a second session), having an opportunity for follow-up to material presented in the first session, and perhaps greater openness of family members. Other notable family therapists who utilized marathon sessions include Carl Whitaker and Salvador Minuchin. Minuchin (personal communica- tion, March 12, 2010) explained that, after finding out that Whitaker would have families come to Wisconsin for a weekend and have a two hour session with them in the morning and then a two hour session in the afternoon, he decided to borrow this format and experiment with it as well. Although he found these sessions to be intense and useful, he only conducted three or four of these types of sessions. Multiple impact therapy has also utilized intensive sessions with families (Shaw, Fore, Ritchie, McAnulty, & Nixon, 1977). This process was developed in the 1950s in Texas to help troubled families. In this approach, the family meets with a multidisciplinary team, Solution-Focused Marathon 41 perhaps consisting of a psychiatrist, psychologist, clinical nurse special- ist, and a social worker (although other helping professionals can be included). During the two-day intensive session, the therapy team meets with the family in various configurations, such as individually, in subsystems (i.e., parents, siblings), and the whole family and team. Currently, marathon sessions are used to allow couples and families to stay engaged with each other and the therapist. These sessions address the issues they are dealing with that have brought them to therapy, as well as the poten- tials of their relationship, then shift the conversation to their future goals via focus on exceptions and the miracle question. SFMS are amenable to incorpo- ration of philosophies and techniques from other theories, such as an exploration of how issues of gender and power are impacting the couple. Integrating solution-focused therapy with narrative therapy can be quite productive in a marathon format. The foundation of the marathon session is conducted through a solution-focused modality with the possibility of narrative therapy concepts facilitating the discourse. The author works in a private practice designed spe- cifically for couples who are “on the brink”—potentially ready for dissolution of their relationship. Usually, when these couples present in the office, they have a litany of complaints, usually extremely strong, that they want to get off their chest. Thus, solution-focused marathon sessions were developed to allow the clients to initially express themselves on what they do not want in their relationship while in the same session allowing movement of the discourse toward the picture of the future that the clients are imagining. A case illustration follows.

CASE ILLUSTRATION

Pete* called up the day of the session requesting a male–female co- therapy team. Only the author was available to meet with the couple. The couple had called the therapy office while driving to the divorce lawyer but had wanted to give their marriage one more chance. Their family consisted of two sons, twelve and ten, who were not seen in therapy. The SFMS began with a focus on their present concerns. Pete started by say- ing that the relationship was in serious trouble, and we began exploring their concerns of their relationship. Pete and Christie had been married

*All identifying information was changed to protect for anonymity. 42 Reiter for seventeen years and had had a very pleasurable honeymoon period in their relationship. Over the last few years, Christie had been becoming increasingly concerned about what she saw as Pete’s depression and anger. She did not like when he yelled at her or their children. Although she did not fear violence from him, she felt that the negativity emitted by Pete was too overwhelming for the marriage. Pete’s concern was that Christie had just recently informed him that she had met with a lawyer and had drawn up divorce papers. He stated that he was still in love with Christie and wanted to make the marriage work. He agreed with her that, at times, he got angry, but that he had never been physically abusive in the relationship. Christie was concerned about Pete’s anger as well as potential depression, which there was a family history of in Pete’s family. During this portion of the SFMS we discussed how Christie had “put up a wall” to protect her feelings against what she saw as Pete’s unpredictable anger. Approximately midway through the four-hour marathon session, I asked them the miracle question. We then had a short break, and when we reconvened we began focusing on their answers to the miracle question. They were both thoughtful in their responses. Pete stated his miracle would include lovemaking in the morning (it seems Christie displayed grumpiness in the morning), joking around, and being comfortable with one another. Christie’s miracle included the use of positive words to one another, Pete helping their children on their schoolwork, giving lots of smiles and hugs to each other, and having a peaceful and calm home. For most of the second half of the marathon session we explored their miracle and how they had already been doing many pieces of their miracle (exceptions). At the end of the SFMS, I gave them the First Session Formula Task. de Shazer (1985) explained, “The first session task was designed to shift the clients’ focus from the past to present and future events and implicitly to promote expectations of change” (p. 137). It asks clients to focus, during the interval between sessions, to notice what is happening in their life/relationship that they want to continue to happen. I asked Christie and Pete to pay attention to all of the things that the other is doing that they want to continue to happen or have happen more of and to notate this, either men- tally or by writing it down. I knew that this couple utilized notes, especially Christie, who had come to the first session with a written list of some of her major concerns for the marriage. Solution-Focused Marathon 43

One of the aspects of the SFMS is to send the client a therapeutic letter. Before the couple left, I asked them if they would be okay with me writing up what I thought occurred in the session and sending this to them via email. They both agreed. Three days after the session, the couple was emailed the following letter:

Dear Christie and Pete, I am writing you this note to share some thoughts with you both from our recent meeting. Firstly, thank you for coming and sharing your story with me. It was extremely important that you recognized that you were indeed a couple on the brink, yet somewhat hopeful because you were determined to give your marriage at least one more try. You told a story of frustration, resentment and anger. Also, Christie, you shared some of the ways Pete is a good husband and how, even through the veil of anger, you continue to love him. Pete, you shared your commitment to Christie and your family and your hope to move forward to a happier future together. Is it possible that you might be at the beginning of finding new ways to explore the potential of your marriage? Can you tap into your present commitment to each other and your marriage to uncover a new level of strength that might help you to find and unfold a happier future? It would be very interesting to see what happens when the two of you renegoti- ate your marriage. At our session, we discussed how anger has taken on a large role in your relationship. A role that neither of you wants it to have. It seems that anger, and its cousins, resentment and frustration, have enveloped your marriage. This has, at times, prevented calm- ness, respect and love to shine through. It seems in the beginning of the relationship, this wasn’t the case. As you said, “It was a great love affair.” It will be very interesting to see how, with a renegotiation of what your marriage is and what it means to be husband and wife to each other, what type of love affair you are able to have. It is really nice to know that you both are deciding to be more assertive (different than disre- spectful) and trying to figure things out to be in the relationship that is mutually satisfying. We all agreed that the present role that anger has in your marriage is just not working. This is the mystery. How is it that two intelligent and nice people, who clearly have love for each other, continue to engage in a process that is destructive for them? I’m not sure how you 44 Reiter

might engage in disagreements/fights with one another that are more productive, but this is a definite possibility and one that each of you has an active role in figuring out. Conflict can be a very good thing in a relationship, as you learn so much more about the other person and what they are hoping for and wanting. Things such as name-calling and spi- raling out of control tend to overshadow this. Thus, if you see that your new discussions on disagreements are starting to spiral into your old pattern, how might you remind each other that that way of arguing isn’t useful for you two? What I think would be very interesting for you both, is instead of letting anger get so between you, would be if the two of you could gang-up on anger and not let it play such a prominent role in your marriage. This is where you would both develop the skills of Healthy Fighting. In our session we talked about possibilities and miracles. Some of the things that you said you would notice if a miracle happened included:

• Lovemaking in the morning (right when getting up) • The use of positive words to one another • Helping your sons on their work • Giving lots of smiles and hugs to each other • Having a peaceful and calm home • Joking around with one another • Being comfortable with one another

What I found interesting about your miracle picture is how many of these things have been happening in your marriage throughout your 17 years. It is amazing how periodic bits of hurtful anger (expressing itself in negative rather than positive ways) overshadows all of this. One thing I was quite excited about was our talk of emotional foreplay. For Christie, this was in showing respect to her as a woman. This process it seemed, takes days. Pete talked about this in terms of physical comfort/caressing. I can foresee a time when Pete is doing a lot of complimenting, no loud yelling (name-calling), prizing Christie, which would lead to Christie finding this quite attractive and leading to physical closeness, which would lead to more respecting which would lead to more physical comforting. . . . This would lead to a calmer feeling Solution-Focused Marathon 45

around the house and a greater sense of happiness, for everyone. This would also be related to the wall that the two of you talked about that is between you. Every day of this emotional foreplay will bring down more and more pieces of that wall. Again, I think more conversation on what each of you can do to work together to bring down the wall would be useful. Remember that lasting change often takes time and may initially be challenging. How you decide to move forward now will lead you to reconfirming your relationship and creating some way to recommit to each other . . . from this point forward. One thing that Christie sug- gested that seems to be a beautiful thing is that, when the miracle has really taken hold, the two of you might renew your vows to one another. Those vows, written individually, will surely be very powerful. I hope that our time together was useful for you. We left the session with an assignment: Pay attention to all of those things (big, small, and everywhere in-between) that the other person is doing that you like and that you want them to continue to do (or do more of). You should notate these things and we can talk about them when we meet again. Take good care of yourselves, Michael

The couple came back for their second marathon session three weeks later. At this point, there was an additional therapist to form a male–female co- therapy team. I began the session by asking them, “What is better since the last time we talked?” The couple’s demeanor was remarkably different from the previous session, and they said there had been a 180-degree turn. They explained how they both had felt listened to and understood at the previous session and that no one’s side was honored more than the other. They both agreed that having the marathon session was extremely useful. They had gone to couples counseling in the past, but going for only one hour, one time a week had left them wanting more. Their explanation was that spending four hours hashing things out and being heard, and then talking about what their vision of the future was allowed them to connect in a way they hadn’t in a long time. A day or two after the first marathon session they had sat down with each other and “put everything on the table.” They explained that although at the end of the first session there was still a wall up, it had started to 46 Reiter lower and that with each sign of effort on each other’s part more pieces of the wall had came down. Christie and Pete had put serious thought and effort to the between session assignment (FSFT). They each brought a list, pages long, of actions that they noticed the other person doing that they wanted them to continue to do. We started with Pete’s list and asked Christie if she could guess what Pete noticed. She said that having sex with him would be on there, which he agreed. Then she guessed about cooking dinner and taking care of the children. These were on the list as well. For the next 30 minutes we discussed the various components of Pete’s list and then asked Christie what this told her about Pete that these were what he noticed. She said that she saw that he was really trying. She related this to the metaphor of the wall and how seeing him take this therapy, and working at the marriage, very seriously helped her to bring down some of that wall. Then we focused on Christie’s list. We asked Pete to guess what was on Christie’s list. He did a good job of guessing. We spent another 30 minutes or so talking about what Christie noticed Pete doing. There was a lot (she had about six pages worth, having notated each day for the three weeks between sessions). At the end, we asked Pete what this told him about Christie, that these were what she noticed. He said that he was happy to see that she could notice these and still loved him because their marriage was the most important thing to him. During the session we discussed their concern that some of the negative patterns (or as they called them, “bad moments”) would reemerge. These bad moments were reframed into learning episodes where they could take a step back and observe the process of their interactions and see if that was what they wanted. The couple, during the three weeks between sessions, had come up with what they had called, “the do-over,” where, if they started to see past patterns that they didn’t want, they would take a few minute break and then engage each other in discussion again. They found that this worked for them. We highlighted this exception and discussed with them how they might continue to be creative like this to see how their relationship can be enhanced further. Since the couple had worked very hard during the two sessions and the intervening three weeks and had made miraculous strides, we all decided that the best thing to do was to end the session early and keep the remaining hour-and-a-half in the bank for future use. Solution-Focused Marathon 47

ADVANTAGES AND DISADVANTAGES

Solution-focused marathon sessions allow the model to take action within the first session, as it gets maximum use of a single visit. It is used primarily with couples and families in crisis and allows client(s) to have time to tell and hear each other’s view of the problem. By providing an extended length of time for problem-talk, members’ views may change within the session. Clients are able to hear another person’s viewpoint, consider and respond to it, and then see how there might be a shift to a discourse of solutions. Another benefit of using SFMS is that clients may be from a non- local area and still receive services. Couples and families can drive or fly to an area where the therapist works and have lengthy therapeutic services for a time period of one to three days. Although there are many benefits to SFMS, there are some contraindications. The first is that it may be difficult for clients to use insurance to pay for the session. Further, many practitioners of the SFBT model may not provide a diagnosis (which is necessary for many insurance companies), thus, clients tend to pay cash for this type of format. Cash payments might limit the number of clients that can participate and also may draw these clients from a small pool. However, given the setting, therapists may be able to figure out how they might provide this format for those who are not able to afford the normal fee. Another difficulty with SFMS is that the upfront cost for the session may be initially shocking for the client. Clients might be used to thinking in terms of how much one session costs. A SFMS is, in essence, four sessions combined into one. Thus, the cost will probably be about four times that for a normal one-hour session. A further contraindication may be exhaustion. Because a significant amount of time is spent in one session (a four-hour model is presented here but it might be shorter or longer), clients and therapist may be exhausted during portions of the session. Many SFMS occur at night or on the weekend. For those occurring at night, clients have usually spent their day at a full-time job. Sessions typically last from 6 in the evening to 10 pm, and clients may be tired from their day. Lastly, time can be an issue. Because four hours tends to be too lengthy of a period for younger children, it is not recommended that younger children be included in SFMS, or at least not for the whole of the session. Thus, clients with children must make arrange- ments for extended babysitting services. 48 Reiter

CONCLUSION

Solution-focused brief therapy is an approach that helps clients move from the past to the present and the future. Utilizing aspects of hope and expectancy (Reiter, in press) it shifts clients’ lenses from the problems of their lives to solutions. SFBT is also an approach that is quite amenable to being used in various settings and contexts. This article presented the utilization of solution-focused marathon sessions and how these can be extremely useful for certain clients. SFMS provides more flexibility for problem talk, allowing each member of the couple/family to express themselves as well as feel heard by the other members. There is also more in-session discussion of the miracle picture during one specific time period, instead of spreading the beginning of the miracle conversation over several sessions. Interestingly, SFMS and traditional one-hour SFBT have the same probable number of hours. SFBT traditionally has an average of about six sessions. SFMS may total anywhere from 4–16 hours over one to three days, but usually only one or two marathon sessions are needed. By staying engaged with each other as well as the therapists for extended amounts of time during the session, couples are able to move past the problem-saturated talk that has been bogging them down to co-create a vision of their future that they are then able to take steps toward achieving.

REFERENCES

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