Background: Acupuncture is a popular form of alternative medicine. It has shown large non-specific effects, but which factors contribute to these effects is unclear. We therefore aimed to identify the psychosocial factors that could contribute to treatment outcomes in acupuncture. Methods: We interviewed a purposive sample of 35 individuals (29 women) who had used acupuncture for various conditions and to varying effect. We used framework analysis to summarise and interpret the data. Findings: Participants described intra-personal and inter-personal experiences before, during and after acupuncture needling that could contribute to treatment outcomes. Key themes in the analytic framework reflect individual physicality, cognition and emotion; social negotiation and support through the therapeutic relationship and close social networks; and societal and environmental influences. Discussion: The psychosocial context of acupuncture from patients’ perspective is broad. We must expand placebo theories in order to generate more comprehensive understandings of non-specific treatment effects in complex interventions.