As is well known, dreams are still seen as via regia to the unconscious by many psychodynamic and psychoanalytic clinicians and researchers. Therefore, this article reports on decades of efforts to understand changes in manifest dreams in psychodynamic therapies as indicators for relevant, sustaining transformations in the inner object world of patients and to use them in comparative psychotherapy outcome studies. An empirical psychotherapy study by Leuzinger-Bohleber has described the following changes in manifest dream during successful psychoanalyses: reduction of nightmares, widening of the affective spectrum, increase of successful problemsolving, fewer observer dreams and more mature object relations. These transformations are illustrated in a detailed case report of a chronically depressed, early traumatized patient of the LAC Depression Study. In the next section the results of a systematic focused literature review aiming to identify suitable instruments for the study of dreams are presented. Finally, we discuss which conclusions can be drawn for the development of a dream transformation scale capturing changes in manifest dreams in psychodynamic therapies with depressive patients. Such a scale would be an important methodological addition for future comparative psychotherapy outcome studies, since it takes into account dreams, as a genuinely psychoanalytic criterion for psychic transformations.