This study examines the sex differences in the perception of working alliance and the perceptions of optimism regarding future employment and job satisfaction with adult cancer survivors receiving vocational rehabilitation services. No significant differences were found between males and females in terms of the three components of the working alliance. However, examination of effect sizes indicated that the females reported higher levels of tasks (d=0.40) and goals (d=0.55) than their male counterparts. The three components of working alliance explained 60% of the variance with bonds ([beta]=0.865) making a significant and unique contribution to employment prospects. Working alliance was not associated with current job satisfaction in the employed group. Overall results of this study suggest that working alliance seems to be an important variable in the vocational outcomes for cancer survivors receiving vocational services.