The therapeutic alliance as measured by the Working Alliance Inventory was examined on an inpatient unit for eating disorders. Unit staff and patients (n = 33) admitted within a 2-year period completed the rating scales at 3 weeks after admission and again at 8 weeks. Patients who remained in the program (n = 21) perceived the therapeutic alliance with staff to be significantly stronger than patients who left the program (n = 10). The perception of the alliance strengthened over time for patients while staff perceptions did not. Little correlation was observed between staff and patient perceptions of the alliance. The findings suggest that patient perception of the alliance may be a critical factor in the decision to remain in the treatment program. It is argued that helping a patient feel involved in a structured program presents a particular challenge to staff.