Daphny,+Teresa+&+Melissa's+Sample+RFA+Paper

Introduction The purpose of this paper is to provide a meta-theoretical understanding of a narrative therapy case involving a young man with schizophrenia. Using the model of Recursive Frame Analysis, the authors will demonstrate how cases are conceptualized through a narrative framework. The authors will also show how using narrative techniques can shift conservations away from problem talk toward more solution orientated discussions.

Case Description

Paul is an 18 year old Hispanic male who was referred to the Community Counseling Service by his school psychologist. Paul is in his final semester of high school and attends an alternative school where he will finish his class work by December. Paul is brought to his appointments by both his mother and his father who are still married but have been separated and living in separate homes for the last 12 years. Paul lives with his mother and his father lives in a separate home. He has one older brother who is 21 years old, but he does not live in the home with Paul. Paul entered therapy with questions about hypnosis. He shared with the therapists that he believed that he induced self-hypnosis with the assistance of a computer program. He stated that he inserted a subliminal message into this computer program, and this subliminal message has changed his “consciousness” and “unconsciousness.” He does not know how to correct this. He was diagnosed with schizophrenia by his psychiatrist when he was 16 years old. He started experiencing problems in school and was referred to the CCS by his school psychologist. Paul complains that he is unable to un-hypnotize himself and would like to find resources for help with his problem. Although Paul expressed that his symptoms started a year ago when he started “feeling empty” and “being detached from his emotions and senses.” The psychiatrist informed Paul’s co-therapists that Paul’s father also has a diagnosis of schizophrenia. Paul’s co-therapists recommended that he seek out an order for a CT scan from his primary care physician to rule out an organic reason for his sudden change in behavior. Paul is a slightly overweight Latino man in his late teens. He appeared a bit disheveled and was wearing shorts and a tee-shirt. His long black hair was pulled back into a pony tail that sat low on his neck. Paul was wearing glasses and displayed decreased psychomotor activity. He displayed limited eye contact with the therapists. Although Paul appeared to understand the questions, he generally responded with one word answers. He had minimal spontaneity and most often spoke in a low voice that could only be understood by those sitting close to him. His mood appeared mildly depressed as evidenced by expressions of hopelessness about his hypnosis and further exemplified in his overall slow physical actions and responses. Paul demonstrated a decreased intensity and range of affect as he tended to stay in a very flat and narrow range of emotion. His therapists observed poor recent memory as evidenced by an inability to remember events of the prior week. Paul appeared to function at the borderline range of intelligence. This was indicated by his completion of work for his courses and graduation December 2006. Paul had a minimal vocabulary but understood and demonstrated knowledge in technological and computer related concepts. Paul also played strategic video games and understood the humor in various television shows. Paul’s thought was often incoherent and illogical. He expressed his delusion of the subliminal messages and hypnosis and often laughed or smiled to himself. He most recently asked questions such as, “What?” or “What did you say” when no one was talking. He was unable to report what he heard or to what he was responding. He was goal-directed so much as he wished to find a means of un-hypnotizing himself. Throughout the session, he demonstrated slow thinking and difficulty with some questions. There was no evidence of perceptual disturbance such as hallucinations during the interview. He expressed unusual ideas such as the description of being controlled by the messages from his computer. Paul also appeared worried about his feelings of sense-lessness and existing without a soul. Paul’s co-therapists diagnosed him on Axis I with schizophrenia, disorganized type: 295.1. The DSM-IV TR classifies schizophrenia as a combination of both positive and negative symptoms and signs that have been present with the individual for a significant portion of time lasting at least one month (2000). The signs and symptoms are usually demonstrated with impairment in social or occupational areas for the individual. His diagnosis was also not better accounted for by another disorder, substance use, or general medical condition. According to his psychiatrist, Paul displayed prominent delusions as well as hallucinations. He encapsulated a range of cognitive and emotional dysfunctions such as perception, inferential thinking, language and communication, behavioral monitoring, affect, fluency and productivity of thought and speech, and attention (DSM-IV-TR, 2000). Paul displayed a decrease and loss of normal functions and this resulted in his negative symptoms. He is classified as disorganized type because of his disorganized speech, behavior, and flat and inappropriate affect (DSM-IV TR, 2000). The co-therapists have deferred diagnosis on Axis II: 799.9. Axis III is also deferred dependent upon medical test results from his primary care physician. Axis IV included information on the strained relations in his family between his parents and his desire for his parents to one day live together again. Axis IV also included information on the client’s inability to plan for the future. Axis V is a Global Assessment of Functioning range of 31-40. This range is denoted by the client having some impairment in relation testing or communication or major impairment across the areas of work, school, family relations, judgment, thinking, or mood. Considered together, this diagnosis and Paul’s current state of functioning posed problems for Paul and his family. The client had perpetually tried to “un-do” the hypnosis with no relief. He has acquired the assistance of his parents in his journey to find a way to “get back to normal” and this has changed the lives of his parents. The family is very supportive and involved with Paul and this involvement has shown Paul the strength of his family while simultaneously positing challenges to the lives of his parents.

History of Narrative Therapy

Researchers rely on scientific methods to find answers to the problems of mental disorders. However, constructionism is challenging empirical methodology and the very nature of its explanation. It is changing the way physical existence is understood while also challenging what research regards as “mental.” Postmodern theorists believe that one cannot know reality directly. Central features of postmodern therapies include an emphasis on knowledge, a concern about the politics of therapy, and a rejection of reliance on psychological laws (Drewery, Winslade & Monk, 2000). Narrative is described historically as a guide we use to make sense of our world. According to Kelly (1998), people’s lives and relationships are shaped by the stories they tell and the meaning they make out of their experiences. Individuals produce meanings and these meanings emerge in specific contexts, rather than being given and applied in these contexts. Meaning does not occur in an isolated context, it is constructed socially (Drewery & Winslade, 1997). Subsequently, we make sense of our lives in the context of our past social experiences. We shape our stories according to the groups we associate with and how we turned out to be who, how, and where we are in our lives. Narrative therapy takes the perspective that individuals do not have direct contact with reality. It states that we do not know reality directly, but people think of themselves as eliciting stories or discourses that help them make sense of their world. Discourses are the stories or statements that individuals make about how they believe the world should be. Furthermore, Sluzki (1992) claims that discourses are the frameworks used to make sense of the world and they also give structure to our relationships.

Major Influences

Michael White and David Epston developed narrative therapy, an approach to psychotherapy and counseling that draws from postmodern constructivist ideas. It focuses on the uniqueness of every individual and does not use diagnostic categories. According to narrative therapy, an individual’s understanding is a constructed meaning scheme that is ascribed to the self. It also holds that an individual’s meaning is constructed through linguistics. A person’s narrative about the self helps provide a sense of congruence and continuity in their life. The objective with narrative therapy is to assist clients in becoming aware that the source of problems is due to a restrictive self story. It is through awareness that an individual is able to distance themselves from the restrictive story and begin the process to create a new story (Polkinghorne, 2000).

Overview of Narrative Therapy

Narrative therapy involves the telling, retelling, and reconstructing of life stories (Draucker, 2003). The first strategy of narrative therapy is to assist the client in deconstructing their problem story. The deconstruction phase opens the client to their awareness of the self-stories and the cultural assumptions built into them. This can be accomplished through externalizing conversations where the client engages in unmasking their hindering stories and replacing them with a more preferred story. By using externalization, the client is able to distance themselves from the problems they have generated. The second strategy is to reconstruct the self-stories by creating an alternate and preferred interpretation of who they are and who they will soon be. This stage is also known as re-authoring. Re-authoring the life story is not a matter of making the client into someone else, but rather a process of devising a story that displays past actions and serves as a guide for future ones. Reconstructing allows the client to create unique outcomes. Unique outcomes occur when a client contradicts their dominant self-story through their actions. This attending to unique outcomes allows the individual to make visible life events that had been made invisible by their old self-stories (Polkinghorne, 2000). Both externalizing the problem and identifying unique outcomes serve to separate clients from previous self-stories. This allows the client to play an active role in how they see themselves (Polkinghorne, 2000).

Problem Formation, Maintenance, and Resolution

//Problem Formation// From a narrative perspective, problems originate when clients develop and adhere to stories about their lives that define themselves as problematic (Freedman & Combs, 1996). The person is placed in a problematic position in the story they tell about their life (Monk, Winslade, Crocket, & Epston., 1997). In Paul’s case, the problem story began when he did hypnosis on himself and, as a result, experienced changes in his body and an altered state of consciousness. Paul described this altered state of consciousness as not being able to feel emotions and a lost connection with his soul. Considered with a narrative lens, it may be that Paul has embodied a story that he could form changes in himself, and then maintain these changes. The formation of his problem is the prelude to his continuous story of hypnosis. Narrative therapy was founded on social constructionist beliefs. Social constructionists assert that all knowledge is a representation of the language shared between people and not something an individual possesses. When looking at a case through a social constructionist lens, one considers how the person’s social, or interpersonal, reality has been constructed through their interaction with other individuals or institutions, and how social realities influence the meaning people make of their lives (Freedman & Combs, 1996). It is unknown at this time what social or environmental conditions brought on the client’s change in consciousness. Paul told his therapists that, at the time of the hypnosis, he was using a computer program that produces subliminal messages in an attempt to make himself smarter and make his muscles grow. Paul’s father reported that Paul was a typical child growing up; he was very active and had many friends. The client’s father informed the therapists that Paul’s behavior changed abruptly when Paul was 16 years old. Currently, he isolates himself and prefers his television shows, video games, and computer research over conversing or being among family or friends.

//Problem Maintenance//

According to narrative theory, after the problem is formed, the individual adopts the problem and uses it to create a problematic story. This story is perpetuated as the person continues into the maintenance stage. At this level, the individual continues to live within the problematic story and in doing so, becomes rehearsed into unhelpful habits. Paul lived with this problematic story and through living this story, maintained his behaviors and constrained his interactional options. The story was also maintained in the belief that anything he attempted will not fully rid him of the hypnosis and bring back his feeling. Paul had tried, unsuccessfully, to use his computer to reprogram himself back to normal. He also visited a professional hypnotist who was unable to undo his hypnotic state. As a result of these disappointments, Paul started to believe his brain is damaged and cannot be fixed. This story became a self-fulfilling prophecy and a meaningful stage where he perpetually remained (Monk et al., 1997). He had gotten caught up in the problem story to the point where he was no longer able to attend to times when the problem was not influencing his life, such as when he was able to feel emotions while watching comedy television or listening to music.

//Problem Resolution//

Narrative therapists work with their clients to develop alternative stories that create new meanings and allow for new behaviors. This is based on the premise that people are resourceful, they are life-long learners, and they can continually and actively re-author their lives. In a sense, narrative therapists help clients create alternative histories, or different ways of looking at the problem. They collaborate with their clients to bring forth new stories that do not support or sustain the problem (Freedman & Combs, 1996). For Paul, the problem will be resolved when he returns to feeling “normal” or “alright,” though he has not been able to articulate what those two words mean for him. The therapists on this case are working with the client to bring forth stories that do not support or sustain the problem. They have been using narrative techniques to help Paul develop a story of his life that is meaningful and potentially fulfilling despite his current state of consciousness. This has entailed helping Paul uncover what is left that he can still do successfully, allowing him to see that there are still a lot of things he can do, and also help him feel comfortable with the 5% of his brain that he feels still functions correctly.

Recursive Frame Analysis

Recursive Frame Analysis (RFA) is a method used in understanding and deconstructing conversations (Keeney, 1991; Chenail, 1995). RFA provides therapists a means of conceptualizing dialogue and framing the context into problems or solutions. It also gives therapists a way to maneuver within conversations to help clients develop alternative views of the problem story. RFA can be represented graphically through the use of symbols representing shifts in meaning. In RFA a //gallery// is used to demonstrate a “framing of frames” (Keeney, 1991, p. 56). Within the gallery, //frames// are used to denote conceptual or cognitive views of the client’s particular situation and are ways of labeling context (Chenail, 1995). In the following case study, the //presenting gallery// represents the client’s problem story. Through dialogue, the therapists and client traverse frames through the numerous galleries that develop in the course of therapeutic conversation. Therapists are then able to utilize frames as resources. To move from one gallery to another, an "opening" is required. Keeney (1990) sees this as a therapeutic distinction which he calls an //entrance maker//. Our //bridging galleries// are the //entrance markers// that we used to exemplify openings that invite our client to move the conversation from the problem gallery into a new, therapeutic gallery. The //therapeutic gallery// portrays the therapists’ attempts at co-constructing a new story in which the client is empowered to overcome his presenting problems. Through dialogue and graphical representations, the following case analysis demonstrates the therapists’ use of RFA to conceptualize the shifts in meaning that occurred over the course of five sessions.

The Case of Subliminal Messages and Hypnosis

Problem Gallery A: Paul did hypnosis on himself and now he feels his mind is insane.

Frame A-1P: As a result of the hypnosis, Paul has a terrible feeling throughout his body and it’s given him a “bad life”.

//Comment:// Narrative therapy assumes that the problem is formed and maintained within the story of the client. In order to get an understanding about the meaning of the story for Paul, the therapists began with asking him about his experience with hypnosis. This was an important place to start because it initiated a dialogue about the problem story while staying within the client’s beliefs regarding what happened.

A: So when did all this start?

P: [mumbles] One year ago.

A: A couple years ago?

P: One year ago.

D: What was happening around the time when this started? What was happening in your life?

//Comment:// This is an example of the therapists asking //curious questions//. Curious questions put the therapist in a position of “not knowing” while giving space for the client to describe how he perceived the problem. The therapists were also trying to gain an understanding of what was happening in his life when the problem presented.

P: Nothing much, just some… I’d rather not say what I did.

D: Okay. But you were doing some stuff and then what happened?

P: As a result of doing this to myself my mind is now messed up and insane.

D: Okay. What does it mean to be messed up and insane?

P: It’s hard to explain.

D: I’m really just curious. Any small words you can use, just to kind of give me an idea, give us an idea?

P: I also have this terrible feeling throughout my entire being.

D: Mmm-hmm

P: Yeah, it doesn’t feel good.

A: And this has been going on for how long?

P: It’s been going on for like a year now.

A: A year now? What was the difference? What was it like before?

//Comment:// This example showed the therapists attempting to move the client out of the presenting gallery into the bridging gallery, while getting to know the client apart from the problem and began the process of //externalization//, both fundamental concepts in narrative therapy.

Frame A-2P: He felt a change in his consciousness and his mind is “not right.”

B: You did a lot of research on the Internet and in the process of doing this… tell me exactly what it was that happened to you during your research process.

P: I did some hypnosis on myself and now my mind is not right.

B: Not right. How did you figure out that it was the… tell me about the hypnosis, what happened, so we can maybe track back and pull it apart.

//Comment:// Through //deconstructive questioning//, the co-therapists prompted the client to describe how the problem began for him. Deconstructive questioning was used to gain an understanding of the dominant story. Through the use of various questions, therapists obtained a bigger picture of the problem which was used to find possible sources of the problematic dominant narrative.

P: I did a lot of things to my mind that I want to undo, a whole load of hypnosis that I did on myself.

B: Mmm-hmm.

P: I’d rather not say what I did.

B: Better not, ok. We want to stay within your comfort level. Were you just doing a lot of reading on the… as you were doing your research. How did you realize you were hypnotized? I guess maybe that’s a better question.

P: I felt a change in my consciousness.

B: Can you… that’s probably a really hard thing to describe, isn’t it, the change in your consciousness.

P: Yeah.

B: But were you doing things differently as well, when this change in consciousness happened?

P: No… no.

B: So nobody could really tell by looking at you or watching what you were doing that this change in consciousness had happened.

P: Well, my father always… no, no, not really.

B: Your father kind of, you guys are pretty close so...

P: Yeah

B: So he kind of new something was going on for you.

//Comment:// Here the therapist asked a //relative influence// question about the client’s father and whether he picked up on any changes in the behavior. Relative influence questions were used to elicit the client’s understanding of the problem as it might be seen from another person’s perspective. This technique allowed for an exploration of alternative narratives, or meanings, for the client. Frame: Terrible feeling and a bad life Frame: Felt a change in consciousness and now mind is “not right” ||
 * ** Paul did hypnosis on himself and now his mind is “insane” **


 * Figure 1: Presenting Gallery A**

Bridging Gallery A: Undo the hypnosis.

B: Have you tried to undo the hypnosis on your own?

P: Uh… yeah. I’ve tried, uh… No, no, not really.

B: Not really.

P: No.

B: I wonder what would happen if [client’s name] tried to hypnotize himself to be back to his old state of consciousness.

D: Because it sounds like he did a good job getting himself hypnotized, and getting into that, changing his thinking, so I’m wondering if he could do it again, change his thinking again.

B: Or maybe that’s too scary.

D: I don’t know.

P: Yeah.

//Comment:// Staying within the client’s frame of reference and using the client’s language, therapists began co-creating possible solutions with the client. This is an example of the client re-authoring the problem story to one that offers hope for change. Frame : Terrible feeling and a bad life Frame: Felt a change in consciousness and now mind is “not right” ||
 * Paul did hypnosis on himself and now his mind is “insane”


 * ** Undo the hypnosis ** . ||
 * Figure 2: Bridging Gallery A**

Therapeutic Gallery A: Help Paul get back to his previous state of consciousness.

Frame A-1T: Have Paul explain what it means, or what it feels like, to be in a better state of mind.

B: If you were in a better state of mind, how do you think, you said you would feel different? Can you think of what that feeling might be?

P: Yeah, I would feel. Yeah, I would be, I’d be back to the way I was before I used hypnosis. I’d be alright.

B: You’d be alright.

P: Yeah.

B: Yeah. And how did you feel when you were alright?

P: Normal.

B: Normal. So it’s kind of like wanting to return to normal. Okay

D: Mmm-hmm. The good thing is that you were there at one time, right?

B: Man this must really be hard.

Frame A-2T: Problem solve with Paul ways he can hypnotize himself back.

//Comment:// The therapists connected the Bridging Gallery to the Therapeutic Gallery. Frame A-3T: Ask Paul to identify any glimpses of normal in his life.

B: Is there any piece of normal in your life right now, [client’s name]? Any glimpses of normal in your life right now?

P: Not really.

B: Not really? You’re able to go to school, right?

P: Yeah.

B: Yeah, and Ken told me you were doing pretty well, like a month away from graduation? A credit and a half?

P: Yeah.

B: How have you managed to accomplish that in this “not normal” state?

P: I don’t know. I just…I don’t know.

B: There’s a real strength there.

D: Mmm-hmm.

A: Yeah.

B: That he’s able to push away this not normal state of consciousness in order to be able to do well in school. I can imagine that he doesn’t know what he wants to do after graduation; this seems like the biggest challenge for him right now to try to get back to this…some feeling of normal.

//Comment:// Within this Therapeutic Gallery therapists used Keeney’s (1991) “Weaving” frame-to-frame relationship. The language used in the above transcript took the client’s identification of glimpses of normal in his life and through conversation with the therapists, frames were implanted and replanted which provided proof that the conversation belonged in that gallery. This weaving assisted in strengthening the therapeutic gallery.




 * Finishing high school ||


 * Interviewing for jobs ||

||


 * Pushing hypnosis away ||


 * Identifying glimpses of normal ||

Frame: Paul explains what it means, or what it feels like, to be in a better state of mind. Frame: Problem solve with client ways he can hypnotize himself back. Frame: Ask the client to identify any glimpses of normal in his life. ||
 * Help Paul get back to his previous state of consciousness.




 * Undo the hypnosis. ||

Presenting Gallery B: Paul feels incomplete.
 * Figure 3: Weaving and**
 * Therapeutic Gallery A**

Frame B-1P: Paul cannot feel things.

A: Last week, [client’s name], you were telling us that you can’t really touch the wall and you couldn’t really feel that too much. I mean you could feel that it’s the wall but you can’t feel the feeling…is that what you were kind of telling me?

P: Yeah.

A: Is it like that with other things too?

P: Yeah.

A: Why do you think it is like that?

P: Well, because of something I did that to myself in the hypnosis but I’d rather not say.

A: Okay, but it was because of that, hypnosis?

P: Yeah.

Frame B-2P: Paul is unable to feel his “soul”.

A: And you also mentioned that your soul, you can’t really feel it?

P: Yeah, yeah.

D: Has that changed at all since last week?

P: No, no.

A: When was the last time you did feel your soul?

P: Like one year ago.

A: A year ago?

P: Yeah.

A: You haven’t felt it at all since?

P: Yeah.

A: You kind of miss that feeling, [client’s name]?

P: Yeah.

Frame B-3P: “Normal” means you can feel things.

A: What was it like before?

P: It was like, it was normal. Well, it was normal. I could feel everything.

D: So normal to you is when you can feel things?

P: Yeah.

//Comment:// This discourse occurred in a circular manner where the therapists asked questions in response to the client’s answer and the client’s answer in turn, elicited specific questions from the therapists. They were engaged in a recursive dialogue in which they discovered that “normal” and “being able to feel things” held the same meaning for the client. This conversation exemplifies ways in which these two frames are connected.

Frame: He can’t feel what he touches, his emotions, or his soul. Frame: He did this to himself during hypnosis. Frame: It happened year ago. Frame: Before that he was “normal,” he could feel everything. Frame: The client agrees. ||
 * Client

Frame: What does it mean to not be able to feel things? Frame: Why do you think it’s like that way? Frame: When did this happen? Frame: What was it like before? Frame? So normal is when you can feel things. ||
 * Therapist


 * Figure 4: The Recursion**

Bridging Gallery B: Search for unique outcomes.

//Comment:// The therapists asked questions which allowed for the client to expand upon times when he was more conscious and aware. This allowed for the therapists to highlight times when the client was able to feel “normal.” The narrative technique of searching for //unique outcomes// was useful with Paul because he was so focused on the problem story. These unique outcomes provided therapists new frames to use in building the re-authored story.

Therapeutic Gallery B: Times when the client is released from the hypnotic state and able to feel

things.

Frame B-1T: Watching comedy television.

Frame B-2T: Listening to music. Frame B-3T: Laughing at something. // Comment: // The first two frames are examples from a previous session where Paul had articulated that he enjoyed these activities. The third frame was based on observations the therapists have made during a session where the client engaged in spontaneous laughing to himself.

Presenting Gallery C: The client feels his brain is not working.

Frame C-1P: Brain is damaged and senses are turned off.

A: Have you tried any messages without the “don’ts” or “nots?”

P: Yeah, yeah, but I haven’t really tried one that will undo all of the hypnotic suggestions in me. You know “not”, “no”, stuff like that. But the thing is maybe it did work but I’m not able to feel it because I have brain damage.

A: So it might work, you just might not be able to feel it.

P: Yeah.

A: Because of the damage?

P: And not just there, not just in my brain but all over my body because my senses were shut off and they probably deteriorated or rotted or something.

A: So is that what you were kind of telling me when you were touching the wall last week?

P: Yeah.

Frame C-2P: The client does not know how, or if, he can bring his neurotransmitters back to life.

D: I’m wondering what your thoughts are, if your senses shut off or your brain deteriorates; it sounds like you believe that your brain, your cells can die. And they deteriorate or they go away. What are some things that can bring them back to life?

P: I’m not sure. I’m not sure, I don’t know. //Comment:// In the process of the therapists asking desconstructive questions, the client informed the therapists that he was not certain whether or not he can undo the hypnosis. This led the therapists to consider a new therapeutic gallery in which the problem resolution lied in getting the client to make the most of the parts of his brain that are still working. This is an example of Keeney’s (1991) “Frame Destruction” in which the client’s answers eliminate the therapeutic frame of hypnotizing himself back to his normal state of consciousness (Frame C-1P and C-2P). The therapists were then forced to move into the bridging gallery of re-authoring the problem story.

The Hypnosis ||
 * Undo


 * Figure 4: Frame Destruction**

Bridging Gallery C: Re-author the problem story

Therapeutic Gallery C: Help client recognize when his brain is working.

Frame C-1T: The client is using his brain to play the RPG games.

A: I know Peter you told me last week that you like to play RPG games?

P: Yeah

A: And it takes a lot of thought and your brain to play those types of games. How do you manage to use your brain to play those games?

P: Uhh.

A: How do you turn it on?

P: Oh, I don’t really – yeah, I try, I try.

A: Yeah because I think we were saying last week that those games are usually pretty long, the RPG games. And they take a lot of patience. How do you stick with those games, because they take a lot of time to play?

P: Yeah, I try to do what I can.

A: Have you beat any of them lately?

P: No, no I haven’t.

A: But you do enjoy playing them?

P: Yeah...yeah.

Frame C-2T: The client has been able to finish high school.

//Comment:// Through this discourse, therapists were asking questions to exemplify ways in which Paul has been able to set the hypnosis aside. The therapists used the narrative technique of externalizing to uncover times when Paul has been able to separate himself from the hypnosis. Following the reflecting team, therapists returned to the room with the client and briefed Paul how these two frames are connected, and proved that despite the hypnosis and brain damage, there were still times when he is able to function normally such as when he plays computer games and attends school.

High School ||
 * Finishing

RPG Games  ||
 * Playing


 * Figure 5: Frame Connected to Frame**

Conclusion

Paul was in a constant creative process of co-constructing his new story with his therapists in the room. Throughout this slow journey, he had the support of the therapists on the case, the team and the support of both of his parents. Because of this support combined with psychotherapy, he will be able to embody a new story for himself; one in which he is the hero and able to conquer challenges which includes being managing his schizophrenia symptoms. He had aspirations for the future which included this task as well as continuing his education. Paul hoped to obtain employment and had been practicing social skills so that he can be prepared to interview for a position one day. He planned to enroll at a local community college in the fall and through the utilization of social skills, he will be able to take classes with other students in a mainstream setting. The work within the therapy room had been on preparing Paul for this outside world; one where he can manage his symptoms while accomplishing his goals. The analysis exemplified the therapists-client discourse over a few sessions. Through the utilization of RFA, the language used by the therapists and Paul himself was dissected and provided a means of graphically reviewing the language used in sessions. Through RFA, the analysis contributed to a different understanding of the client by providing a graphic lens to view Paul and his case, as well as provided several routes of previous discussion which provoked ideas for further therapeutic questions and conversations with Paul. Questions still remain over what can be done with Paul to help him accomplish his goals, and his therapists continue to look for ways to concretely ask questions in an effort to engage him in treatment planning. RFA has allowed his therapists and the team to consider the questions asked of the Paul, and brainstorm new ways of looking at the same problem, allowing for multiple realities and solutions to the problem, which coincides with postmodern principles of therapy. This analysis revealed new avenues to be taken with Paul that may have not been discovered without the use of RFA.

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