This paper examines Swedish school social workers’ (SSWs) experiences of counselling children experiencing mental ill-health and their parents. Eight SSWs from elementary schools in a large Swedish city were interviewed online. The interviews were transcribed and analysed using thematic analysis. As a theoretical frame, the study uses Minuchin’s structural family approach. The results indicated that SSWs schedule counselling together with children and parents depending on the degree of mental ill-health, wishes, and consent. The SSWs emphasised structure, role, information, and passing forward. They also took account of the family system as a whole, its parts and its broader context. This study contributes to the development of future initiatives for school social work counselling with children and their parents. It addresses a gap in the literature, as Swedish SSWs’ counselling of children experiencing mental ill-health and their parents has not previously been studied or reported in peer-reviewed publications. This paper meets an identified need and demonstrates how social work counselling can be conducted in schools.