On February 8, 2019, Alexis Davis was in a foul mood as she entered Charlie's Pub. "Arrogant bastard," she grumbled when she sat down at the bar then ordered a ginger ale. Neil was surprised by the outburst, prompting Alexis to explain that she had not been referring to him. Alexis admitted that he seemed like a nice guy because he had been reading a book. She noticed the book about Russian history then began to ramble as she opened up to the stranger about her life and her family -- especially her ex-husband, Julian Jerome.

Neil offered a bit of insightful advice, which impressed Alexis. Encouraged, Neil suggested that they go out sometime, but Alexis warned him that it a bad idea because she had a lot of issues. Disappointed, Neil gave her his card then invited her to call him if she had a change of heart.

Later that day, Neil welcomed a new patient, but he was stunned to realize that it was the woman that he had met at the pub. Alexis was embarrassed that she hadn't taken a look at his business card because she would have recognized the name of her new therapist. Neil acknowledged that it was an awkward situation and he offered to refer her to another psychiatrist, but Alexis admitted she'd prefer to stay because she had already told him everything.

Neil assured Alexis that he would never have asked her out if he had known that she was his patient. He suggested that they see how the first session went before Alexis made a decision. Alexis sat down then talked about her father Mikkos, an exiled Russian aristocrat. She confessed that she had been both drawn to and repelled by Mikkos at the same time, but she had never earned his love. Neil was confident that he could help Alexis develop healthier relationships, so Alexis booked another appointment.

Alexis continued to see Neil, and the attraction between them remained but neither acknowledged it. In April, Alexis turned to Neil for help when she suspected that her daughter had been pulled into a cult. Neil claimed that the best thing that Alexis could do for her daughter was to do nothing because her daughter was an adult. Neil revealed that he had worked with families in similar situations, and he was confident that Kristina would resent Alexis if Alexis attempted to force Kristina's hand. Neil suggested that Alexis plant seeds of doubt and allow them to take root. Alexis was not pleased, but she accepted the doctor's professional advice.

On April 9, 2019, Neil was "invited" to Sonny Corinthos' office. Sonny was concerned about his daughter Kristina who had been lured into a cult. Neil realized that the powerful mob boss was the father of Alexis' daughter. Neil carefully explained that "exit therapy" was a challenge, but Sonny was desperate because he had already lost a child. Neil relented, but he warned Sonny that his previous experiences with exit therapy had ended badly.

A few days later, Sonny arranged for Jason Morgan to kidnap Kristina from the Dawn of Day house then take her to a safe house. As promised Neil went to the safe house to help. Alexis was furious that Neil had turned her plea for assistance down, but he had agreed to help Sonny. Neil explained that he hadn't realized until he had talked to Sonny that Sonny and Alexis had shared a child, and that Sonny hadn't given him much of a choice. As Neil had expected, Kristina was reluctant to participate in exit therapy, but Neil assured her that he would help her communicate with her family.

On June 20, 2019, Diane Miller saw an exchange between Neil and Alexis in Kelly's. After Neil left, Diane teased her friend about the new man in Alexis' life, but Alexis confessed that Neil was her therapist. Diane had seen the chemistry between the two, so she encouraged Alexis to find another therapist. As they talked about Neil, Diane decided to do a quick online search to see what she could uncover about Neil. Alexis and Diane were surprised when Diane found a death notice for Neil's daughter, Joanna Marie Byrne. Joanna had died on July 31, 2014. Neil and his wife, Deirdre, had held the funeral on August 7 at St. Ignatius Church in Montclair.