Nina Coltart (1996) has commented on the oddness of ending a (therapeutic) relationship that is clearly so important to the patient and the way in which 'We have clothed this oddness in theory, technique and familiarity' (p. 149). She goes on to describe in detail how important the authenticity of the patient-therapist relationship is to the patient and how absorbing and central it can become in the patient's life. And then she adds: 'So what do we do? We bring it to an absolute end' (p. 150). No wonder 'good enough' as well as difficult endings are so hard to think about.
The counterpart of the patient's attachment may well be that the therapist has felt him or herself to be in the 'caregiving' role, which it is not easy to relinquish when it is time for therapy to end (Bowlby 1988; Holmes 2001). This is the aspect of the therapist's role which relates to the ordinary parental task of letting go of their child in the interests of furthering growth and development-in all the small and larger steps that are required in life.
The counterbalancing processes of holding and letting go need to be addressed so that a point is reached where ending therapy acquires the quality of 'a page in life' being turned. This is where the idea of 'transitions' rather than stark beginnings and endings can be helpful. In ordinary life, progressions cannot take place without letting go of something-whether this be the infant letting go of the breast, or letting go of the side of the pool and realising that they really can float or swim. The reality is that developmental processes do not take place in isolation. Beginnings and endings belong together and remain essentially paradoxical in nature. And yet if the idea of, and capacity to, tolerate paradox during a transition can be maintained there is a richness of experience which compensates for the anxieties that change inevitably brings to the inner world.
One of the most paradoxical and at times challenging aspects of ordinary parenting is to be able to appropriately 'let go' of a loved child, because it is
1 This chapter is based on the 1999 paper, 'Holding and letting go: some thoughts about the process of ending therapy', Journal of Child Psychotherapy, 25(3):357-378.