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This study examines how transference work (TW) impacts alliance ruptures in short-term psychoanalytic treatment (STPP) for adolescents with depression. Using a mixed-methods approach, this study analyzed 16 STPP sessions with 4 adolescents. Observer-based measures were employed to assess both alliance ruptures-resolutions and TW, while qualitative analysis provided insight into TW’s role in repairing ruptures. The findings demonstrate that TW was commonly employed in STPP sessions and also in response to ruptures. The most frequently utilized forms of TW centered on interpretations addressing immediate issues within the therapeutic relationship, rather than drawing connections to relationships outside of therapy (genetic interpretation). Overall, this type of TW contributed positively, albeit modestly, to repairing alliance ruptures. Key factors enhancing TW efficacy included the therapist’s ability to maintain a focus on transference dynamics in the present moment and their capacity to be validating and flexible in applying TW techniques. Conversely, rigidity in the use of TW and promoting dependency between the adolescent and therapist/therapy hindered the resolution of ruptures.