https://doi.org/10.1177/1534650119845503 Clinical Case Studies 1–18 © The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1534650119845503 journals.sagepub.com/home/ccs Reviews Attending to the Alliance in the Application of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: A Case Study Joseph M. Donahue 1 , Julia M. Hormes 1 , Elana B. Gordis 1 , and Drew A. Anderson 1 Abstract As conceptualizations of mood and anxiety disorders shift toward a dimensional approach, transdiagnostic treatments have gained recognition and support. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is an evidence-based cognitive behavioral therapy that targets the core processes that underlie common and comorbid mental disorders. It is designed to help clients learn how to confront, experience, and respond to their emotions in adaptive ways through the modification of their emotion regulation strategies. The current case study describes the flexible application of the UP with a treatment-naïve 25-year- old female who presented to outpatient therapy with symptoms of anxiety and depression. Additions to the UP were made to address issues related to the therapeutic alliance and information discovered over the course of treatment. Outcome measures administered to the client reflect significant symptom improvement and add to a growing body of literature that supports the usefulness of transdiagnostic approaches to treating a range of disorders. Moreover, quantitative and qualitative data point to the necessity for clinicians to attend to the therapeutic alliance and consider cultural factors when delivering manualized treatment approaches to individuals from diverse backgrounds. Keywords transdiagnostic, Unified Protocol, therapeutic alliance, emotional disorders 1 Theoretical and Research Basis for Treatment Mood and anxiety disorders are among the most common mental health disorders and cause significant distress and impairment (Rapaport, Clary, Fayyad, & Endicott, 2005), as well as a substantial social and economic costs (Simon, 2003). In the United States, approximately 28.8% of the population will meet diagnostic criteria for at least one anxiety disorder in their lifetime 1 University at Albany, State University of New York, USA Corresponding Author: Joseph M. Donahue, Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222, USA. Email: jdonahue@albany.edu 845503CCS XX X 10.1177/1534650119845503Clinical Case StudiesDonahue et al. review-article 2019