Individual psychodynamic psychotherapy in the NHS has very specific characteristics: the absence of self-referrals, time and resource limitations, a client group very often presenting with complex issues. Engaging the patient initially, maintaining the therapeutic alliance through the process and preparing to ‘let go’ without leaving the patient with the feeling of being ‘let down’ can be a difficult task. The use of letters, when carefully thought through, can be an invaluable aid to creatively resolving the problem of impasse at various stages of the therapeutic process.