Chronic high-risk suicidality and self-harming behaviors present a great challenge in clinical practice. Often individuals find themselves frequently cycling through inpatient hospitalization as they are assessed as too high-risk to be treated in an outpatient setting. These hospitalizations can be lifesaving in emergent situations with a focus on means restriction and acute stabilization. At the same time, hospitalization may not be able to address the underlying cycles and longer-term psychological treatment needed to address and change future acts of suicide. Furthermore, hospitalization can inadvertently become a reinforcing factor in difficult to change behavior. In this talk we will use Dialectical Behavioral Therapy theory and strategies to identify how we can effectively treat individuals struggling with high-risk thoughts, feelings, and behaviors in an outpatient setting.