More than half a century of psychotherapy research has yielded compelling evidence implicating the quality of the therapeutic alliance as one of the most robust predictors of overall treatment success (Horvath & Symonds, 1991; Martin, Garke, & Davis, 2000). This is a finding replicated multiples times across treatment modalities. Other findings indicate that poor outcome cases demonstrate greater evidence of negative interpersonal process (e.g., hostile interactions between patient and therapist or deterioration in the quality of the alliance) than good outcome cases (e.g., Coady, 1991; Henry, Schacht, & Strupp, 1986; Samstag, 1999). There is also evidence that therapists who are more helpful are better able to facilitate the development of a therapeutic alliance (e.g., Luborsky, McLellan, Diguer, Woody, & Seligman, 1997). Taken together, these findings suggest that recognizing and attending to negative interpersonal process or ruptures in the therapeutic alliance may playa valuable role in successful treatments.