Acts of violence by youth in the United States have prompted mental health professionals to become increasingly attuned to the potential for violence among their clients, particularly adolescents at risk of such behavior. The counseling relationship offers adolescents a space in which they can share their thoughts about and intentions for violence, thereby placing counselors in complicated situations in which they must protect public safety while also attending to the therapeutic needs of the client. In this article we: (1) review literature on adolescent threats of violence, (2) examine leakage style threats of targeted violence, (3) synthesize this work within an evidence-based framework of structured professional/clinical judgment, and (4) provide general recommendations for outpatient and school-based mental health counselors. Three clinical vignettes are presented for the purpose of illustration and pedagogical exploration.