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In The Sixth Sense, several months(?) after an "incident", child psychologist Malcolm Crowe (Bruce Willis) takes up a new case: 8-year old Cole Sear (Haley Joel Osment).

Sixth Sense [Source]

But how did Crowe learn of Cole's issues? Given the "state" Crowe is in, it seems unlikely that it was Cole's mother who reached out for his help and hired him.

Who hired Malcolm Crowe to look after Cole Sear?

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    This seems overly harsh. When you're dreaming, do you realize it at the time? Do you notice that your dream has no beginning or history? Do you notice things that seem out of place? It doesn't seem unreasonable to suppose that Crowe's dead state is similar, but even more so.
    – Kyralessa
    Commented Aug 7, 2013 at 3:31

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No one hired Malcolm Crowe to look after Cole. Over the course of the movie it is established that Cole can see dead people and that reason the dead haven't moved on is because they have something they still need to see accomplished on earth (for example, the little girl who's mother had poisoned her wanted her father to know the truth).

In all the pictures of Cole there is always a white streak around his head to signify that dead people that were always around him. Though it is never specifically spelled out, it is suggested that both Cole and Vincent (the patient that shot Malcolm) are inundated with the spirits of the dead. I don't think the dead even understand that they are drawn to the people with this gift, it just happens - like steel to a magnet.

Thus, Malcolm was drawn to Cole (instinctively) and as he (Malcolm) did not realize he was dead, he automatically fell into the roles and rites of his job - thus assuming that he was there to help Cole as a therapist. What was really happening though is that he was dead and had not moved on because of his guilt about not helping Vincent etc.

If you watch carefully, after Malcolm is shot nobody speaks to him other than Cole for the rest of the movie.

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    In all the pictures of Cole there is always a white streak around his head to signify that dead people that were always around him. I think that that the dead were drawn to him (like a moth to the light) since he could communicate/see them. I think that Malcolm was drawn to Cole (instinctively) and as he (Malcolm) did not realize he was dead, he automatically fell into the roles and rites of his job - thus assuming that he was there to help Cole as a therapist.
    – djmadscribbler
    Commented Aug 29, 2012 at 17:45
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    Looking at some quotes from the movie it does seem possible that Malcolm's sense of reality is "distorted". It would explain how he doesn't notice that no one talks to him, or even acknowledges him. So in his distorted reality it might be possible that he believes Cole's mother has hired him. (I don't think he would treat a child without parental consent)
    – Oliver_C
    Commented Aug 30, 2012 at 20:55
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    Remember that the dea only see what they want to see and, presumably, generate memories they want to generate. If asked Malcolm would probably remember whatever he needed to remember to make his story make sense. At one point he is on the bus with Cole - did he remember paying the driver? The interesting part of the question is how did he find out about Cole in the first place? Did he simply appear next to him? Did he roam around until he saw him?
    – Stefan
    Commented Aug 31, 2012 at 12:40
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    +1, but a very gentle note that steel itself is not magnetic unless you add iron to it. Now I will duck and cover and apologize, because this is a perfect answer.
    – Mikey
    Commented Jun 4, 2017 at 21:17
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    If you remember, she already at the restaurant when he arrives. In this theory, his wife isn't actually talking to him. She is there commemorating their anniversary by herself. She looks angry or upset because he's dead and she's alone now. She says "happy anniversary" out loud but not to him, per se.
    – djmadscribbler
    Commented Sep 30, 2017 at 7:35
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Lynn (Cole's mother) hired Dr. Crowe.

In a city that crawled with psychotherapists, Dr. Crowe's name stood out. His success rate was legendary. His appointment book was full for months.

Lynn Sear had known about him for years. So had nearly every other parent of a troubled child. Many called him in a panic, and most were politely referred to other therapists with less crowded schedules. But Lynn believed her son needed the best, and she'd been persistent. One month from now, Cole had an appointment to see Dr. Crowe, due to a last-minute cancellation. Dr. Crowe had already interviewed Lynn over the phone about her son.

... [1 year later]

As he sat on a bench across from a line of brick rowhouses, he reviewed the problems of an intriguing case. It was one of the many he had never been able to follow up on. He vaguely remembered talking to Mrs. Sear. She had been especially eager for her son to see Malcolm as soon as possible.

Sixth Sense - Official Novelisation

This explains how he had a dossier of facts about Cole and knew their address and contact details. It also places Cole very firmly into the 'unfinished business' category, since Crowe is killed by a patient with a similar set of symptoms.

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I think it starts with Malcom on bench looking through Cole's files in an undifined twilight zone where they both help each other and the world with aid of ghosts to all find their peace and karma in life.

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