Ruptures in the therapeutic alliance are common. If left unresolved, they can lead patients to drop out, among other poor outcomes. Repairing therapeutic ruptures is an important process that is relevant for practitioners of all theoretical orientations. This volume collects the work of 2 teams of scholars and clinicians, each of whom is expert in a different therapeutic context or theoretical approach, to describe clinical challenges in resolving common therapeutic ruptures. The authors use case studies to describe realistic, complex clinical examples of rupture and provide strategies and principles therapists can use to help navigate these challenges more successfully with their patients. As therapists and patients work together their alliance can come under strain, sometimes because of disagreements over therapeutic goals, and sometimes due to a lack of trust and respect. These moments of stress where the relationship has ruptured are challenges, but also opportunities for growth.