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Paul, I agree. I also think, in light of much of what we have discussed, the worst part about him not thinking his sister is his sister is the pain those around him bear the brunt of -- namely, his sister. I think it might work best to simply work with him on the emotional issues surrounding what this loss of a sister is like (since that is what *he* perceives his problem to be, even if it is not what the world is seeing) and helping him to engage with the imposter on a human level. Perhaps this will lead to some cognitive rebirth (such as when Adi's dad changed his story, and returned to Pittsburgh to main), or, might simply allow him to function happily within his narrative, and to interact with the world more openly and happily.