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Malcolm's Therapist Isn't Real
Malcolm's therapist is a figment of his imagination, based on one of the girls he saw his father murder. He imagines the girl as an adult helping him through his psychological issues, but in reality he sits alone in a room and talks himself into deeper spirals of self-doubt and paranoia. Part of his subconscious realizes that the girl died, and that's why he thinks of her as a child psychologist.

Ainsley's Boyfriend is Only Dating Her to Get Close to The Surgeon
It's already clear that Martin is willing to take on "apprentices." Ainsley's boyfriend knew about her connection to The Surgeon and sought her out in order to get closer to Dr. Martin Whitley. He's been faking their relationship all along because he's a nascent serial killer who wants to become an apprentice of The Surgeon.
  • Or he could only be with Ainsly to steal her scoop on Martin.

Malcolm killed the girl in the trunk
He's repressed the memory entirely, but that's what he and Martin did on that "camping trip." They took the girl to an isolated location and let young Malcom be the one to finish her off. His father was grooming him to be a killer like him. That's why Malcolm was given a hunting knife, and that's why Martin said, "We're the same" to him before the police took him away.
  • Possibly Jossed, as both Martin and the Junkyard Killer claim that Malcolm really suppressed those memories because on that trip they tried to kill him. Of course, this depends on if they're telling the truth.
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