Sean and Christian begin group psychotherapy in an attempt to resolve their escalating problems, with both revealing long-held secrets and their true perspectives on one another. Liz joins in with therapy too, revealing her own opinions on the Sean/Christian relationship, as well as a secret she has been keeping from Christian. Meanwhile, Matt announces his plans for his own future and introduces Sean and Christian to his fiancée Ramona.

Julia visits Sean and Christian in Los Angeles to share some life-changing news, and she also rejects romantic advances from both men. Meanwhile, Matt gets a blast from his past when Ava Moore, who caused immeasurable family chaos years ago, turns up as Matt prepares to marry Ramona. Also, Liz reveals that she's happily pregnant.

In the series finale, Christian agrees with Ava to operate on baby Raphael in exchange for her to stay out of Matt's life who has abandoned everyone to be with Ava. While preparing to leave for London, Julia worries about Sean's mental state of mind as he continues to be in denial about his feelings of abandonment. Liz is overwhelmed by Sean's excitement over her pregnancy when he adds her name to the practice and sets up a nursery at the office. Christian's worry about Julia moving far away, and a vision of the deceased Kimber forces him to reconsider his long-standing relationship with Sean. Also, Hiro Yoshimura is elderly Japanese porn star who comes to McNamara/Troy requesting surgery to remove a surgical scar before his big debut in an American porn movie.