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Dr. Lynn is real and the sequence at the beginning of the game is not inside Alex's head. Alex blocks Dr. Lynn's number after receiving a few texts from her, there could be several reasons for this. My guess is she blocked her because she has no intention of taking any more antipsychotic medications. The doctor had prescribed these to her while she was a ward of the state at the orphanage. They, understandably, believed her empathetic powers, visions, and mind-reading to all be delusions and put her on medication which would have helped had she really been suffering from a mental illness. Since we know she wasn't, they may have made her worse.
When we hear from Dr. Lynn again in the final episode it's during a dream that is taking place while Alex is knocked unconscious. She's a representation of her anxiety, self-doubt, isolation, rejection, and other things she has dealt with growing up. You are correct that it is not actually Dr. Lynn talking to Alex here, but Alex's own negative feelings about herself. There is some background and true info to be found during this nightmare, like in the pictured file folder, but it may be distorted by her own self-image.
She's not actually talking to Gabe at the end. She's feeling positive now about her future and so she's imagining Gabe telling her about what it will be like. But for the purposes of the game and plot, we can assume that everything he is narrating is what will actually happen.
Yes i am confused...
My biggest question is how is alex still recieving help from the orphanage if shes 21, and why is this so called docter attached to orphanage in this way, they treat her like shes a teenager? Or like shes coming out of some kind of rehabilitation center? Idk
There are adult psychiatric facilities. They are sort of like rehab centers. The impression I got of the first scene was that Dr. Lynn was doing Alex's exit interview, the last little check-up they normally do to see if she was okay to leave.
Edit: Nvm, just watched the intro again and they say she's leaving the group home after being there for 8 years. I think it's just written that way for plot convenience, not to be realistic or for us to question whether it's a dream or something.
T-T