The objective of this study was to explore, using first-hand accounts, adolescents’ understandings of why they self-harmed, what their responses to self-harm were, and how they resisted or ceased self-harm. Secondary analysis was conducted of video-recorded family therapy sessions from the Self-harm Intervention: Family Therapy (SHIFT Trial). Recordings of 22 participants, approximately 170 hours of footage, formed the dataset. The study developed 5 core themes: (1) Distress can be difficult to convey; (2) Self-harm and suicidal ideation: a complex relationship; (3) Self-harm as a form of communication; (4) Self-harm to manage emotions; and (5) Moving forward. Self-harm was a means of communicating distress as well as managing emotions. Accounts highlighted the complex interplay between self-harm and suicidal intent. Encouragingly, many participants described being able to resist self-harm.