After a brief critique of the current emphasis on symptom reduction as a criterion of therapeutic change, this paper presents several methods for assessing changes in the developmental organization and thematic content of mental representations (concepts of self and significant others). These methods constitute psychodynamically oriented ways of assessing therapeutic change in psychological structures in both long-term, intensive and brief treatment. We also consider how differences in pretreatment characteristics among patients have an important impact on the therapeutic process and on the nature of therapeutic change.