In Session with “The Patient”

Dr. Sam & Dr. Fran shift from the multiverse to a creepy serial killer’s basement this week. Join us as they put Hulu’s show, The Patient on the couch (and review the first half of the season)!
What happens when your patient becomes your kidnapper? The doctors attempt to analyze an unusual therapist-patient relationship and treatment plan. Dr. Alan Strauss attempts to curb Sam’s “compulsion” to kill others after being kidnapped and held in Sam’s basement. Sam describes his urges to kill as obsessions and compulsions. They discuss OCD and give their impressions about what they believe may be going on with Sam with a Diagnosis Bingo.
Despite the unique therapy circumstances, the doctors also discuss if there are aspects of Dr. Strauss’ and Sam’s therapy sessions that people may see in actual therapy sessions. They also break down aspects of the treatment that Dr. Strauss attempts with Sam. Does Sam actually want help? Could this type of therapy work?
Interestingly, Dr. Sam and Dr. Fran also discuss whether Dr. Strauss would have to turn Sam, his patient, into the police for committing murder or for planning to commit a future murder. Finally, they review the family therapy session including Sam and his mother. She knows her son is a murderer and has not turned him in. What could go wrong?

This session is sure to hold your attention captive!



Content warning: child abuse

Glossary of Terms

Obsessions– recurrent and persistent thoughts that are intrusive and unwanted and often distressing

Compulsions – Repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession; typically aimed at preventing distress or some dreaded event 

Obsessive Compulsive Disorder (OCD) – a mental health diagnosis characterized by the experience of obsessions and compulsions (see definitions above)

Ruminating – repetitive thinking or dwelling on symptoms of distress

Antisocial Personality Disorder –a mental health diagnosis characterized by a long-term pattern of disregard of, or violation of, the rights of others

Dialectical behavior therapy (DBT) – evidence-based treatment focused on building mindfulness skills, effectiveness in interpersonal relationships, emotion regulation strategies, and tolerating distress

Emotion dyregulation – difficulty managing or controlling emotional responses


What would you do if your client disclosed they were planning to murder someone? Drs. Sam and Fran discuss the legal mandate of duty to warn for psychologists. Learn more about the origin of this requirement through the Tarasoff case here.

We discuss potential diagnoses for Sam’s character, including Obsessive Compulsive Disorder and Antisocial Personality Disorder (ASPD). Listen to our episode on You for a deeper dive into ASPD.

Drs. Sam and Fran also discuss the therapy provided by Dr. Strauss and how some aspects align with Dialectical Behavior Therapy (DBT). Learn more about DBT and particularly the use of distraction skills for coping with a crisis.