Cognitive behavioural therapy (CBT) with youth owns a solid and growing empirical literature base. CBT also recognizes the contribution a good therapeutic relationship makes to favourable treatment outcome. However, it is argued that the therapeutic relationship is insufficiently operationalized and the extant definitions neglect the role of therapeutic presence, immediacy, and transparency. Indeed, presence, immediacy, and transparency represent critical elements in creating the necessary therapeutic alchemy leading to propitious symptom change. Accordingly, therapeutic presence, immediacy, and transparency are defined and explained. Additionally, clinical parameters for using presence, immediacy, and transparency in clinical encounters with young patients are articulated. Finally, these crucial processes pervade cognitive behavioral modules such as self-monitoring, cognitive restructuring and behavioural experiments/exposures are explicated through specific examples and therapeutic dialogues.