School refusal brings children into conflict with the immediate family, the school, and the community, thus affecting their social and psychological well-being. School refusal may be an emotional problem of the child that is closely associated with unresolved dependency relationships, usually with the mother. The nature of this pathology can be meaningfully understood from a psychoanalytic perspective, which is presented in this article, accompanied by a case presentation. Central to this pathology are hostility issues expressed in transference and counter-transference, which often perplexes adults who are close to the child. Parents, educators, and health care professionals might overlook the actual emotional cause of the problem and respond with anger, forcing the child to return to school. However, school refusal requires comprehensive psychosocial interventions at the individual level and at the level of relationships among the child, the family, and the school.