Diminished self-care practices and heightened stress of school counselors is a continuing problem in education. With role ambiguity, high student-to-counselor ratios, emotional exhaustion, and others adding pressure to the roles and responsibilities of school counselors, this study investigated the self-care practices of Missouri school counselors and the internal and external factors which influence them, specifically within the context COVID-19. Clayton Alderfer's (1972) Existence, Relatedness, and Growth theory was used as a theoretical framework for chosen self-care practices represented in this study and was supported by Robert Kegan's and Lisa Lahey's (2009) Immunity to Change theory to understand the competing commitments combating healthy self-care practices among school counselors. Findings demonstrate the failed attainment of many basic human needs according to literature recommendations and guides for best practices. Additionally, with data collection occurring at the precipice of COVID-19 (i.e., spring of 2020), its impact on the self-care practices of Missouri school counselors was evident. These results indicate three levels of decision making which are paramount to school counselors achieving and sustaining healthy self-care practices--the individual as a decision maker; the organization as a decision maker; and policy as a decision maker. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]