People with medically unexplained physical symptoms (MUPS) are often referred to psychotherapy, which has been shown to be modestly effective in reducing symptom severity. An investigation of clinical strategies used by experienced psychotherapists in the treatment of clients with MUPS may offer important insights into the treatment process with this challenging group of clients and help further improve the effectiveness of psychotherapy. Individual interviews with 31 psychotherapists experienced in the treatment of adult clients with MUPS were collected. The grounded theory method was used to identify clinical strategies. Clinical strategies were organized into three treatment phases. In the first phase, the psychotherapists’ intention was to draw clients who may resist the psychological view of somatic symptoms into psychotherapy. In the second phase, the psychotherapists aimed to influence the impact of the symptoms on clients’ lives. In the third phase, the psychotherapists focused on reinforcing the clients’ gains from treatment, and they remained open to treatment continuation. The clinical strategies shared by psychotherapists with diverse theoretical orientations point to common mechanisms of change in the treatment of clients with MUPS. Psychotherapists’ responsiveness to client preparedness for psychotherapy appears to be important for specifically challenging clients.