This chapter helps practitioners to better understand and recognize tensions in the therapeutic relationship. We highlight the emergence of tensions in the relationship between therapists and clients as an expected and common relational phenomenon in psychotherapy. The chapter reviews concepts commonly used to describe relational difficulties, allowing practitioners to explore and differentiate similar constructs such as empathic failures, misunderstandings, therapeutic impasses, resistance, therapeutic alliance ruptures, breaks in therapeutic collaboration, misalignment, and disaffiliation. Then, we explore the most fine-worked constructs in the field and their respective observation methods, namely alliance ruptures, collaboration breaks, misalignments, and disaffiliation. In the second part of the chapter, we provide practitioners with different tools that may allow them to spot tensions that emerge in therapeutic conversation and to understand their nature and origin. These include verbal or discursive and nonverbal markers such as motoric, physiological, prosodic, or behavioral responses. Afterward, using a hypothetical cognitive-behavioral therapy clinical vignette, we illustrate some of these markers, which are potential red flags on the quality of the therapeutic relationship. Finally, we provide a set of key considerations and general guidelines for managing these crucial therapeutic events.