The question is discussed how changes concerning the patient's ability to recognize and obtain insight into dysfunctional relationship patterns, life-determining conflicts, and structural vulnerability as well as the readiness to take on the responsibility for the negative effects caused by these may be conceptualized. A model has been developed based on Operationalized Psychodynamic Diagnosis (OPD) in which individual problem areas for each patient may be chosen from a list of foci. Changes in these foci are evaluated using the Heidelberg Structural Change Scale which is presented and discussed in detail. This concept is applied to a sample of patients who had been treated in an in-patient setting. It is demonstrated that this method of measuring changes can be used reliably. Furthermore, the changes registered with the structural change scale correlate on an absolute level quite high to the global assessment of outcome through the therapeutic team; this correlation is even higher than the correlation between symptomatic changes and the global assessments. How this concept may be applied in planning, evaluating, and ensuring the quality of psychotherapy is presented in conclusion.