This chapter reviews the existing empirical research on the topic of therapeutic alliance ruptures in psychotherapy. Ruptures in the therapeutic alliance are defined as episodes of tension or breakdown in the collaborative relationship between patient and therapist. Two meta-analyses were conducted. The first reviewed studies examining the relation between rupture repair episodes and treatment outcome. The second reviewed the research examining the impact on treatment outcome of training therapists in the use of alliance rupture intervention principles. Both meta-analyses provided promising evidence regarding the relevance of alliance rupture repair processes to therapeutic outcome. The limitations of the research reviewed are discussed, as well as practice implications for repairing the inevitable alliance ruptures in psychotherapy.