Contains spoilers for this episode and earlier episodes.
Tony's panic attacks return while he tries to manage his family without Dr. Melfi. Janice arrives from Seattle and moves closer to their ailing mother, complicating Tony's plans to sell Livia's house. He suspects his sister has financial motives for coming home. Meanwhile, Christopher helps run a stock brokerage scam, where Matt Bevilaqua and Sean Gismonte attack an employee whose honest investment advice threatens the fraudulent shares they are promoting.
Big Pussy reappears after his unexplained absence, claiming he was treating his back in Puerto Rico. Tony welcomes him with a hug that also lets him check for a wire, but the reunion does not settle his doubts. Gossip about Tony and Livia has consequences elsewhere: Gigi kills Philly Parisi after accepting a ride from him. Tony's authority is intact, though his closest relationships continue to give him reasons for suspicion.
After another panic attack causes a car accident, Tony looks for psychiatric help. A new doctor declines to treat him because of his criminal connections. Tony eventually finds Melfi at a diner and apologises for the danger that forced her out of her office. She remains furious about the disruption to her patients and refuses to resume their sessions. His attempt to recover the support he once rejected ends without an agreement.