Step One is the fifth episode of the fifth season and the 81st overall episode of Private Practice.

Short SummaryEdit

Addison begins in vitro fertilization treatments with Jake's help, unbeknownst to Sam, Amelia is deeply conflicted when her terminally-ill friend, Michelle, asks her assistance in her suicide, and Sam and Violet contend with a patient who refuses his anti-psychotic medication.

Full SummaryEdit

Addison explains the five steps of IVF to her therapist. She's at step one. She also feels like that.

Addison enters Jake's office with her hormones. Addison hasn't pulled the trigger yet because the shots go in her ass. She wants to be sexy to Sam and this is not sexy. He understands and while she pulls down part of her skirt, he assures he won't tell anyone. He gives her the shot and starts rubbing the area as it helps the body to absorb them. He assures Addison he's not taking pleasure in it. Jake congratulates her for starting the process.

In the lobby downstairs, a man is freaking out, saying it's not safe. His mother is trying to calm him down as Sam enters. He's the man's doctor and his mother tells Sam her son is refusing to take any meds. Sam tries to get through to Wes by talking about the painting he's holding on to, but it doesn't work. Sam tries to say he needs to see doctor Turner, but Wes keeps repeating he can't and runs out. His mother runs after him.

Amelia meets her friend Michelle in a restaurant. Michelle's been in Italy for 6 months and she's finally back. Italian men are incredible, so she suggests Amelia go there. She wants to take her glass, but bumps her hand against it. Amelia asks when her symptoms started. Amelia says they can try to manage th symptoms. Michelle says she had 6 great months in Italy, but she refuses to die a slow death. It's time. She reminds Amelia of her promise. Michelle is ready and she needs Amelia to help her die.

Sam visits Violet at her house. Violet is trying to bake with Lucas. Sam asks if she remembers Wes. Violet does. Sam tells her he's off all his meds and she's the only one Wes wants to see. He's hoping Violet can to talk to him, unofficially. Violet says she'll consider it.

Erica wants to set ground rules with Cooper for seeing Mason. First, Charlotte is not allowed to speak or be near Mason. Cooper says Charlotte is very sorry, but Erica doesn't change her mind. Also, for now, Cooper can't tell Mason he's his father.

Wes is painting while talking to himself about it. Violet approaches him and introduces herself. He says she's not Dr. Turner. She says she is. She asks if he remembers how she used to visit him when he lived in a box in Venice beach and talked about how he felt and the frightening voices in his head. Then, he started to take medications and he didn't live in a box anymore, but an apartment instead. He remembers that. He had a show in the local art gallery and his paintings were loved. Violet asks if he wants to get back to that. Wes then says she's not Dr. Turner as the machines got to her and took over her mind. The real Dr. Turner would never have left her and he won't talk to her anymore.

Amelia is talking to Sheldon and Pete about Michelle's symptoms. Sheldon says there's therapy and support groups, but Pete soon figures out she doesn't want the lucid time she's got left. Amelia says Michelle wants her to euthanize her and confesses she promised Michelle she would in order to stop her from killing herself. Amelia says Pete did it, too. Pete wanted her to keep that to herself and his patient was old and only had a few weeks to live. Sheldon reminds Amelia of her oath, but Amelia is uncertain if she's doing less harm by letting Michelle die slowly and painfully. Sheldon knows she wants to help, but this is not the way. Physician-assisted suicide is murder in California.

Mason and Cooper are fishing with Erica. Mason catches a fish and they help him reel it in. Erica leaves to get Mason a hot dog. Mason asks if Cooper is dating his mom. Cooper says they're just friends. Mason says a guy friend usually means a boyfriend, and they're kinda dumb. Cooper juggles water bottles to show he's not dumb. Mason says he wants to go find his mom and walks off.

Violet walks into Addison's office and asks if she's heard about her schizophrenic patient who's off his meds because her license got suspended. Addison did. Violet is thinking about suing the medical board or she'll go to the press to bring attention to this broken system. Addison starts crying and asks if Violet is angry at her. Violet hasn't let herself realize the fact of her suspension until now. Her patients must feel abandoned. Addison offers her a donut to put on top of her feelings, like Naomi did. Violet says she doesn't do comfort food as a therapist, but eventually caves. Sam comes in with an idea for Wes. Addison tells him she's doing great.

Sam and Violet tell Wes's mother they can keep him in a psych hold, because his destructive behavior puts him in a life-threatening situation. Karen says she's had him committed before, it makes it worse. It makes Wes trust her less. She can only be there for him if he trusts her. He's still her boy and he's somewhere in there when the voices get quiet. She won't allow them to hold Wes against his will.

Amelia is in Pete's office and asks him how he did it. He says morphine, as his patient was halfway there with other pills. His patient was extatic, but when his body started to shut down, there was fear. Even though he wanted it, he wasn't prepared for it. Pete stayed with him, but it took an emotional toll on him. Pete wonders if he did it because maybe he was the one who couldn't take it anymore. If he had been stronger, maybe his patient would've died in his sleep without that regret or despair. Amelia asks that if he had known how it feels now, he'd still have done it. Pete would have, but Michelle's situation is different. It's not a relief, so Pete advises her to take back her word before she ruins her life and her career.

Pete sits down with Sheldon. They're both worried over Amelia. Sheldon is physically sick over her, but he's not her therapist or her father. Cooper comes in and tells them about the fishing. It was awkward and weird because it seemed like Mason didn't want anything to do with him. Charlotte comes in, too, and the other people leave. Cooper says he and Mason got along great until Charlotte interferred. If Erica hates Charlotte or Cooper, it's gonna rub off on Mason. Charlotte understands he's going through a rough patch, but he can't blame her for this.

As Jake is walking patients to the elevator, Addison loudly swears. He goes to check up on her and she's in blizzard of paperwork over the practice. This is not what she signed up for. Addison is really worked up and then realizes it's the hormones. Jake says it's not her fault her filter is gone. He advises her to breathe and if she wants to cry or scream, she should go somewhere quiet to avoid emotional triggers, like... Sam comes in and Jake pretends he was just giving her a peptalk. Sam sits down with her and says he hates this thing about Wes. He feels bad for all mothers everywhere. Wes was perfectly normal until he was Maya's age. Maya is the biggest blessing of his life, but sometimes he wonders if not having a child and the worries that come along with it is a blessing, too. Addison stands up and walks out. Sam gets a call and rushes out.

At her home, Michelle is shaking as she asks Amelia what will happen after she's gone. Amelia says she'll call the police and tell them she found her. They'll think she took pills. Amelia scatters pills on the carpet and gives Michelle the bottle to put fingerprints on it. Michelle suggests she just take the pills, but that could leave her in a coma or with severe liver damage. Michelle doesn't want to get Amelia in trouble, but Amelia doesn't want her to suffer, either. Amelia takes the drugs she brought. There's one to relax her, one to put her under, and a final one to stop her heart. Michelle gets comfortable on the couch and says she's ready. Michelle turns to Amelia and thanks her. Amelia tells Michelle she loves her and asks her to say hi to her dad. Michelle jokes she'll fix him up with her mom. Amelia administers the first drug, but Michelle suddenly can't breathe. Amelia asks if she should stop or continue, and Michelle tells her to stop. Amelia stops and starts to resuscitate her.

In the ER of St. Ambrose, Wes is fighting the doctors. He had a psychotic episode and collapsed on the street. Sam says that's because he stopped taking the meds for his hyperthropic cardiomyopathy. Charlotte administers drugs to calm him while the doctors are struggling to keep him down. Wes begs his mother to make them stop. While they take Wes away, Michelle arrives in the ER and Amelia updates Pete on what happened. She wants to help, but Pete says it's time to step back. He'll keep her updated. Amelia sits down in the waiting room, next to Karen, but she soon gets up and leaves the hospital.

Jake is giving Addison another shot while telling her it's harder to get to know the women at the practice. Addison feels like her brain is broken and she hates her boyfriend because he thinks it's a blessing not to have children. Addison thinks that's maybe why he's dating her. Jake tells her that hating her boyfriend and the broken brain is just the hormones. However, he thinks she can't do this alone. Even single women have friends and family, but Addison is too afraid to tell anyone, even Sam. He asks if she's even gonna tell Sam when she gets pregnant. Jake insists she needs people on her team.

Cooper is at Erica's house, but Erica wants to reschedule because Mason had a meltdown. She was too busy to talk him out of his bedroom to call him. She doesn't know why Mason doesn't want to spend time with him. Cooper thins that may change if Mason knows Cooper's his father. Erica wonders if he's ready to be a father. She means being an actual father, with room in his life and home for him. Fatherhood would change his life. Cooper gets that Charlotte scared her off, but she's like a mama bear when she's threatened. She growled loudly, but she's not a bad person. Charlotte loves him and she'll love Mason, like him. Cooper is glad about Mason and Erica was the one who showed up in his life. Mason has a father now.

Pete sees Violet in the hospital and asks if she's seen Amelia. He notices something's up and Violet says she's worried about Wes because she's not allowed in his room. Her lawyer is working to reopen her case. She's following the letter of the law by not seeing any of her former patients, but she's still worried about all of her patients. Pete says it's going to be okay, but he doesn't know how. Pete's favorite thing about her is how much she cares about her patients. He's glad she's fighting the board. Violet's glad he still likes things about her.

Amelia is sitting on the couch while Sheldon is knocking on the door, trying to convince her to let him in. Amelia gets up and opens the door. Sheldon asks if she's actually crazy. Even he didn't think she was stupid enough to go through with it. By telling him about it before, she technically made him an accomplice and he should call the police, but he won't because Michelle didn't die. He asks why she's this self-destructive. Amelia is happy to hear Michelle's alive, but soon after breaks down. Sheldon holds her.

Amelia arrives in Michelle's room with a wheelchair. Amelia helps her to sit down in it. Michelle apologizes. She doesn't know if she wants to die. Amelia says she doesn't have to apologize, or figure it out today. It's not easy to be alone. Michelle has her and she can even move in because Amelia herself is struggling with booze and pills and Michelle moving in would help her, too. They can be there for each other like some kind of messed up buddy system. No drinking and no suicide Michelle agrees to that.

Sam tells Karen they stabilized Wes's heart. Karen says Wes can't hear him when he's like this. He's always like this when he's on his meds. It makes him feel like he's 10 feet under water. Working with Dr. Turner helped, but Karen knew it was just a matter of time. Sam advises her to legally petition for conservatorship so she can make his medical decisions and have him admitted to a facility, but Karen doesn't want to hear anything about it. She won't do that to her son. Sam revealss his sister Corinne was a lot like Wes. Corinne would always find a way to run away. One day, she never came back. That was a long time ago. Sam still doesn't know if she's still alive, but he does know his mother's never been the time. He knows she loves Wes and wants him to be free, but he wonders if she's ready for the day he'll disappear forever. Karen says her son's an artist and a thinker. He's passionate and funny. That man is not lying in this bed. If she keeps him like this, he's already disappeared.

Sam lies down with Addison on their bed. They play around and Sam playfully spanks her, and Addison can't help but let out a little scream. She tells him about having started IVF treatments and that Jake's been helping her as she didn't want the entire office gossiping. Sam says he doesn't want another kid because he already got his through. He was terrified every day of Maya's childhood, but he got her through. It's wonderful as well as terrible, and he doesn't know if he has it in him to do it again. However, that does not mean he does not love Addison or that she gets to keep secrets from him. She says okay. He kisses her.

Amelia arrives at Michelle's house for a girl's night, but Michelle doesn't answer. Amelia eventually finds her body on her bed, with a bottle of pills next to her.

With a glass of wine in her hands, Amelia is talking to the detective about Michelle's disease. She says Michelle took 15 of the pills, so she didn't last long. The detective asks if she's okay. Amelia assures him she's okay, aside from missing her friend. She's not all right, but she will be. She's fine. The detective leaves her alone. Amelia then takes the three pills she'd been hiding in her left hand.

Outside the hospital, Karen asks Wes if he's sure he doesn't want to ride with her. Wes says cars aren't safe. The night sky is much better for her. Karen gives Wes some money and her phone number. Wes thanks her for saving him. She's his hero. Karen says he's also hers. She hugs him and he walks off, with a backpack on his back. Sam walks up to Karen. He offers her a ride. She thanks him.

Erica lets Cooper into her living room and leaves him alone with Mason. Cooper sits down and says he had fun yesterday and he'd love to keep hanging out. They can do whatever he wants. Mason asks if Cooper is his dad. He's pretty sure he is, because they look alike and his mother acts weird when she talks about him. Cooper asks how he'd feel about that. Mason says that if he's not going to be around, they can't be friends. Erica comes back and says Coooper is indeed his dad. Cooper says he's not going anywhere. Mason asks if he wants to watch Phineas & Ferb. Cooper says yes and takes a relaxing pose. Mason watches it and copies it.

Addison tells her therapist that step one is the hardest, as they always say about everything. It's like when you watch a baby take her first step. She spent months literally teaching her muscles how to function, but once they do, it's never that hard again.

Jake finishes giving Addison another shot. Addison asks if Jake wants to be her fertility doctor. Hers is fine, but Jake is clearly better for her. Jake says yes.

Addison's therapist asks what muscle she trained in order to take this step. Addison says he'll laugh. He promises he won't. Addison says hope. She had to learn to let herself hope.


  • Addison Montgomery
  • Pete Wilder
  • Jake Reilly
  • Cooper Freedman
  • Charlotte King
  • Sheldon Wallace
  • Amelia Shepherd
  • Sam Bennett
  • Violet Turner
  • Karen
  • Erica Warner
  • Michelle
  • Wes
  • Mason Warner
  • Detective
  • Lucas Wilder (with Violet Turner)

Main CastEdit

Guest StarsEdit



  • Courteney Cox as Woman #1
  • Christa Miller as Woman #2

Medical NotesEdit

Addison Forbes MontgomeryEdit

  • Diagnosis:
    • Infertility
  • Doctors:
    • Therapist
    • Unnamed reproductive endocrinologist
    • Jake Reilly (reproductive endocrinologist)
  • Treatment:
    • Talk therapy
    • Hormone therapy

Addison talked to her therapist about the five steps of IVF, saying she was at step one. She had Jake inject her with the hormones. Because of the hormones, she became overemotional. After having Jake inject her several times, Addison switched her care from her original doctor to Jake.


  • Diagnosis:
    • Schizophrenia
    • Hypertrophic cardiomyopathy
    • Arrhythmia
  • Treatment:
    • Haloperidol

Wes is a psychiatric patient with schizophrenia who was refusing to take his meds, including his heart meds. He'd been a patient of Violet's until her license was suspended. His mother said she needed to start seeing him again. Even though she couldn't legally see him as a patient, she agreed to go talk to him. She spoke to him where he was outside painting and he didn't believe she was really her. Sam suggested a psychiatric hold, but Wes's mom, Karen, rejected the idea because it would make it worse for him and he wouldn't trust her anymore. He had a psychotic episode and collapsed in the street, so he was brought into the ER, where they gave him haloperidol to calm him down. They were able to stabilize him and he was resting comfortably afterward. Sam again suggested they put Wes in residential care, but his mother said no. He was discharged and went on his way on the streets.


  • Diagnosis:
    • Huntington's
    • Respiratory distress
  • Treatment:
    • Flumazenil

Michelle, 30, had spent six months in Italy living her life and had started displaying symptoms of Huntington's disease. She decided she wanted to kill herself with Amelia's help. Amelia consulted Pete, who had helped a patient die before. He told her how he did it, but recommended that she not do it. Despite this, Amelia planned to give her benzos, barbiturates, and finally sodium chloride to stop her heart. However, after the first injection, she had trouble breathing and Amelia started CPR and called 911. At the hospital, Pete treated her and got her breathing well again. After she was discharged, she killed herself.


Song Performer Scene
"My Little Dove" I Hate You Just Kidding
  • Amelia prepares to help Michelle die and explains to her what will happen.
  • Michelle gets comfortable and they say goodbye.
  • Amelia starts injecting the drugs.
"The Ghost You're Haunting" Robotanists
  • Michelle has a bad reaction and Amelia stops.
  • In the ER, the doctors treat Wes, who heavily resists. His mother is taken away.
  • Michelle arrives in the ER with Amelia and Pete starts taking care of her. He tells Amelia to go.
  • Amelia leaves the hospital.
"Going Home" The Bony King of Nowhere
  • Cooper says Mason now has a father.
  • Violet and Pete talk about her worries over her former patient. 
  • Sheldon gets angry at Amelia, who didn't know Michelle survived. Amelia breaks down and Sheldon comforts her.
"Just You" Amy Stroup
  • Cooper tells Mason he will always be around. Erica tells Mason that Cooper is his father. Mason mimics Cooper's position as they watch TV.
  • Addison talks about step one being the hardest.
  • Jake gives Addison another shot of drugs. He accepts to be her fertility doctor.
  • In therapy, Addison says she had to learn how to have hope again.

Notes and TriviaEdit

Private Practice - Trailer Promo - 5x05 - Step One - Thursday 10 27 11 - On ABC

Private Practice - Trailer Promo - 5x05 - Step One - Thursday 10 27 11 - On ABC

  • This episode scored 6.59 million viewers.
  • Courteney Cox and Christa Miller made (uncredited) cameo appearances as part of a Cougar Town cameo appearance series. The Cougar Town cast made cameo appearances on several other ABC shows in order to let their audience see their faces on screen during Cougar Town's hiatus. Their colleague Ian Gomez appeared in the Grey's Anatomy episode Love, Loss and Legacy.


Episode StillsEdit


Addison: Do you want to be my fertility doctor? I mean, mine's fine. She's great, but You're clearly the better choice for me. I mean, that's assuming that you would still take me on. I I wouldn't blame you if you didn't--
Jake: Yes.

Sam: I don't want to have another kid because I already got mine through.
Addison: What?
Sam: Oh, I was terrified every single day of Maya's childhood. But I got her through. I mean, it was wonderful and it was terrible, both, equal parts. And it's definitely an experience that you should have if that's what you want. But I just don't know if I have it in me to do it again. But that doesn't mean that I don't support you. That doesn't mean that I don't love you. And it doesn't mean that you get to keep secrets from me.

Cooper: Mason and I were getting along great until-
Charlotte: Until what? If you're having an issue with him, it has nothing to do with me. I only talked to the mother.
Cooper: We hung out today, and it was awkward. And it never was before, and if Erica hates you or us, that is gonna influence Mason.
Charlotte: Coop, I understand you're going through a rough patch. But if you think you can blame me because an 8 year old doesn't want to share a corn dog with you, you have another thing coming.

Violet: That new lawyer is working overtime to reopen my case, so I am following the letter of the law. No contact with my former patients. But, um, yeah, I'm worried about him. I'm worried about all of 'em.
Pete: It's gonna be okay, Violet.
Violet: How?
Pete: I don't know. I don't know how. I just... This is my favorite thing about you.
Violet: When I get the crazy eyes?
Pete: No. That's pretty cute, too, but my favorite thing about you is how much you care about your patients. I'm glad you're fighting the board.
Violet: I'm glad you're remembering things you like about me.

Amelia: I know it's not easy being alone. Your mom had you, and you have me. I will be there the whole way. You can even move in if you want.
Michelle: Oh, I couldn't do that to you.
Amelia: You'd be helping me, too. I know it doesn't compare to what you're going through, but I struggle, too, every day.
Michelle: Pills?
Amelia: Booze. I'm branching out.
Michelle: I didn't know. I'm sorry.
Amelia: You don't have to be sorry. I mean, so we're both screwed up. But maybe we can be there for each other, like some kind of Like some kind of messed-up buddy system. You know, I won't drink today if you don't kill yourself.

Addison: Step one is the hardest. I mean, they say that kind of about everything. You know, it's like when you watch a baby take her first step. I mean, she's spent days and weeks and months literally teaching her muscles how to function. But once they do, it's never that hard again.

See AlsoEdit

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