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Suicide is the gravest outcome facing patients, families, and clinicians. Clinicians treating adolescent patients and their families face these life-and-death realities with justifiable fear. The effective assessment and management of suicidality in children and adolescents is critical and complex for even the most seasoned clinician. Helping the adolescent overcome emotional suffering and suicidal despair is the primary task for those of us clinicians who undertake such treatments. In this paper, we focus on the treatment of a suicidal adolescent using a mentalization-based approach. We believe a mentalizing approach opens up nonsuicidal pathways for enduring and dealing with suffering, while supporting the adolescents’ developmental needs. We highlight the challenges and benefits of making mentalizing a core focus of therapy with a suicidal adolescent and reflect on its usefulness in the context of dynamic and psychoanalytic approaches to suicidal patients. In the pages to follow, we take stock of the sobering risks of the adolescent epoch, link the adolescent suicidal crisis to Maltsberger’s (2004) psychodynamic formulation of the suicidal crisis, articulate how a mentalizing treatment frame addresses the primary problem of the adolescent suicide crisis, and provide a case example to link theory to practice.