The Water Framework Directive commits European Union member states to achieve good ecological and chemical status of all water bodies. As hydromorphology is a key factor for ecological status, a consortium of 26 partners from 15 countries studied the role of hydromorphological pressures and measures in the REFORM project. Its main objective was to answer the question: How to make river restoration successful? The project developed guidance for this by structuring the information along the different stages of restoration projects and river basin management plans, posing a logical sequence of questions: How does my river work? What’s wrong? How to improve? Things can be wrong for ecological status as a result of morphological alterations. These alterations form pressures that can be countered or mitigated by measures that improve sedimentological and morphological features. We present two specific results of REFORM that focus on river morphology. First, we provide an overview of methods to assess morphological quality and diagnose alteration. Second, we present systematic cause–effect relationships for restoration measures.