...To Change the Things I Can is the season four finale and the 76th overall episode of Private Practice.

Short SummaryEdit

The doctors of Oceanside Wellness are faced with a tough decision -- to point out all areas of vulnerability within the practice and risk the termination of some of their own, or to dissolve the practice and each go their separate way. Addison has a new admirer in town who offers her a very tempting proposition. Meanwhile, Charlotte is assigned to a case that hits very close to home.

Full SummaryEdit

Episode in detail.


  • Addison Montgomery
  • Pete Wilder
  • Naomi Bennett
  • Cooper Freedman
  • Charlotte King
  • Sheldon Wallace
  • Amelia Shepherd
  • Sam Bennett
  • Violet Turner
  • Jake Reilly
  • Gabriel Fife
  • Jason Windsor
  • Angela Windsor
  • Neal Chaplin
  • Betsey Parker
  • Kaitlan Mills
  • Marisa Windsor
  • Gate Agent
  • Nurse Debbie and Charlotte King
  • OR Nurse

Main CastEdit

Special Guest StarEdit

Guest StarsEdit


Medical NotesEdit

Addison Forbes MontgomeryEdit

  • Diagnosis:
    • Depression
  • Doctors:
    • Psychiatrist
  • Treatment:
    • Talk therapy

Addison went to talk therapy to talk about her feelings of loneliness and her desire to have a child.

Addison's PatientsEdit

  • Diagnosis:
    • Pregnancy
  • Treatment:

Addison was shown seeing several pregnant patients and performing a c-section.

Kaitlan MillsEdit

  • Diagnosis:
    • Blunt trauma
    • Kidney injury
  • Treatment:

Kaitlan, 32, came into the ER after a sexual assault with blunt trauma and a possible kidney injury. Charlotte examined her and ordered a scan. She said she also needed to do a pelvic exam and get a rape kit. Kaitlan insisted she didn't want a rape kit. Charlotte later sat down with her and told her she could get through this.

Marisa WindsorEdit

  • Diagnosis:
    • Juvenile Krabbe's disease
    • Seizure
    • Severe allergic reaction
  • Treatment:
    • Sedatives
    • Stem cell infusion

Marisa, 8, seized during a routine exam. She had Krabbe's disease and had already suffered deterioration of her neurological system. Her parents blamed themselves for reducing her sedatives because they made her a zombie. Her prognosis gave her six months to a year left to live. Pete suggested a stem cell transfusion, but Cooper was dubious. The parents decided to do the treatment While they were doing the infusion, Marisa had a severe allergic reaction and suffered additional brain damage. She had only minimal brain function. Her father asked Cooper to euthanize her, but Cooper didn't do it.

Jason and Angela WindsorEdit

  • Diagnosis:
  • Treatment:
    • Talk therapy

The Windsors had been talking to Sheldon, who was trying to help them adjust to their daughter, Marisa's, prognosis. He was there with them when they learned about a new treatment option and helped them while they made a decision.

Amelia's PatientEdit

  • Diagnosis:
  • Treatment:
    • Surgery

Amelia met an ambulance at the door that had a motorcyclist who hadn't worn a helmet. Amelia later told Charlotte the motorcyclist had gone downhill and she was going into a risky surgery. The surgery went well, despite the fact that Amelia had been drinking.

Pete WilderEdit

  • Diagnosis:
    • Myocardial infarction
  • Doctors:
  • Treatment:

Pete collapsed on the floor because he was having a heart attack.


Song Performer Scene
"Easier Said Than Done" Morcheeba
  • Addison talks to a therapist about what she's feeling.
  • Addison sees multiple pregnant people.
  • Addison says she loves her job, but she misses Sam.
  • She feels disconnected from her life.
  • Addison does a c-section.
  • The therapist tells her her life will change when she makes it change.
"Time To Go" Sara Swenson
  • Addison tells her therapist she's good. Then she admits she might not have a job to go back to, but she met a guy.
  • She feels like her life is changing.
  • Violet looks around the practice.
  • Pete goes through his files while Violet talks about not being a doctor anymore.
"I Saw a Stone" The Rocketboys
  • Amelia struggles before surgery.
  • Cooper talks to Marisa's dad and says he can't euthanize her.
  • Cooper says he'll be there to support them.
  • Charlotte talks to Kaitlan about her recovery. Kaitlan holds her hand.
  • Naomi tells Sam Addison went home. Sam asks Naomi if she's okay.
  • Naomi says Gabriel's gone. Sam tells her to make it work with Gabriel.
"I Don't Know" Shelly Fraley
  • Addison talks to her therapist about going to Fiji with the stranger.
  • Pete and Lucas say goodbye to Violet as she prepares to leave.
  • Charlotte talks to Cooper about the serenity prayer.
"Make a Noise" Katie Herzig
  • Naomi tells Addison she's always be there for her.
  • Naomi goes to the gate as the door closes. Naomi then sees Gabriel not on the plane. He says he knew she would come.
  • She kisses him and he proposes to her. She accepts and says they're moving to New York to be with Maya and Olivia.
  • Addison starts to have doubts as she goes to her gate.
  • Addison tells the others they can dissolve the practice and open a new practice. She'll fund it.
  • Addison and Sam lie together in bed. She says she still wants a baby and she's going to have one on her own.
  • He says he can try to love her with her baby.
  • Amelia plays pool at the bar and drinks.
  • While cleaning up the living room, Pete collapses in pain as Lucas watches.

Notes and TriviaEdit

Private Practice 4x22 - PROMO - ..

Private Practice 4x22 - PROMO - ...To Change the Things I Can

  • This episode scored 7.45 million viewers.
  • This episode's title originated from the serenity prayer.
  • The serenity prayer has been adopted by Alcoholics Anonymous, so it's most likely a reference to Amelia who starts drinking again.
  • This episode marks the last episode in which Audra McDonald is credited as a main cast member.
  • This episode features a guest appearance by Joshua Malina, who portrays David Rosen in Shonda Rhimes's other TV show Scandal.
  • Addison starts seeing her therapist, which becomes recurring throughout the fifth season, where she visits her shrink almost every episode. However, in this episode, the shrink is played by Kevin Koster, while in the fifth season, he's played by Scott Alan Smith.
  • This episode marks the introduction of Dr. Jake Reilly. It's the first and only episode in which Benjamin Bratt, who portrays Jake, is credited as a special guest star rather than main cast.


Episode StillsEdit


See AlsoEdit

A complete overview of this episode's crew can be found here.

Community content is available under CC-BY-SA unless otherwise noted.