They're back and dealing with issues

Back after three months off, and the first thing Meredith needs is a shrink.

When ABC hit Grey's Anatomy returns tonight (9 ET/PT) with the first of five post-writers'-strike episodes, the first image we see is dark and twisty Meredith Grey (Ellen Pompeo) seeking psychiatric help.

The surgical resident is trying to work out the romantic and trust issues blocking her on-again, off-again relationship with McDreamy surgeon Derek Shepherd (Patrick Dempsey). This week, the relationship is off again. Sort of.

"I don't think Meredith knows what her issues are," says Grey's creator, producer and writer Shonda Rhimes. "But therapy is a pivotal part of the journey for her in the back half of the season."

She's not the only one with issues. Further unhinging the Mer/Der relationship is Derek's budding romantic interest in nurse Rose (Lauren Stamile).

Rhimes and her writing staff compressed plotlines and story arcs to fit the strike-shortened season. But first, they watched Grey's previous 72 episodes, "holed up in my office, watching 10 episodes a day," she says. The viewing marathon refreshed writers on character development and story lines.

"It put things in perspective and made it easier to pick up steam" for the season's remaining shows, Rhimes says. "We had to adjust, but we also had an opportunity to start anew and do things in a way that's interesting."

Tonight's show, in TV time, begins six weeks after the Jan. 10 episode ended, with medical and personal angst rampant at Seattle Grace. Bailey (Chandra Wilson) is coping with an unraveling marriage. There's a high-stakes contest among surgical residents to determine the hospital's best doctor. Amy Madigan guests as Meredith's psychiatrist; Cheech Marin appears as a patient.

Meredith and Derek will reunite by season's end, Rhimes assures fans, although Rose is part of "an interesting love triangle." Kate Walsh, who starred as Derek's estranged wife, Addison, before spinning off into Private Practice (on hiatus till fall), will return for at least one episode. But Rhimes is coy about revealing how the rest of the season unfolds.

"Alex's (Justin Chambers) relationship with Ava (Elizabeth Reaser) comes to a head, Yang (Sandra Oh) will do stuff you haven't seen before, Izzie (Katherine Heigl) has some stuff — the reality is, there's some really good stuff" with all of the central characters, she says.

Taping of the May 22 finale, expanded to two hours, begins Friday. Rhimes promises a cliffhanger, a hallmark of season-enders past. "There'll be some surprises in the last two or three minutes. There'll be things people will be talking about all summer long."