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Dexter becomes suspicious when he discerns a pattern of recent deaths of powerful women by suicide. He discovers that all the women have consulted the same therapist, Dr. Emmett Meridian, and Dexter visits him under the pseudonym "Sean Ellis." The therapist actually helps Dexter with his intimacy issues, allowing him to have sex with Rita. During his therapy appointment Dexter notes that the therapist is surreptitiously recording his sessions. At night, Dexter breaks into the therapist's office, erases the video of his session, and reviews the videos of the sessions of the dead women, discovering that the therapist has used both drugs and psychology to induce them to commit suicide. Dexter books another appointment as Sean, confronts and subdues the therapist, and kills him.
Neil Perry confesses he is not the Ice Truck Killer after he freaks out at the sight of a severed head. Dexter sends the real Ice Truck Killer a message via Craig's List. Dexter's sister Debra brings her relationship with the prosthetist, Rudy, into the open. Rudy is revealed as the Ice Truck Killer when he responds to Dexter's message via e-mail, and then walks into his freezer of body parts, blood, and sliced Barbie dolls.
- Michael C. Hall: Dexter Morgan
- Julie Benz: Rita Bennett
- Jennifer Carpenter: Debra Morgan
- Erik King: James Doakes
- Lauren Velez: Maria LaGuerta
- David Zayas: Angel Batista
- C.S. Lee: Vince Masuka
- James Remar: Harry Morgan
- Geoff Pierson: Tom Matthews
- Mark Pellegrino: Paul Bennett
- Christian Camargo: Rudy Cooper
- Sam Witwer: Neil Perry
- Tony Goldwyn: Emmett Meridian
- Mark Matkevich: Alex
- Milauna Jemai: Co-ed
- Kyle Lupo: Scott Solomon
- Christina Robinson: Astor Bennett
- Daniel Goldman: Cody Bennett
- Devon Graye: Teenage Dexter
- Suzanne Lanza: Vanessa Gayle
- Rolando Millet: Court Official
- Del Hunter-White: Court Supervisor
- R.F. Daley: D.A.
- Renneker Jenkins: Joshua
- K.C. Ramsey: Reporter
- Rene Ashton: Meghan Dowd
- Mary Chris Wall: Carolyn Jillian