A review of some pertinent literature shows that many authors recommend supportive therapy in psychosomatic patients manifesting alexithymic characteristics. Only when positive changes occur in affect tolerance, psychoanalytic psychotherapy can be attempted. In this article it is demonstrated that the occurrence of dreams can be understood to signify such a change in affect tolerance. A clinical example is given in which psychosomatic (and traumatic) dreams gradually change into dreams in which the ego is trying to master the trauma (traumatolytic function). It is concluded that the occurrence of dreams can be of value in determining changes in alexithymia during psychotherapy of alexithymic patients.