Patients who suffer from psychosomatic disorders often find it hard to imagine that their symptoms could indicate something more than somatic distress. They have little skill in self-observation and little capacity to think abstractly. Yet psychoanalysis relies on interpretation and insight for change. Frustration may develop on both sides of the couch as the analyst discovers that the patient cannot make use of the best tools in the analyst's arsenal. This article discusses the treatment of a concrete patient with irritable bowel syndrome (IBS), in whom long work on the metaphor of his illness eventually enabled him to use analytic interpretations for change and growth.