This study utilized qualitative methodology to provide a rich description and a deeper understanding of the professional experiences and practices of twelve school counselors who work with adolescent students who self-harm. Four themes included: suicidal or non-suicidal, role of the school counselor, referrals, and identified interventions. There is a need for school counselors to gain more training and knowledge regarding effective interventions that are appropriate to use with adolescents who self-injure in the school setting.