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Cases of school refusal, as most child therapists are well aware, are difficult to treat and typically involve not just an anxious child with a tendency to withdraw and avoid but also anxious parents, enmeshed family relationships, and a rather inflexible, and at times punitive, school system. A unique feature of cases of school refusal is the pressure therapists are likely to experience from the moment the referral is made to help their young client transition back to school as quickly as possible. The urgency to get a child back to school with as little delay as possible has resulted in treatments that are more direct and symptom-focused and devote less attention to understanding the child’s emotional state and the family dynamics that may have contributed to the refusal to go to school.
Regardless of how enmeshed family relationships are, how intense the child’s social anxiety is, and how conflicting the contingencies at home and in school may be, the tendency to avoid reflecting on experiences and contemplating one’s acts is present in all cases of school refusal. Children who refuse to go to school can be regarded as existing in a state of retreat (Steiner, 1993), a state of not processing and not seeking to make sense out of what is happening in their lives. To use Ferro’s (2005) analogy, these are children who display an almost agoraphobic anxiety toward meaning, an anxiety that has contributed to their withdrawal from school and leaves them unable to process their experiences. Their retreat to the relative safety of home may temporarily lessen their anxiety but leaves them painfully aware of what they cannot process and contain. Establishing a therapeutic alliance with children who withdraw from contact and avoid contemplating experiences is a difficult task to achieve, especially when the expected results are not quick to come and parents and teachers begin to question the value of the treatment.
In their article “School Refusal and the Parent-Child Relations