This chapter critically evaluates the literature on therapeutic alliance ruptures, particularly in the context of cognitive-behavioral therapy. We discuss two distinct categories of ruptures: confrontation ruptures, in which clients and/or therapists move against the other or the work of therapy; and withdrawal ruptures, in which clients and/or therapists move away from each other or the work of therapy. Research has found that compared to repaired ruptures, unrepaired alliance ruptures are associated with a weaker therapeutic alliance and poor psychotherapy outcome and may even lead to client dropout. Research also suggests that rupture repair predicts treatment success. Analyzing the repair process has demonstrated how therapists can employ immediate and expressive resolution strategies to repair alliance ruptures. This chapter describes rupture repair intervention strategies and delineates their relevance and implications for cognitive behavioral therapy, discusses clinical implications, and provides specific clinical suggestions. An important precondition to rupture repair is a therapist’s ability to recognize alliance ruptures when they occur. No matter which specific strategy a therapist chooses, by maintaining an empathic, validating, and curious stance in the face of a rupture, a therapist can strive to facilitate a new relational or corrective emotional experience for a client.