N. Peseschkian proposed a novel approach to psychotherapy for psychosomatic disorders, emphasizing the function of symptoms as capacities to discharge the tension of inner and outer conflicts and to restore health. He introduced the “psychosomatic arch” model to visualize the process of somatization, which has been refined and expanded upon based on recent research. Innovative psychodynamic operationalization models in positive psychotherapy (actual primary capacities and secondary capabilities, balance model, and four dimensions of relationships/modeling, actual, basic, and inner conflicts) illuminate the formation of conflictual tension and the abilities to deal with it. The identification and systematic description of the key conflict provides a clear understanding of how stress can become chronic and transform into psychosomatic symptoms. The Evaluation Criteria for Psychosomatic Practice (ECPP), inspired by positive psychotherapy, offers a refined and operationalized framework for psychodynamically informed diagnosis, treatment planning, implementation, and evaluation in psychosomatic care. This knowledge paves the way for innovative treatments, which focus not only on resolving inner conflicts but also on developing the primary capacities that allow for constructive, asymptomatic resolution, ultimately improving the patient’s overall well-being. The five-stage strategy of positive psychotherapy offers a systematic framework to address the challenges faced by psychosomatic patients, such as their fixation on physical symptoms, distrust towards healthcare providers, and deficits in primary (structural) capacities, limiting their mentalization ability.