A change in Monk's insurance policy means the end of his private sessions with Dr. Bell. In desperation, Monk joins a therapy group and stumbles on murder. Members of the group have died suspiciously close to one another. Monk attempts to solve the case while coping with the change — and particularly with Harold Krenshaw, who has made an unwanted reappearance.
This episode includes examples of the following tropes:
- Acquitted Too Late: Monk is investigating Rhonda, a somewhat aggressive member of his therapy group, to see if she could be the killer when he finds her on the floor of her workplace, dead of chlorine gas poisoning.
- A Day in the Limelight: Dr. Bell gets the spotlight in this episode.
- Borrowed Catchphrase: Harold Krenshaw borrows a couple phrases Monk usually says when laying out his theory about Monk being the murderer.
- Bread, Eggs, Breaded Eggs: Monk tries to squeeze as much therapy out of his last free session with Dr. Bell as possible by bringing cards with all of his problems on them. When he says "fear of bees," Dr. Bell reassures him that an urban environment makes it a minor fear. "Fear of blenders" is met with the point that one who does not own a blender needn't fear them. "Fear of bees in blenders" just merits a stunned look from Dr. Bell.
- Call-Back: When Natalie is trying to convince Monk he couldn't have been the killer, he brings up that he sometimes has blackouts, which has happened before in the show.
- Censor Suds: At the beginning of the episode, the soon-to-be-murdered Barbara O'Keefe is taking a bubble bath and (this being a basic cable show) the bubbles prevent the audience from seeing her naughty bits. She then puts on a Modesty Towel before being confronted by her killer.
- Chekhov's Gun: Natalie mentions a drought early in the episode. This turns out to be part of the reason behind the murders — the killer murdered a woman and sunk her car (with her body in the trunk) in the reservoir. He was afraid it would be discovered soon and wanted to get rid of the people who could tell the police about his obsession with her.
- Chekhov's Gunman: Harold Krenshaw points out a former patient at the grocery store. He turns out to be the killer.
- Empty Chair Memorial: When Monk has his first group therapy session with Dr. Bell, he notices an empty seat and learns when one of the other clients gets mad at his trying to take it that it belonged to a young woman who used to be in the sessions until she apparently drowned in her swimming pool. That death is later proven to be murder.
- Fire-Forged Friends: Monk and Harold Krenshaw actually become friends after being locked in a car trunk by the killer and having to overcome their claustrophobia together.
- HeelFace Turn: Downplayed; after years as Monk's Sitcom Arch-Nemesis Harold realizes that the two are a lot alike and becomes his friend. Then he makes a un-Krenshaw gesture and joins a new group therapy to allow Monk to have Dr. Bell to himself (Though his insurance required him to be in group therapy, the other members were murdered by the bad guy leaving only Harold and Monk so Harold leaving left Monk as the only member remaining).
- He Knows Too Much: The reason behind the murders; the people in the therapy group had heard the killer talk about his obsession with the woman he murdered. He wanted to get rid of them so the police couldn't connect him to her slaying.
- Hoist Hero over Head: In Harold Krenshaw's summation about how Monk committed the murders, he lifts Augie over his head before throwing him off the roof. Augie was a plus-size guy, which makes the situation unlikely.
- Loophole Abuse: Monk is no longer allowed to have any more one-on-one therapy sessions because hes hit his lifetime limit but he is allowed to have group sessions. By the end of the episode, hes the only person left in the group sessions meaning theyre technically still group sessions but with only one person.
- Make It Look Like an Accident: Monk discusses how Rhonda's death could not have been an accident, because, having had this job for years, she would have known better than to mix bleach and ammonia.
- The Summation: When Monk tells the rest of the group about the possibility of the deaths being homicides, Harold mimics Monk's investigation style and then goes into a summation-slash-Hannibal Lecture in which he points out that Monk had motive, opportunity, and a advantageous position complete with fake flashbacks that portray Monk as an Ax-Crazy pseudo-Yandere who wants Dr. Bell all to himself (Harold was right about the last part). This is effective enough to make Monk himself seriously consider that he might be unconsciously killing people.
- Theme Serial Killer: Randy suggests the possibility of a serial killer murdering people in accordance with their worst fear. Monk undermines that by saying the victim was afraid of spiders, not heights. Undeterred, Randy suggests there's a serial killer murdering people with the opposite of their worst fear, and dubs him "the Opposite Killer."