The current study retrospectively examined the relationship between female clients' perceptions of microaggressions directed toward women, working alliance, and therapeutic outcomes (N = 121). A measure, the Microaggressions Against Women Scale (MAWS), was developed specifically for this study, based on a content review of the literature, focus group, and a panel of seven female psychologists. A latent class factor analysis (returning one factor) and internal consistency estimates supported the measure. Clients' MAWS scores were negatively correlated with working alliance and therapy outcomes, suggesting that clients' perceptions of microaggressions can influence the process and outcome of therapy. Last, working alliance mediated the negative relationship between microaggressions and therapy outcomes. Implications for practice and further research are provided. (Contains 3 tables and 1 figure.)