Primary care facilities and hospitals have a large number of patients coming in for consultation who do not have any physiopathological changes found in them. It can be said that in most of these cases there is no pathology present. The phenomenon of seeking physical treatment in the absence of physical pathology is often called “somatization”. This term is narrowly defined as the presence of emotional problems in the absence of physiopathological changes that manifest as somatic symptoms. However, somatic symptoms that lack physiopathological changes do not necessarily indicate emotional problems. So the somatization aspect will be used here in a broader sense. The structure of the health care system reflects a dualistic perspective. That is, it draws a strict division between physical and psychological health care. Somatization challenges this dualistic view. Patients’ somatic symptoms lead them into the physical health care system. However, this is usually only the act of being ill that meets some of the patient’s needs; they are more likely to be a psychological problem that is psychologically scoped from the time they are identified to the time they receive psychological treatment. So it is thought that many patients in this category do not receive good treatment services. Generally speaking, the psychological needs of somatized patients are not significantly different from the other patients mentioned in this book. They all have a number of symptoms that they need to understand and be afraid of. Like patients with chronic illnesses caused by severe physical conditions, many somatized patients are incapacitated, impaired, and dependent (Stanley et al., 1999), and somatized patients simply lack the biomedical pathology that distinguishes them from other patients. This largely simplifies the psychological management sector. There are indeed better understood methods and procedures to help somatized patients now. The management of the somatized patient will be considered in detail in this chapter for two reasons. First, we will see that these are important clinical issues in the overall somatic health care medical treatment; second, the lack of physiopathological alterations makes psychological management easier to carry out, and some of the important psychological treatments used with patients in this group of patients can be described more clearly. In clinical practice, somatization problems are often confused by “functional” labels or diagnoses. Examples include allergic bowel syndrome, fibromyalgia, or chronic fatigue. Patients with chronic pain also fall into one of these categories, i.e., their pain, either from a previous acute injury or without any apparent cause, cannot be explained by existing pathology. There is a general impression among patients and physicians that these “disease labels” “explain” the condition in the same way as a conventional medical diagnosis. Unfortunately, the functional diagnoses explained in this way are roundabout, because they are purely descriptive classifications. For example, saying that someone has tummy pain because they have allergic bowel syndrome is the same as saying that they have tummy pain because they have tummy pain on a regular basis! As one patient with allergic bowel syndrome commented, “They call it IBS when they don’t know what IBS is (Peters et al., 1998).” In fact, many somatized patients suffer from multiple symptoms simultaneously, or over time (Stanley et al., 1999), so these diagnostic labels are not very useful in distinguishing particular patient groups. However, patients often value medical diagnoses as a way of justifying the existence of their problems (Henningsen and Priebe,1999). Of course, both physicians and patients are aware of psychological evidence derived from and related to functional disorders. The mistake is to assume that this psychological evidence implies that there are pathological changes that cause these disorders. For example, some evidence suggests that “tension pain” is associated with contraction of the head muscles. However, this seems to be the cause of the headache (Hopkins, 1992). The proportion of these problems is high in medical and surgical wards (Fink, 1992). For example, the functional diagnosis of unexplained abdominal pain (Barker and Mayou, 1992) is more common than appendicitis in many patients hospitalized for acute abdominal pain. Even among those who underwent appendectomy – a minority had normal appendicitis (Fink, 1992). The number of outpatients without physiopathological changes is considerable, estimated to be in the range of 30-70% (Bass, 1990). Estimates are more difficult in primary care settings because authoritative surveys are not available. However, about one fifth of patients with recent onset physical illness have symptoms that fit the narrow concept of somatization; that is, their condition is more likely to be the result of an emotional disorder than a somatic cause (Bass, 1990). Many patients with unexplained symptoms often have negative test results and have difficulty getting better. However, some continue to receive symptomatic treatment. This treatment accounts for a significant proportion of health care consumption in Western societies. There are also economic, social and medical factors that give patients ineffective therapeutic management. Patients who persistently present with somatic symptoms are thus a major medical problem in this context, and even this segment of somatic patients constitutes a large group of people. In the United Kingdom, general practitioners estimate that almost one fifth of those with significant somatic symptoms lasting at least three months without physical illness (Peveler et al., 1997). These become the “usual suspects” in primary care (Baez, 1998) and are difficult for clinicians to help (Sharpe, 1994). The extreme cases in this group have become known as “heart failure” patients, due to their frequent complaints and the helplessness of their physicians (Butler and Evans, 1999). Thus, somatized patients include those dependent patients who are the most frequent visitors to health care facilities, who are more impaired, and who require physician care. In the United States, expenditures for medical care for persistent somatization disorders in primary care have been reduced due to the standardized training of family physicians in consultative guidance, and patients no longer have to consult other physicians (Smith et al., 1995). This is one way to control this problem. However, the successful treatment of somatization disorders depends on our perceptions and the need for patients to undergo counseling. This means participating together with the patient and helping the patient to focus on meeting his psychological needs and later on meeting other needs.