Psychoanalytically oriented psychotherapy outcome research has yet to differentiate between a psychological structure that is present but temporarily inactive and genuine change in that underlying structure. Thus, a decrease in maladaptive responding following treatment may sometimes reflect illusory structural change, with the patient remaining vulnerable to relapse in situations that activate the underlying pathogenic structure. Genuine structural change would be better assessed by deliberately seeking and failing to find evidence of the enduring presence of a pathogenic structure under conditions that typically activate that structure, using both implicit (e.g., free response) and explicit (self-report) outcome measures. Because implicit and explicit measures are differentially affected by situational variables (e.g., mood, mindset priming), rigorous psychotherapy research must use experimental techniques and multimodal assessments to assess outcome under the conditions most likely to evoke a pathological reaction in a seemingly recovered individual.