7 This Is Us Tissue Moments Ranked: Randall Fantasizes Jack's Survival, Reaches a New Low

The penultimate episode of "This Is Us" was the requisite calm before next week's inevitable storm, spent mostly in Randall's therapy room where a stellar Pamela Adlon challenged him on all of his bullshit.

But Randall is a master of manipulation, desperate to control everyone and everything, so learning to let that go is not going to be resolved in one therapy session, or even ten. And yet, we spent the hour rooting for him to have a genuine breakthrough even as we applauded the incredible work of the writers, as well as Adlon and Sterling K. Brown in bringing it all to life.

"This Is Us" has been a champion of therapy and male vulnerability, with Randall standing as a beacon that it is okay to live with your flaws, your anxieties and your deep-rooted issues and still be a man. You can be vulnerable and emotional. And you can go to therapy.

Even better, through two fantasy exercises where Randall presented his best- and worst-case scenarios for what could have happened had Jack survived the fire, it was the aftermath that proved so remarkable. The fantasies themselves were very telling in themselves, especially the second one where Randall at least seemed away of his stubborn streak and what refusing to forgive Rebecca might do to his life.

But it was his therapist's response to those fantasies, picking them apart and showing him what he's said through a different lens, pushing him to question some of those details -- like why the first thing that happens in each is that Rebecca admits she'd met William and had been lying about it -- that really pulled the episode together. It even almost had a neat, tidy little bow on top of it until the final reveal devastated us to our core.

Before we get to the moments, it's worth looking at that second fantasy. The first is too much perfection to really be of value, though it'd be interesting to explore if Randall really believes that, really believes his agency is capably of creating utopia for himself and his family? That's a bizarre hubris that's more than a little disturbing.

In the second one, though, we noticed that everyone's life was different because he was unable to forgive Rebecca's lie. Kate wound up with a different man much earlier in life (Evan) and had two kids. Kevin stayed and worked construction with Jack, marrying Sophie. In some ways, their lives turned out much more peaceful.

Even Rebecca and Jack stayed together and managed to work through Jack's anger that Rebecca held onto that secret. It was Randall who ran away from real connections with people. Beth never happened, and instead he became a teacher who callously slept with his TAs and callously threw away William's memories of him (and the poetry book) after receiving them upon William's death.

So in his worst case scenario, Jack surviving is good for everyone in the family but him, and it's really more about the fact that his survival spurred Rebecca to come clean about having met William all those years ago and Randall could not forgive her for two decades. Is this some small self-awareness to his stubborn pride and control issues? If so, it didn't last long!

As we do every week, we're going to single out the show's most powerful moments, scoring them by how many tissues we tore through just to watch them. Believe us, these are happy tears of anguish.

Look, we're going to be pretty honest with you. We're pretty frustrated with Randall at the moment. What he's doing is unfair and it's selfish and it's definitely going to be the thing that tears him and Kevin apart. And we absolutely believe he will be in the wrong here.

Kevin and Kate appear to be rebounding from their respective rock bottoms, settling and moving into more positive directions as individuals. Randall, on the other hand, appears to be spiraling toward his. How much might he lose along the way? And we're not sure we're up for this journey.

Dr. Leigh (Adlon) was a rock star in this episode, parsing through Randall's story and all his bluster and nonsense to really get at the root of his issues. She was even able to get him to see and acknowledge that even though he thinks it's all about losing Jack and William, it's more that he's not at peace with Rebecca's decision to keep William from him all those years. She denied him time spent with a second father after he'd lost the first.

1 tissue (that's some good therapying)

Even in the "utopia" fantasy, Randall was ready to hold that grudge over Rebecca, so he clearly knows the depths to which he is capable. It took young Beth to snap him out of it then, but she didn't exist in the darkest timeline to stop him. She does existing in the real timeline, but her powers must be waning.

We're going to consider this the mantra for the remainder of the season and however long they've got left. Mommy issues is an understatement for this show. Kevin and Kate have had to work through theirs, and Randall really, really needs to work through his.

2 tissues (Beth is the best thing that happened to Randall, if he'll let her be)

Another interesting observation from Dr. Leigh, that Randall had picked a middle-aged white woman around the age of Rebecca when Jack died as his therapist. We never even considered there might be weight in that decision, but she is starting to see through him and his -- yes cliche -- mother issues. But this show is apparently all about mother issues in the wake of Jack's death.

Why should Randall be any different? It's a powerful insight as to just how dysfunctional his relationship with Rebecca is inside his head, as he's clearly not dealt with her betrayal. The direction he took this a-ha moment and the eye-opening revelations of this session are truly heartbreaking.

2 tissues (he stands naked before the power of therapy)

We get a glimpse of what's to come as Randall breaks down the difference between losing Jack -- which he can't get over -- and losing William, which he appears to have processed in a somewhat healthier way. The control freak in him was able to accept William's death because he chose to stop trying, to let William die in his own way. In other words, even by choosing to stop, Randall was in control of that situation. And that's what he can't let go of.

3 tissues (we had no idea the sinister foreshadowing)

Randall acknowledging to his wife that he has unresolved issues with Rebecca should have been a turning point in his mental health, and it may well be. But rather than turn toward the light, he appears to be going the other way. And Beth, who is all heart and tough love and support, had no idea in this moment.

What looked like Randall having a genuine moment was really him turning even more away from the unconditional love Beth ha always given him as he plumbed the depths of his capabilities and found new strategies to manipulate and control. Our tears here came after the fact as we realized what a betrayal this was between Randall and his wife.

3 tissues (oh no Randall, what is you doing?)

This was the turning point when the rug was yanked and we realized that Randall had simply put back up his wall and was refusing to really face what was going on. Even faced with the reality of his issues and the chance to reconcile his emotional relationship with his mother before she may not be able to, Randall cannot even see that path. Only one way lies before him and that is the way where Randall gets what he wants, total control of the one (out of four) parents remaining to him.

He acknowledges that losing Rebecca would break him entirely, but rather than realize that's something he needs to fix because it's unreasonable to think it won't happen someday, Randall instead decided that Rebecca's continued existence for the sake of his mental health was simply something he could control, just as he has done everything else in his life. What could go wrong?

3 tissues (you're losing him, doctor)

Mandy Moore was incredible as the face on the other end of this incredibly potent and manipulative and gross misuse of love for selfish reasons. Randall stoops to the point of shame, guilt and manipulation to convince Rebecca to give up time with her family -- as she's enjoying right now -- so that she can stay existent for his mental health.

The total disrespect for her wishes, her very autonomy, is appalling as Randall fully slips into disgusting villainy with this move. That he did it late at night with the family in bed proves that he knew he was doing something despicable. He also knows Beth would never allow it, and so he is lying to her through omission the same way Rebecca did to her family in keeping William a secret all those years.

Randall is so deep down the rabbit hole on this one it's almost irredeemable. It's one thing to care passionately about Rebecca getting better, but its not even about doing it for her, it's about doing it for him. He needs to know that she's out there alive so he can have peace of mind.

What she wants no longer matters because he only cares about what he needs. His mental illness is winning the battle here, to the detriment of his relationship with Rebecca and presumably Kevin, and possibly the whole family.

The rock that thought he was holding his family together is about to tear it apart for the most self-centered of reasons, and with no regard for any of them as actual human beings with their own thoughts and feelings and desires. It's shameful to watch.

5 tissues (angry at the son, shattered for the mother)

Next week brings the season finale, called "Strangers, Part 2." That's a title pick-up from the season premiere that introduced new faces like Cassidy, Malik and Jack (who turned out to be Kate and Toby's baby grown up). It offered us a fresh perspective on some of our characters through these new eyes, so we're excited to see what this thematic sequel to that strong opener brings.

"This Is Us" wraps its fourth season next Tuesday night at 9 p.m. ET on NBC.

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