For the final time this season (and with a boutique show like this one, you never know if a given season will be the last one), we're going to review all four episodes of "In Treatment" in one post. My thoughts on the finales coming up just as soon as I'm voted off the island...

"I need to stop." -Paul

There's a formula that "In Treatment" has developed over its three seasons. Because, other than Paul himself, we have yet to continue a patient's story from season to season(*) - and because, as mentioned above, this is a show living precariously on HBO's largesse - we need to get some level of closure with all the stories. That can involve death (Alex), a patient quitting on Paul (April), a patient doing just well enough to stop (Sophie) or patients continuing therapy, but at a stage where it won't be as dramatically interesting anymore (Walter, Mia). And every year, Paul quits therapy himself, vowing never to return - until the show gets renewed and we need a closing episode for the week.

(*) In the Israeli show, the Jake/Amy characters from season one came back in season two so Paul could help their son cope with the divorce; because Warren Leight relocated Paul from Maryland to New York between seasons, that story was reconfigured to be about Oliver and a different set of knuckleheaded parents.

That formula can be distracting at times - I certainly would have found Paul's departure from Adele more powerful if we hadn't seen variations on it with Gina in the first two seasons - but in many other ways, Futterman, Epstein and company did some really interesting things with it in the final week. I'll get into specifics as we go patient-by-patient, but this was an awfully dark final week. Sunil turns out to have been playing Paul for weeks and is leaving the country, Jesse quits to align with his dad and Paul quits therapy and suggests (as he has many times before) that he's on the verge of quitting being a therapist. And even the Frances story, which ends with the two of them discussing their future therapy, isn't really a happy ending, since A)we know Tricia is going to die very soon, and B)We know that Paul may not be there for Frances the way she asked him to be.

For a season that felt a bit too familiar going in, it was a surprisingly, fascinatingly messy final week.

FRANCES

"I really did fuck this up." -Frances

First of all, I had to laugh at the Sunil/Frances switcheroo on Monday, not just because I often enjoy when the series tweaks the format, but because I know there are still some viewers who pick and choose which patients they're going to follow. Given that Sunil seems to be this season's most popular storyline, and Frances the least, I imagine there were some people who just DVR'ed the first episode, turned it on later that night or the next day, and were irked to realize they got the wrong one. (Though hopefully those people also have HBO On Demand.)

Paul talks in the Adele episode about how the incident with Sunil has made him second-guess everything his patients tell him, which was one of the things I talked about last week with Frances' story. Is she really the insufferable narcissist her daughter takes her for, or the more confused and vulnerable person we see in Paul's office? We don't know, because we don't get to follow her out into her life, and even she admits in recounting the story of calling the ambulance that she's not entirely sure what Tricia told her to do: "Maybe that wasn't what she was saying. Maybe I just heard what I wanted to hear."

And because we don't know that, we can't entirely know what she's going to do about the ventilator, or how much Paul can really help her deal with her own problems. She ends the season in a similar position to Walter and Mia last season, but where those two made significant breakthroughs in their final sessions of the season, I don't know that Paul has really come close to peeling this particular onion. We're just at something of a natural stopping point because Tricia is close to dying.(**)

(**) And I like that the show finally let Paul put into words some of the pain he's clearly been expressing about her the last few weeks. Again, we'll never know what that relationship was like, but I think it's pretty clear that Laura wasn't the first patient for whom Paul had inappropriate feelings.

Maybe the idea is that, if there's a fourth season, Debra Winger might come back, and that therefore Alison Tatlock and company didn't want to "solve" her problems here. But whatever the motivation behind ending it this way, I would have to say that this began as the season's least satisfying story and ended it the same way, even though there were some strong moments in between.

SUNIL

"This was my only way home, Paul." -Sunil

Damn.

On the one hand, something about Sunil's game feels a little too David Mamet, or "Primal Fear," for a show like this. On the other hand, what Sunil did feels like a natural extension of what the show has been saying for three seasons about Paul's difficulty in erecting the proper barrier between doctor and patient. He treated Sunil like a friend rather than a patient - let him smoke, drank tea with him, discussed his own life - and Sunil took advantage of that. In his first episode, we learned that he was very smart, very stubborn, and wanted most of all to leave his son's home and return to Calcutta, and he worked Paul until he got what he wanted.

But what made this one - which, like all other episodes outside the office, was still structured as a therapy session - so strong was that there was blurring of the lines from both sides. Paul was too open of himself to Sunil, but at the same time, Sunil wasn't gaming Paul 24/7. There really were parts of the therapy that were honest and effective - just not effective enough to change Sunil's mind, nor enough to salve Paul's wounded ego. This wasn't just an episode about Keyser Soze cackling as he revealed his master plan to his mark, but rather two men grappling with what was and wasn't real about their friendship, and how much they've been hurt. Irrfan Khan mostly kept himself composed in this one, but there's that spectacular moment when Sunil pauses at the thought of never seeing his grandchildren again, and then of course the reprise of the Indian folk song, which Sunil continues even after he knows Paul can't hear it anymore.

Just a fantastic acting duet between these two, and though some aspect of the twist doesn't entirely sit right with me, I have to admit that I really want to go back now and watch the previous six episodes (particularly the last few) to see if I have any better sense of what was real than Paul is left with.

JESSE

"I'm sorry." -Jesse
"Me too." -Paul

Earlier in this season, it seemed Jesse had an abundance of parental figures from which to choose. Now he's down to Roberto, and while I can't begrudge him that choice, it does stink that he felt he had to make that choice - and I suppose Adele might be right that this is yet another unintended consequence of Paul dropping his barriers. The very thing that makes Paul seem like such a compassionate therapist - and a character worthy of building a TV show around - is that he takes these cases very personally, and makes that clear to his patients, but there's a downside to that. A Paul who doesn't let Sunil smoke and drink tea maybe gets the silent treatment for several weeks, but he also doesn't get played like a mark in a long con. A Paul who doesn't let Jesse into his office at night, doesn't talk to him like a father rather than a therapist, might never have been able to build up trust with this confused, damaged kid, but a therapist with a more professional relationship would probably still be seeing him.

I liked that our brief glimpse of Roberto showed him to be neither saint nor demon, but just a guy. He cares about his son but doesn't see the world the same way, can be strict but not cruel, may be good for Jesse's short-term emotional health but stifling to his long-term creative growth, etc.

When Sophie left Paul's care, you could tell she was going to be okay. When April did, you understood why, and suspected that she would also survive. Jesse, though, I worry about. His search for a father figure was one of many, many issues he left on the table when he quit.

PAUL/ADELE

"Again and again, you have allowed your own feelings to interfere." -Adele

Though Paul was often a complete ass to Adele - including the opening moments of this session - I was glad to see that he was at peace with her in their session's closing moments. He could smile and acknowledge her skills as a therapist, not in a self-aggrandizing way like she suggested in their second session, but as a genuine compliment. But of course he could do that, since he has no intention of seeing her again - even if the demands of this TV show might say otherwise.

I have no idea what HBO's plans are for the show. They took a very long time after season two to decide on a third season. I wouldn't be shocked if Futterman and Epstein are as burnt out as Leight and Rodrigo Garcia were after their seasons, and Paris Barclay has already taken a job as chief director on "Sons of Anarchy" season four. It may be that the show returns with a new batch of behind-the-scenes personnel, or HBO might be done with it, or Byrne might be done. (His workload is extraordinary.)

There was a point after the first season where I suggested the show might be better off shifting to another lead shrink: possibly making Gina the main character, with Paul as one of her patients. I'm well past that point, though. Paul is the show, not just because Gabriel Byrne is so flippin' great in a reactive role that would crush many other actors, but because the problems Paul has in maintaining distance from his patients is what makes the show work as drama. I love Amy Ryan to pieces, and have greatly enjoyed the Paul/Adele episodes this year, but I think three or four episodes a week of Adele reacting Sphinx-like to her patients' issues wouldn't be nearly as compelling as seeing Paul care a little too much about them, let them manipulate and push his buttons, etc.

But at the same time, I don't know how much longer the concept can go. Paul's life has been a wreck for three years, but he's just barely gotten by in helping his own patients. Real people's emotional problems can endure for a lifetime, but as ongoing drama, the repetition can be problematic. I want to see more of Byrne performing these little one-act plays with the various incredible actors the show has cast, but I also get frustrated with Paul after a while, and also, as mentioned above, with the increasingly formulaic nature of the show. The longer I watch it, the harder it becomes to avoid comparing the new patients to the old ones. (I think over the course of this season, I compared Sunil to everybody but Sophie, though I have no doubt Irrfan Khan is a helluva gymnast.)

If the show comes back, I'll happily tune in for the great moments, for the new actors (and maybe the return of Debra Winger and Amy Ryan), etc. But there's a part of me that feels like that final shot of Paul disappearing into a sea of people on a busy Brooklyn street is the place where we should stop. Paul has decided that the solution to his life can't be found in a therapist's office. Whether he's right about that or not, I don't know, but I've gotten attached to the sad bastard, and I'd like to think he'll find something that makes him happier and more fulfilled, rather than just returning to that office again. He could be a damn good therapist at times, but he wasn't doing very well at healing himself.

What did everybody else think?