The irritable bowel syndrome (IBS) is a common condition consisting of abdominal pain, abdominal distension and an altered bowel habit in the absence of underlying organic pathology. Most people can be helped by conventional medical treatment but a small proportion (15%) run a chronic course with disabling symptoms that are unresponsive to medical intervention. This paper briefly describes a recent randomised, controlled trial of brief psychotherapy in 102 patients with refractory irritable bowel syndrome. The trial showed that two-thirds of people with chronic symptoms of IBS show significant improvement following brief therapy. Six cases of patients seen during the trial are presented to illustrate the nature of the therapy employed and the range of people who can be helped by such an approach. The advantages and inevitable limitations of brief dynamic therapy with IBS patients are then discussed.