The current public concern about childhood molestation and abuse has fueled the debate in psychoanalysis about historical versus narrative truth, a subject that has implicitly and explicitly been an important theme since the origin of psychoanalysis. The evocation of false memories by suggestion has had significant social consequences. This raises important questions about the role of real trauma as contrasted with fantasy in the genesis of psychic conflict. This paper explores the conditions for the emergence of long repressed trauma. It is argued that such traumatic memories emerge only after significant structural change has occurred, in particular modifications in the representational world (self and object representations). This substantive change may be viewed as a macroscopic way station in the evolution of the analysis. This is demonstrated in the description of the analysis of a patient born with a congenital anomaly. The analysis of her unconscious fantasies about her deformity, her identifications with defective people, and of a negative paternal transference had to occur before the development of an erotic transference. It was then that fragments of the memory of the sexual trauma emerged. Details of the reconstruction are presented. The successful integration of this painful experience is described. Six years after termination of the analysis, the patient wrote a letter describing a confirmation of the event, now sixty years past, from the sole other survivor of the period who had knowledge of what had happened.