Alliance ruptures in adolescent psychotherapy can significantly influence treatment outcomes. Despite this, there remains a scarcity of clear guidelines on how to repair these ruptures effectively. This chapter synthesizes research findings and clinical insights to offer practical guidance for cognitive-behavioral therapy (CBT) clinicians, providing clinical and research-informed strategies for addressing alliance ruptures effectively. Delving into the distinctive challenges of working with adolescents, it explores specific developmental factors such as the drive for autonomy, power dynamics, and systemic influences. Through case examples, the chapter examines age-specific developmental challenges, highlighting crucial aspects like caregiver or family involvement, confidentiality, risk management, and safeguarding, all pertinent to adolescent therapy and potentially influencing alliance ruptures. Additionally, the chapter addresses common challenges in CBT, including collaboration with exposures and homework, and presents examples of rupture types (e.g., withdrawal and confrontation). By illustrating clinical strategies that may be more helpful and effective in rupture repair, using session dialogue examples and case descriptions, the chapter aims to guide clinicians in navigating alliance ruptures with adolescents effectively.