By all accounts, Dr. Alan Strauss is a pretty great psychiatrist. He’s present, he’s caring, and he’s nonjudgmental. But even the best therapists are only agents of change; they’re not magicians. Unfortunately, Alan’s newest patient seems to be under the impression that his mental health is guaranteed to improve if he engages in the therapeutic process … as long as he can obsessively control every aspect of it.
Conceived by Joel Fields and Joe Weisberg, the co-creators of FX’s critically acclaimed darling The Americans, The Patient stars Steve Carell as Alan and Domhnall Gleeson as Sam, the titular patient. By the end of the first episode, we learn that the series promises plenty of screen time featuring the two in a small, airless room. Sam is a serial killer, you see, and he’s seeking catharsis and healing; he doesn’t want to kill people anymore, but he doesn’t quite know how to stop. But he knows he can’t be fully honest with anyone without them turning him in to the cops, so he kidnaps the good doctor Strauss and chains him up in his modest basement.
Clocking in at a lean 21 minutes, the first episode of The Patient is a bite-size exercise in world-building, bookending Alan’s lonely and quiet life in the outside world with the peculiar conditions of his captivity. The series isn’t trying to pull any punches about what’s about to happen to him, with a cold open that immediately outlines Alan’s predicament as he comes to in an unfamiliar place. Alan is an observant guy, so he begins to scan the room for clues. Oddly enough, he’s been gently tucked into bed, and daily necessities such as his glasses, medications, and even his preferred brand of toothpaste have all been carefully arranged on a bedside table. Someone wants him to be healthy and comfortable.
But not too comfortable. The next thing Alan discovers is a thick shackle locked around his ankle. There’s a length of chain that allows him some limited movement, but the chain shudders to a halt whenever he gets within reaching distance of any doors or exits. As he strains against his restraints, he begins to shriek.
It’s an eerie and effective kick start to the narrative, and Carell sells every second of it with near-wordless horror. From his rapidly shifting facial expressions to the frustrated shuffle of his feet as he navigates moving around with the chain, he not only makes the horror of the situation palpable, but in his attempt to measure his reaction, he also provides essential building blocks for his character writ large. As a therapist myself, I was especially drawn to the moment in which Alan catches himself mid-panic and immediately employs deep breathing as a coping method to help manage his rising terror. This illustrates that he’s a therapist who practices what he preaches.
If it wasn’t clear, I’m already completely in love with Alan Strauss. Yes, sure, it’s because Carell’s beloved characters such as Michael Scott and Andy Stitzer live in my heart forever and always, but it’s also because he’s clearly taken the time to embody Alan as someone who takes his role as a psychiatrist and helper very seriously. Perhaps that’s why Sam chooses to kidnap him and not the two other Jewish therapists he met with.
When we visit with Alan in his outside life, we see he’s mostly going through the motions. He checks in with his daughter and makes sure to take care of his health. He devotes a lot of time to eating well, flossing, and taking his meds as prescribed. He also tries to reach out to his son by offering him a guitar his mother once owned.
The night before visiting his son, Alan has a dream that features a naked woman holding the guitar while laying in his bed — this is presumably his wife — and a ghoulish baby in a bassinet. What all of this means, I do not know, but Freud would surely have a field day with it all.
We also get to peek in on sessions with a handful of Alan’s patients. We see him interact with a woman who is working on her empathy and a man who’s working on his codependency. And then there’s Gene … er, Sam, who wastes no time in his first session. He hits the ground running as he says, “My dad beat the shit out of me a lot when I was a kid. And I think it fucked me up.”
In my life as a therapist, I know this move. When a client gets that candid that fast, it often means they’re reluctant to go much deeper than a superficial remembering of their trauma. And this is exactly what happens with Sam. Eventually, Alan calls Sam out on these behaviors, reflecting his own feelings of frustration to his patient in order to drive the point home. He also possibly damns himself to a future in that musty basement when he says, “In order for this process to work, you need to be able to tell me things that aren’t easy to tell. And to be honest and truthful.” Sam says he’s trying, and Alan responds with a kind and thoughtful response: Anyone who presents to therapy and is willing to engage honestly in the process can be helped.
Of course, that evening is a dark and stormy one, and Sam makes the best of it. He causes a racket on the patio to get a vulnerable Alan outside. We already know what’s going to happen here, but the feeling of dread is still palpable as Alan spins around with a terrified look on his face.
When Alan eventually learns the identity of his captor, he gamely attempts to leverage his position as an authority figure to gain his freedom. We don’t see a ton of Sam in this episode, but this initial interaction with Alan in the basement paints him as a wry — if badly damaged and misguided — individual who might possibly be capable of change. Gleeson delivers a few moments of laughter with his initial lines about the situation. The thoughtful pause he takes when Sam says “This isn’t as bad as it seems … It’s bad. I know it’s bad” is especially funny, and it’s fun to watch Carell play the straight man.
Sam lays it all out for Alan, but Alan isn’t buying it. It’s very true that all parties need to feel safe and supported in order to engage in therapy, but Sam isn’t giving Alan that opportunity.
That’s our time for today, but I’ll see you at our next session.
• At a recent panel for the Television Critics Association, Carell shared that he was actually chained to that shackle throughout filming. That’s commitment, folks.
• The fact that Sam is a foodie is objectively hilarious, as he’s following in the footsteps of some of the greatest fictional serial killers of all time. Let’s just hope he doesn’t eventually want to chow down on Dr. Strauss liver with fava beans and a nice Chianti.
• When Alan pleads for Sam to free him, he tells him everything they’ve spoken about thus far is confidential. As ethical boundaries often lie in a gray area that’s subject to interpretation from practitioner to practitioner, this statement might technically be true, but if I were Sam, I probably wouldn’t trust that Alan would keep to this promise.
• Did anyone else get Joe Goldberg (a.k.a. the unrepentant serial killer from You) vibes from Sam when he was wearing a hat and glasses as Gene? Given that Joe and Sam both seem to believe that a simple baseball cap will shroud their identity, I think they’d probably get along just fine. Also Joe tends to be at his most honest and vulnerable when he has a literal captive audience, so an alternate theory here would be that Sam is a fan of You. Does Netflix exist in this universe? And, if so, will Sam ever share his password with Alan so he can comfort binge his days away?