“…In addition to empirical evidence for rapid change in alliance and distress, in conjunction with early attrition, research has also demonstrated empirical associations in expected directions among these constructs. Client attrition has been linked with alliance and distress as well as with client expectations, therapeutic dosage, motivation to begin therapy, and both client and therapist interpersonal skills (Clarkin & Levy, 2004;Garland et al, 2012;Holdsworth et al, 2014;Longo et al, 1992;Mallonee et al, 2021;McEvoy et al, 2013;Sun et al, 2021;Swift & Greenberg, 2012;Tracey, 1986;Tryon, 2002). Client attrition, for example, often occurs at roughly the same time the alliance fails to form (Sharf et al, 2010;Tryon & Kane, 1993).…”