Domhnall Gleeson on ‘The Patient’s Killer Finale: “That Is The Only Way This Series Can End”

Warning: Major spoilers for The Patient Episode 10 ahead.

The Patient, FX’s psychological thriller starring Steve Carell and Domhnall Gleeson, finally reached a killer conclusion in Episode 10, “The Cantor’s Husband.”

The Season 1 finale, which takes viewers on an emotional roller coaster, shows Sam (Gleeson) exhibiting unexpected restraint, fully losing his temper, and having a major breakthrough in less than 50 minutes. Unfortunately, Sam’s epiphany comes at the cost of Alan’s (Carell) life.

“When I read it, I was like, ‘That is the only way this series can end. That is the most perfect,'” Gleeson told Decider in a Zoom interview. “[Sam] could have handed himself in. But that wouldn’t have been truthful.”

After Season 1’s penultimate episode ends with Sam on a mission to kill his abusive father, the finale picks up where he left off. As Sam drives off, Alan calls his mom Candace (Linda Emond) for help, but in true Candace fashion, she takes no action. Well, that’s not entirely true. She makes Alan some lunch and tells him, “I’ve been in this situation many times, and there’s nothing you can do. I usually have a beer and try to relax.” Or, you know, you can call the cops!

With Dunkin in hand, Sam rings his dad’s doorbell, steps inside to chat, takes a long piss (classic), and sits down for a sandwich. After asking his dad why he used to hit him, Sam finally gets some answers and an empty apology. He pushes his father to the floor and starts strangling him, but before the man slips out of consciousness, Sam stops, announcing, “My therapist said not to kill you.”

“This is it, Sam. It is a major breakthrough, even if you’re not quite feeling it yet,” Alan explains upon Sam’s return. “You wanted to change. Look at you. You’ve changed.” Sam smiles and thanks Alan, before asking what he wants for dinner. But Alan doesn’t want food. He wants freedom. He tells Sam it’s time to let him go home so he and his son can have their breakthrough. He promises they’ll still continue regular sessions and says he won’t turn him in. The following day, Sam brings a couch and a mini-fridge into the basement and tells Alan that therapy takes time. Once it’s clear Sam has no plans of letting him go, Alan plots his next — and possibly final — move.

Under the glow of his cloud lamp, Alan spends the night writing in his notebook, then hides it behind the pitcher on his end table. He calls Sam out of bed and stresses that he can’t treat him anymore; that for him to truly get better he needs to be physically stopped from acting out his compulsion. “You can turn yourself in or you can end this the other way,” Alan says. The next morning, Sam sits outside the police station weighing his options. Candace goes downstairs to tell Alan her son isn’t ready to be without him. When she starts crying, Alan offers her a tissue, then grabs her and sticks the sharpened edge of his lotion tube to her neck. He screams for Sam and swears he’ll kill Candace if Sam doesn’t call the police. After a heated, emotional exchange, we cut to a morbid vision of Alan and his wife, followed by a scene of him and his family (son included) sitting down to dinner. Everyone is happy, until Alan notices his deceased therapist Charlie (David Alan Grier) at the table. Uh oh…

We cut back to present-day, where Sam is strangling Alan and Candace is begging him to stop. Once Alan takes his final breath, Sam unlocks the chain around his ankle and drags his lifeless body into the boiler room grave. Sam finds Alan’s notebook — which contains a letter to his kids — and sends it to his daughter, along with the coordinates of the body to give them closure. In Sam’s final scene, he imagines Alan telling him he’ll kill again, so he chains himself to the basement floor and gives his mom the keys. The episode ends with Alan’s son Ezra (Andrew Leeds) at therapy. Just as he’s about to dive into his complex relationship with his dad, the screen fades to black.

To find out more about Domhnall Gleeson’s thoughts on the finale, here’s a snippet of our longer chat with The Patient star. If you’d like to read more of his thoughts on the series, his costar Steve Carell, and his character’s love of Dunkin’ and Kenny Chesney, be sure to check out our earlier piece as well.

DECIDER: Did you always know that this was how the series would end — with Sam killing Alan and chaining himself up in the basement?

DOMHNALL GLEESON: No, I didn’t know that from the first episode. It was up in the air a lot. Things [were being] thrown around. But when I read this script, they didn’t tell me what [the ending] was going to be. And when I read it, I was like, “That is the only way this series can end. That is the most perfect.” I thought they just stuck the landing. And I knew they would, but I was nervous about all sorts of different things. I was nervous about what you say somebody like him can achieve. Like what are the limits of his capabilities? And I just thought it said so much about Steve’s character, about what it is to be alive — I thought it was really emotional, and truthful, and yet still surprising. I thought they just kept all those balls in the air just superbly. And I thought they found a way to finish something which for a while, I was like, “I don’t know what the way to do this is.”

Oh totally. We see Sam furnishing the basement in the finale and making future plans for them. So I feel like this cycle of Alan being stuck and trying to treat Sam and escape while fearing for his life, and the lives of others, could have gone on for such a long time.

Exactly, exactly. Or he could have handed himself in. But that wouldn’t have been truthful. He’s not — he’s too selfish to do that. So they found a way to thread that needle. And I thought it was just brilliant.

After Sam’s heartbreaking final kill he does show that he sort of internalized Alan’s therapy and learned something. He sends the letter to his kids and leaves his body to be recovered. And your final shot is Sam imagining this advice from Alan, chaining himself to bed, and passing the keys to his mom. If there were a Season 2, what do you think we’d see from Sam? Would he really commit, or would talk himself out of the chains?

I wonder how long the effects of that last, you know what I mean? I think Strauss gets him to an incredible breakthrough. But without the real Strauss being there to continue helping him to undergo therapy I think the Strauss that Sam would create in his mind — you know the way Strauss went to his own mind to talk to his therapist — I think Sam would do a similar thing and would visit Strauss in his mind, but it would be his version of Strauss, because he doesn’t have Strauss’ expertise. So I think slowly, he’d start convincing himself that he’s probably cured now. I don’t know that it’d last. I don’t know that delusion wouldn’t start taking over. But I do think in that moment he’s learned something really important. I just wonder without the real ongoing gift of therapy how capable he would be of sticking to it.

This interview has been edited for clarity and length.

FX’s The Patient is now streaming on Hulu.