In broad terms, there are four stages of therapy: commitment, process, change, and termination. Throughout its run, The Patient thoughtfully followed Alan and Sam’s therapist-patient relationship through each of those stages, and the finale chronicles Alan’s valiant efforts to execute the final one, peacefully and professionally ending his tenure as Sam’s pet therapist. As the episode builds to its inevitable climactic showdown, Alan tries time and time again to gently terminate his relationship with his patient. Sam’s breakthrough with his dad seems to be the impetus for Alan’s bid for freedom because he is able to tout the aborted murder attempt as a huge step forward (it is) and use this information to argue that Sam doesn’t need therapy anymore (he does). But the termination that finally occurs isn’t exactly what he, or any therapist, would consider successful.
Alan’s brutal murder will be what many viewers talk about in the aftermath of this devastating episode (Michael Scott gets killed by a Weasley!), and it is shocking, especially for those who were rooting for Alan to survive all along. But, in the end, the true beating heart of this series turned out to be a potent blend of human connection and the ever-present search for meaning, concepts that are densely woven throughout this supersize 46-minute finale. Alan brings both ideas home in the heartfelt letter he writes to his children in the hours before his death, and in the aftermath of Alan’s murder, Sam actually illustrates that he may have finally internalized these concepts — or portions of them, at least.
Unlike Alan, we get to follow Sam as he goes to murder, and possibly decapitate, his father. Back in the basement, Alan is horrified, but Candace brushes it off like no big deal, asking why she should care about what happens to this monster who brutally abused both her and her son. Alan doesn’t have a great response because why would he? The two bystanders — one innocent and one complicit — sip beer from plastic cups and wait for Sam to do what he’s going to do.
However, when Sam visits his dipshit dad, things don’t go the way Sam thought they might. The first thing his dad does is offer him food, and we know that’s the way to Sam’s heart. Then, when Sam confronts him about the abuse, the guy apologizes! It’s a brusque, offhand apology, but it’s an apology all the same. Sam is floored and confused and furious. He tries to alleviate these feelings by using his murder-y coping mechanism — jumping on his father and strangling the daylights out of him — but he stops short. He’s identifying new feelings. His desire to kill his father fades even as he’s in the middle of the act. Confused, he runs home to talk about it with Alan.
To Alan’s credit, when Sam tells him about this breakthrough, he beams with pride and excitement. Both Steve Carell and Domhnall Gleeson are fantastic in this scene as Sam finally experiences a cathartic release and is able to accept validation from his therapist. But when Alan tells him it’s now time for Sam to release him, Sam’s face quickly transforms into a crestfallen frown; he can’t lose the one person who has helped to give his life meaning.
Once Sam brings home a sofa and a fridge, Alan realizes he needs to switch gears. In a fleeting session with Charlie, Alan is dismayed to discover Sam means to keep him there indefinitely as a replacement father figure. While recreating a parental dynamic might work in outpatient therapy if both the therapist and patient remain incredibly aware of boundaries, this college-dorm setup ain’t it. And Alan isn’t playing the game anymore.
That night, Alan calls out to Sam and tells him what he really thinks. Alan is done, and Sam needs to turn himself in. The only way Sam is going to get better is if he has time away from society during which the urge to kill is removed. This is certainly ideal in concept, but in reality, most facilities Sam might be placed in if he confessed — a state mental hospital, the general population of a prison, or, worse, solitary confinement — would absolutely not allow him the space, empathy, and time to heal.
In the wake of Alan’s new diagnosis, Sam leaves without a word and heads to the police station. He sits outside until dawn, watching the cruisers come and go. And while Sam doesn’t actually turn himself in, this scene illustrates just how far Alan has been able to take Sam in such a short period of time. The Sam we met at the start of this series would have never, ever thought about turning himself in, yet here he is, mere weeks later, just steps away from confessing his crimes.
Of course, he doesn’t do it — true change takes time, after all — and a desperate Alan plays his final card. When Candace comes down to deliver his breakfast, Alan is waiting with a small smile on his face. He brings all of his therapeutic prowess to bear as he drops a giant truth bomb on Candace: She has been complicit this entire time. Not just with Sam’s killings but also with Sam’s abuse by his father as a child. Sure, at the time, she didn’t know what to do, but by literally doing nothing to change the situation, she failed to protect her vulnerable young son.
Candace starts to cry, and Alan deploys his tried-and-true tissue technique to get her to come close enough to grab her arm and take her hostage. And when Sam runs down the stairs and sees Alan holding his makeshift shiv to Candace’s throat, we revisit the frantic back-and-forth rhythms of the table-tennis match they played a few days prior. The camera utilizes sudden transitions to volley between the two desperate men as they try to negotiate the situation. Sam shouts that he doesn’t think Alan is capable of murder, and then the scene abruptly cuts out.
For a moment, things are unclear. Suddenly, Alan is transported to a gas chamber. Beth is passively looking up at the vents. Then Alan enjoys a Shabbat dinner at Ezra’s house. His daughter, Shoshana, is also there, and all of his grandkids are gathered around the table. It’s a moment of peace and reconciliation — a moment of peace and reconciliation that Alan should have been able to enjoy. But he can’t. Because he’s dead. As he scans the table, he spies Charlie in the corner, a grim look of finality plastered on his face.
We then flash back to Sam strangling Alan, a crazed and possessed look fixed on his face, and Candace is begging him to stop. (Fuck you, Candace.) However, once the act is complete, even Sam himself seems a little shocked by what he’s done. He drags Alan’s body into the boiler room, and for a horrifying, stomach-flipping moment, it seems he might just bury his therapist there in the very grave he dug. Thankfully, Sam doesn’t go that route.
The conclusion of the episode serves as an extended epitaph for Alan’s life and the impact he’s had on the people in it. Shoshana receives her dad’s heartfelt letter in the mail and reads it, sobbing. She calls Ezra, and the two siblings hold each other and read their father’s final words to them. The letter is beautiful, if a little “meshuga,†but it gets to the point. Alan’s family has provided love and meaning for him, and he’s so proud that his two children have found the same in their lives. We learn that, in the face of almost-certain death, Alan found solace in defining himself in his meaningful relationships. He’s Ezra and Shoshana’s dad; he’s the cantor’s husband. (Hey, that’s the name of this episode!)
Oddly enough, Alan’s legacy also lives on in Sam. In his letter to Alan’s kids, Sam tells them where the body is, and he also notes that Alan helped him a great deal. This is progress. Twisted progress but progress. And as the series draws to an end, we get one last glimpse of the empty basement. Sam enters and contemplates the space. Alan appears in front of him, illustrating that now Sam has his own little therapist inside his head. Alan/Sam tells him he will certainly continue to kill. There’s no way around it. And this time, Sam can’t deny these accusations, mostly because the call is coming from inside the house.
After a moment, he calls for his mother and chains himself to the floor. Is this penance? Is he trying to follow through on Alan’s recommendation? It’s unclear, but the knowing squeeze he and his mother share as he hands over the key illustrates that Sam has not abandoned the idea of working toward meaningful change.
A coda to the episode sees Ezra attending his own therapy session. He insists he’s there because he wants to learn how to help the other people in his life get through this crisis, but it’s clear he needs an emotional outlet. As he tentatively begins to share, the scene abruptly ends, leaving us with the knowledge that the pursuit of our best selves is always a worthy one (except when you murder your therapist. Please don’t murder your therapist).
Alas, this is our final session, but I’d invite you all to engage in some group therapy in the comments section. Thank you to everyone who followed along with these recaps!
Progress Notes
• The song that plays over the credits — “You Want It Darker†by Leonard Cohen — is fitting and poignant on a bunch of different levels. Cohen collaborated with his son, Adam, on the song, and it was released a mere two weeks before his death in 2016. Much like The Patient, the song makes reference to Jewish sayings and traditions, repeating Hebrew words in the chorus that refer to responsibility and a readiness to move on to the unknown. (Thanks, Genius!)
• Emmy campaigns for Steve Carell, Domhnall Gleeson, and David Alan Grier start now. Right now. I mean, go tell anyone you know to watch this show right this minute, please and thank you.
• Unless Joel Fields and Joe Weisberg want to go for an anthology series, we now know The Patient will, indeed, have a limited run. There’s no coming back from the events of that finale.
• Coincidentally, I spotted the cloud lamp from the basement at Ikea the other day. It’s called an Upplyst, and it retails for $24.99.
• Sam kept delivering the zingers right until the end. The biggest LOL in the finale? “My therapist said not to kill you.â€
• Alan never used the pitcher, but I kind of get why now. Someone may have heard the crash when he shattered it, or Sam may have noticed it was missing as he walked into the room. It was too risky. But then again, so was using a flimsy metal tube as a weapon, so …
This article has been updated to correct an error.