Initially, Freud proposed two distinctive ways of understanding somatic symptoms: the hysterical conversion and the actual neuroses models. The original conversion model posited that somatic symptoms had meaning and resulted from psychic mechanisms, whereas actual neuroses model proposed somatic symptoms had no meaning and resulted from physiological rather than psychic processes. Psychoanalytic psychosomatics has evolved much since those initial postulates. Insufficiencies in psychic processing of emotional experience has become a key problem for the understanding of somatic symptoms, and consequently supporting psychic processing has become the main technical challenge. Starting from Freud, this paper explores the evolution of explanatory models and technical approaches for the treatment of people affected by so-called ‘psychosomatic’ pathology. Some technical implications of these developments are discussed in relation to a case example.