Treatment for Chronic Suicidal Thoughts
in Washington State
Chronic suicidal thinking is not the same as being about to act. It's a sign that life has become unbearable — and that the pain needs to be treated, not just managed.
If you are in immediate crisis, please call or text 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room.
If you live with chronic thoughts of suicide — not necessarily a plan or imminent intent, but a persistent sense that death would be a relief, or that you don't want to be here anymore — you may have found that the standard response to these thoughts doesn't fit your experience.
Maybe you've been hospitalized during moments of crisis, only to return to the same thoughts days later. Maybe you've learned not to tell your therapist when the thoughts are bad because you're afraid of being sent to the hospital again. Maybe you feel like a burden to the people who love you, or like your life will never feel worth living no matter what you do. Maybe you've carried these thoughts for so long that they feel like a permanent part of who you are.
Chronic suicidality is not the same as imminent suicidal crisis. It is a symptom — often of intense, unrelenting emotional pain that hasn't yet found adequate treatment. And it can be treated. Not by suppressing the thoughts or pretending they aren't there, but by treating the pain that gives rise to them.
Understanding Chronic Suicidal Thinking
Chronic suicidal ideation refers to recurrent, persistent thoughts of suicide that are not necessarily tied to an acute crisis. For some people, these thoughts are a near-constant presence — a background noise of "I don't want to be alive" that rises and falls but never fully disappears. For others, the thoughts return reliably during times of stress, conflict, shame, or emotional overwhelm.
Chronic suicidality is most commonly associated with:
Borderline personality disorder (BPD)
Major depressive disorder, particularly treatment-resistant depression
PTSD and complex trauma
Bipolar disorder
Severe emotion dysregulation
Chronic pain or serious medical illness
Experiences of profound loss, isolation, or hopelessness
People with chronic suicidal thoughts often feel profoundly misunderstood by the mental health system. Crisis interventions — hospitalization, safety contracts, calling 911 — are designed for acute, imminent risk. They are often not appropriate or effective for people whose suicidality is chronic and long-standing, and repeated hospitalizations can actually increase feelings of hopelessness and reduce willingness to seek help.
What people with chronic suicidality usually need is not crisis intervention — it's sustained, specialized treatment that addresses the underlying pain.
What Actually Helps
Dialectical Behavior Therapy (DBT) is the most evidence-based treatment for chronic suicidality and was originally developed specifically for this population. Dr. Marsha Linehan, who developed DBT, was explicit that her goal was to help people build lives worth living — not just to prevent them from dying.
DBT approaches suicidality differently than most treatments:
Rather than treating suicidal thoughts as the primary problem to be eliminated, DBT treats them as a signal of intolerable pain — and focuses on reducing that pain while building reasons and skills for living. The goal is not just survival; it's a life that genuinely feels worth living.
DBT includes direct, non-judgmental discussion of suicidal thoughts in every phase of treatment. You are not punished for having or reporting these thoughts. Your therapist will help you understand what triggers suicidal thinking, what function it serves, and how to respond differently when those thoughts arise.
Skills training gives you concrete alternatives to acting on suicidal urges — distress tolerance techniques specifically designed for moments of acute crisis, emotion regulation tools that reduce the intensity of the pain driving suicidal thinking, and mindfulness practices that help you relate differently to painful thoughts without being consumed by them.
Phone coaching means you have access to your therapist between sessions — specifically so you can reach out when suicidal urges are high and get real-time support before a crisis escalates.
Who We Treat
We treat adolescents (ages 13+) and adults with chronic suicidal ideation, in-person in Ruston, WA and via telehealth across Washington state. We have experience working with people who have had multiple hospitalizations, who have been told they are "too high risk" for outpatient treatment, and who have tried other therapies without success. DBT was designed for exactly this population - you can learn more about DBT here.
Frequently Asked Questions
Do you treat chronic suicidality in teenagers and adolescents? Yes. We treat adolescents ages 13 and up with chronic suicidal ideation, both in-person in Ruston, WA and via telehealth across Washington state. Suicidal thinking in adolescents is one of the most urgent mental health concerns, and DBT has strong research support for reducing suicidal behavior in this age group. Treatment for adolescents involves the family — parents attend skills group alongside their teen, learning skills that help them respond effectively to their teenager's suicidality without inadvertently escalating crisis or shutting down communication.
Do you offer treatment for chronic suicidality via telehealth in Washington state? Yes. We provide DBT for chronic suicidal ideation via telehealth to clients anywhere in Washington state, including Seattle, Spokane, Olympia, Bellingham, the Tri-Cities, and communities throughout the state. Access to specialized DBT treatment is limited in many parts of Washington, and telehealth allows us to reach people who would otherwise have no access to this care. In-person services are also available at our office in Ruston, WA near Tacoma.
What treatment approach do you use for chronic suicidality? DBT is the gold standard, most extensively researched treatment for chronic suicidal ideation and behavior, and it is the primary approach we use. DBT was originally developed specifically for chronically suicidal individuals. It directly addresses both the emotional pain that drives suicidal thinking and the behaviors themselves — through individual therapy, skills group, and between-session phone coaching. Our founders are certified DBT clinicians through the DBT-Linehan Board of Certification.
How is DBT different from other treatments for suicidality? Most treatments approach suicidality primarily through risk assessment and crisis management — identifying warning signs, creating safety plans, and hospitalizing when risk is high. These approaches are important but insufficient for people with chronic suicidality, for whom crisis intervention can become a revolving door. DBT goes further by treating the underlying causes of suicidality — the emotional pain, the lack of coping skills, the sense that life isn't worth living — rather than just managing acute risk. DBT is the only treatment with consistent research evidence showing it reduces suicidal behavior over time. The goal is not just keeping you safe during crises; it is helping you build a life that feels genuinely worth living.
I've been hospitalized multiple times and it doesn't help. Can outpatient DBT still work for me? Yes — and in fact, this is exactly the population DBT was designed for. Repeated hospitalization for chronic suicidality is generally not an effective long-term strategy, and research supports outpatient DBT as more effective than hospitalization for people with chronic suicidal ideation. DBT provides the sustained, specialized skills-based treatment that brief hospitalizations cannot. Many of our clients have had multiple hospitalizations before starting DBT and go on to make significant, lasting reductions in suicidal thinking and behavior. During your initial consultation, we will conduct a thorough assessment to determine whether outpatient DBT is appropriate for your current level of risk.
I'm afraid to tell my therapist when I'm suicidal because I'll be hospitalized. Will that happen here? We understand this concern deeply, and it is one of the most important things we want to address together in treatment. DBT is specifically designed to allow open, non-punitive discussion of suicidal thoughts. We do not automatically hospitalize clients who report suicidal ideation - in fact we try to avoid hospitalization whenever possible. We assess risk carefully, we take it seriously, and we work collaboratively with you to manage safety in ways that don't involve unnecessary hospitalization. Our goal is to create a therapeutic relationship where you feel safe being honest about your experience — because that honesty is essential for effective treatment.