Look at them and laugh.
Save the couple.
Just walk by.
Buy the puppy, then lock it in a room with no other puppies.
Laugh evilly at the puppy.
Smile at the puppy, then go to work and make money for charities.
Buy the puppy, and cherish it forever more, using it to vanquish evil.
Tie them up to a chair and dangle it over a pool of piranhas.
Ask them to leave.
Give them superpowers, and make them your sidekick.
Agree, then kill the therapist.
Say, pretending to be noble, "No, my life is beyond repair."
Say, "I'm okay, and I couldn't possibly take you up on your offer of that."
Shake your head, then reveal your superpowers to them. You then say, "Now do you believe me? I must go save some innocents, if you don't mind."
Grab the boy by the leg and throw him ten miles.
Tell him that it's too bad.
Give him a fresh ice cream.
Lick it off your shirt, while laughing evilly.