Silvio paid a visit and took care of business of someone who's playing on both sides of the fence. Phil Leotardo ordered the "decapitation" of the Soprano crime family and wished to continue business with whoever was left. He then went into hiding while his henchmen closed in on the top men of the Sopranos. At the psychiatric ward, A.J. reconnected with an acquaintance, Rhiannon. At Satriale's, agent Harris forewarned Tony about a possible hit on him and his top men, which caused Tony to talk about it with his men and to decide to pre-empt the strike. Paulie was in charge to conduct the business with the help of the Italian cousins.
Unprofessional and unethical as it was, the psychiatrist bunch had a dinner gathering, where it was divulged who Dr. Melfi's patient had been all this time. The discussion surrounding a psychiatric study led Melfi to believe that she was doing more harm than help to Tony. She cut him loose without a good explanation.
The Soprano hit on Phil Leotardo turned out to be a mistake, which caused the other side to realize what was going on. The squeeze is on as Bobby and Silvio were hit. The episode ended with Tony holing up in a room of an empty house, holding a gun that was given by Bobby for his most recent birthday.