This chapter focuses on navigating alliance rupture and repair with emotionally dysregulated clients with personality disorders. Most of the evidence supporting this chapter derives from research on borderline personality disorder; however, the clinical strategies presented are also applicable to other personality disorders characterized by emotional reactivity and interpersonal sensitivity. Research on the alliance demonstrates that ruptures are more common in clients with personality disorders than in those without a personality disorder. In therapy, heightened sensitivity to interpersonal threat can lead to emotional reactivity and problematic behaviors and communication. When clients are emotionally dysregulated or presenting with high-risk behaviors, therapists are especially vulnerable to becoming reactive and engaging in their own therapy-interfering behaviors that can elicit or exacerbate ruptures. In this chapter, we discuss a framework for conceptualizing client and therapist contributions to alliance ruptures, along with alliance-focused strategies and techniques for helping therapists observe and respond to ruptures in the alliance. The chapter concludes with a case illustration of how therapists can integrate an alliance focus into their therapy sessions with emotionally dysregulated clients.