Ruptures in the therapy alliance reflect breakdowns in the collaboration and/or bondedness between patient and therapist. When unnoticed or unaddressed, such ruptures are associated with poorer patient treatment outcomes. However, alliance ruptures can also represent a clinical opportunity, as successfully resolving them can be therapeutic. Thus, recognizing and pointedly addressing alliance ruptures is an essential component of evidence-based practice. Yet, clinicians may find this process challenging, as ruptures can come in different guises, some of which require distinct types of therapist responsiveness. For example, as one rupture subtype, patients may resist the direction of a treatment. Such resistance can often stem from tensions between the patient’s ambivalence about change and the therapists’ use of change-oriented interventions, such as those in cognitive-behavioral therapy (CBT). In this chapter, we review the evidence-based practice of therapists responsively integrating motivational interviewing (MI) strategies into CBT to address moments of patient resistance and ultimately improve CBT outcomes. We also provide clinical examples of this contextually responsive practice. Additionally, we discuss a special resistance context for which other clinical strategies may be more effective methods for addressing patient resistance—namely, using culturally sensitive strategies to address cultural misattunements. Finally, we propose several future research and training directions on responding to resistance-based ruptures in CBT.