'The Patient' is an effectively terrifying thriller about ... therapy

A man awakens, lying in a bed. He seems confused, but he finds his glasses on the table next to him and puts them on. Fully dressed, he gets up, but when he takes a step, he hears a clanking sound. He looks down to find he is chained to the floor by his ankle. He is in a rec-room-style basement with dark walls. There's a sliding glass door on one side of the room, but he can't reach it. Small high windows on the other side, but he can't reach those either. When he screams for help, no one answers.

This is the beginning of the 10-episode series The Patient, from Joel Fields and Joe Weisberg, the creators of The Americans. The trapped man is Alan Strauss, a therapist, played by Steve Carell. As we soon learn (and as they disclose in the publicity push for the show), he's being held in the home of his patient, Sam Fortner (Domhnall Gleeson). Therapy can be about a lot of things, but Sam has a very specific problem he needs help with: he is a serial killer who wants to stop killing and is finding it very hard.

The elegance of this premise, as well as the challenge, is that it may branch in different directions, but they all must return to one of a simple set of possible outcomes. Alan will escape or be rescued or be voluntarily let go; or he will stay there forever, or he will die. Every option seems plausible at least once or twice in the story, as Alan schemes and struggles to survive his captivity. And every option seems impossible, too. For his part, Sam faces a similar grim set of possible futures: keep killing or stop killing? Survive or die? Let Alan go or keep him as a prisoner until ... what?

Steve Carell's dramatic performances have never quite come together to the degree his considerable gifts suggest they should. Playing Michael Scott on The Office, he was capable of great nuance and emotion, controlled indications of Michael's pain and desire for connection amid his pettiness and cluelessness. But in the film Foxcatcher, in the series The Morning Show, and in other projects (perhaps apart from the family drama Beautiful Boy, which never made much of a splash), he never seemed to find quite the right dramatic role. That suggested there was a gorgeous and humane performance in him that hadn't quite been uncovered. Alan Strauss may be it.

Carell has a difficult task here: Alan is powerless in many ways, but must not seem doomed. He's very smart and holds a kind of authority over his captor, but the fact remains that he is chained to the floor. Carell's performance finesses the big and the small moments, highlighting Alan's cleverness and determination, while leaving space for his fear and grief at the idea that he might not depart alive.

There is also an inherent dark (very, very dark) sense of comedy in the idea of a serial killer deciding that, like everyone else with a problem, maybe therapy would help. After all, isn't a therapist the person who has to help you no matter what awful secrets you reveal? Alan recites his professional obligations reassuringly to Sam when it seems in the interest of his safety to do so. He promises, for instance, confidentiality over what Sam has confessed to him, and promises to help as much as he can. There's a smart ambiguity about whether any part of Alan's commitment might be genuine, and how much is barely-controlled terror channeled into oft-repeated scripts.

Alan is a man trying desperately not to scream or panic, but also not to explode in righteous anger at a person he has tried to help who has rewarded him with imprisonment.

Over the course of these 10 episodes, we see flashbacks to Alan's complicated relationship with his adult children, particularly his son Ezra (Andrew Leeds). The entire family once belonged to a Reform Jewish synagogue, where Alan's wife Beth was a cantor. But as an adult with a family of his own, Ezra converted to Orthodox Judaism, which strained his relationships with his parents. The connection between Alan's family story and his captivity is, thankfully, not clumsy and direct, but complex. As a man in great peril, he wants to get back to his family and longs for a return to normalcy. But his situation gives him a lot of time to contemplate the relationships he will either return to or leave behind, depending on how his story ends. His love of his family grows sharper and more piercing as the danger grows, and his regrets intensify as he wonders whether he will have a chance to make amends.

Fields and Weisberg introduce elements of fantasy as well as flashback, particularly when Alan begins to fixate on his experiences with his own therapist, played by David Alan Grier. The story can be slippery and disorienting — Alan's mind wanders in his abundant alone time, and it isn't always clear whether we're seeing reality or fantasy or flashback. Still, in these episodes, most of which last about a half-hour, that story remains controlled, suspenseful and absorbing. And even with a limited visual landscape, given the time spent in a cellar, everything from doors to staircases to fast-food bags has been carefully considered. The creators are wise to make the site of Alan's confinement both ominous and tantalizingly hopeful — a basement with sliding glass doors on one side that offer the constant possibility of salvation.

Gleeson has the unenviable job of playing an irredeemable character. How do you bring humanity to someone introduced as a merciless killer? And not just any killer, but one with the singularly bizarre notion of affecting a positive change in himself while terrorizing the person he thinks can help him. In Sam's mind, his relationship with Alan is therapist-patient, even though in Alan's mind, it's quite understandably prisoner-captor. And yet, at times, it does feel like Alan is attempting therapy, and it does feel like Sam is trying to benefit from it. Still, there remains the nagging question: Therapy until what? Therapy and then what?

The Patient is thoughtful and moving in the manner of a very good drama, while taut and suspenseful like the best thrillers. Hulu is delivering the first two episodes on August 30, with one following each week through late October. It's a show that will make you wonder, again and again, how it can possibly bring itself to a conclusion that makes any sense. But they do have an ending, and the ending works. And it would be wrong to say one more word about it.

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