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School Refusal Therapy

School Refusal Therapy for Children and Teens

Does This Sound Familiar?

Is every morning in your house a power struggle between you and your child? Do you find your child doing just about anything they can to get out of going to school, from begging and bargaining, to tantrums, to outright refusal to participate in the morning routine? Do both you and your child dread weekday mornings, but find that weekends are easier, at least until Sunday night when the cycle restarts?

Does your child often complain of stomach aches or headaches? Do they visit the school nurse frequently for mysterious illnesses, but their pediatrician has ruled out any medical cause? Does your child regularly miss school, or regularly need to be picked up early? Do they tell you they hate school?

These are all signs and symptoms of school refusal. School refusal can disrupt an entire household, along with escalating the anxiety and stress of the child refusing to go to school. It’s not uncommon for children to experience short term school refusal that resolves with resuming a routine. But if you’ve tried strict routines, bargaining, endless patience, reward and punishment, and anything in-between, with no improvement, you’re probably at your wits end.

Why Do Children and Teens Refuse School?

  1. To stay away from distressing situations in school that make your child feel uncomfortable: This includes distressing locations (lunchroom, hallways, the bus), upsetting expectations (subjects where they struggle to learn, rules they have a hard time following), and people (teachers, staff, other students).
  2. To avoid social situations where they feel judged or like they’ll need to perform: This can include tests, presentations, gym class, school sports, reading aloud, etc.
  3. To get attention from their parents or other friends/family: They may fear being away from their parents and home, because of separation anxiety, and thus seek out attention to alleviate that fear. This can include any attention, including negative attention when they’re refusing to comply with stated rules and expectations, or more compassionate attention when they’re feeling sick or are visibly distressed. as well.
  4. To get to enjoy the benefits of home: If a day away from school involves games, toys, and special snacks, or extra time with parents, instead of the structure of a school day, a child might try to feel safer in their life by simply escaping to the fun space of home. It’s common for this to be an additive reason, on top of the other three.

These reasons can happen one at a time, or more often are combined. Your child is trying to avoid distress, and gain comfort and attention, through refusing to go to school.

Avoidance Increases Anxiety Around School

As your child works to avoid the distressing situations they’re encountering in school, or the loss of comforts from home if they have to go to school instead, their anxiety ramps up. They may experience physical symptoms, such as shortness of breath, racing heartbeat, lightheadedness, or upset stomach. They may also deal with panic attacks, or bouts of severe anxiety and fear.

This level of upset can easily lead your child to avoid as much as they can around school. School refusal can feel like the safest option for them in the short term. Unfortunately, because each time their school refusal is approached with mere avoidance, instead of working toward coping, acceptance, and change, their anxiety is reinforced. The thought of going to school becomes harder and harder to cope with, until the anxiety is overwhelming.

Why Would School Be Distressing For a Child?

When a child is upset by school on a chronic basis, it can be for a number of reasons. Bullying, teacher conflicts, feeling unsafe in school, worry over their appearance or having their self-worth undermined, stress over completing school work, or difficulty in social situations can all be reasons for school refusal. While you might find your child’s reason for upset to be trivial, it is real enough to them that they’re experiencing physical and emotional symptoms strong enough to refuse to participate in their life. That means that it must be taken seriously, and addressed with compassion and structure to help your child persevere.

Underlying all of the potential stressors of school are possible conditions your child might experience. These conditions can add to your child’s sensitivity to the possible difficulties of attending school, and can make school harder for them to tolerate. They can include:

Therapy for school refusal must take into account all potential sources of stress for the child, to make sure any solutions are useful and usable.

There is Hope For Children Who Struggle to Go to School

At Suffolk DBT, we know that sensitive children experience the world in a way that can make it feel overwhelming. Their emotions and behaviors in response to that overwhelm can lead them to have a hard time willingly going to school. When we help children who refuse school, we combine the acceptance and self-regulatory skills learned in Dialectical Behavioral Therapy (DBT) with the coping skills and exposure therapy aspects of Cognitive Behavioral Therapy (CBT), to make the hard parts of school more tolerable.

We start with asking your child to pinpoint the “why” of their school refusal. We then work with them to build up emotional capacity and skills to face their challenges head-on, using coping mechanisms and tools when their anxiety and stress over school pops up again, and again, and again. We consider coping with stress over school to be a process, one your child can work through and use to help themselves over time. We know that chronic school refusal can be stressful, and we are here to help you and your child get to a better place.

The Suffolk DBT Process for Overcoming School Refusal

We employ DBT that is specifically tailored to both children (DBT-C), and DBT for teens and their families (DBT-A), to make sure that the treatment you commit to is age appropriate and will do the most good for your child.

DBT-C, For Children and Their Families

When we start working with a child who is participating in school refusal, our first step is to meet with the parents. We consider DBT for children to be a form of family therapy more than anything, particularly since the skills learned in therapy will need to be practiced at home. Parental involvement is critical.

Assessment is key, so we work with parents first to understand what is going on, and to come up with functional parenting techniques that will help you help your child. After you’ve worked with these techniques for a few weeks, both in session and at home, we will meet one-on-one with your child. This lets us develop a trusting relationship with your child, and helps us understand your child’s perspective on the “why” of the situation.

The DBT process will then continue with the family meeting together. In these sessions, coping skills will be offered to the family to try out in distressing situations, giving you all the tools you need to work toward regular school attendance. Reward structures will be set up to reinforce skill use in a positive way, setting your child up for success. When setbacks happen, skills will be revisited, to reinforce the good work you and your child have put into therapy.

DBT Offers Structure and Success for Your Sensitive Child

You’ll be encouraged to use the skills you develop with your child to create a plan for re-entry to school on a consistent basis.

In time, you’ll be able to measure your family’s success in DBT through calmer mornings, increased attendance in school, fewer instances of unexplained aches and pains, and a strong, deep connection you all share, as you work with the skills you develop with your child.

DBT-A, to Support Teens and Their Families

As teens get closer to adulthood than childhood, they have different therapy needs than younger children, and so we make sure to employ a DBT structure that suits their increased independence while continuing to foster support from their family. We want your teen to feel empowered and supported as they engage with their emotions.

For DBT for teens, we will match your teen with an individual therapist that will suit their particular emotional needs. Since teens are more able to articulate what they actually experience, these individual sessions serve to help your teen better know what they experience and what they can do about it. We will also involve the whole family. You will attend group sessions that include you and your teen, and other families going through the DBT process. These group sessions, coupled with the individual sessions, will let your teen learn the skills they need to navigate their reasons behind school refusal, and will give you enough understanding to support your teen in their process.

Teens will also be asked to track their emotions in light of events that they struggle with between sessions. This will give them insight into what triggers them, and how they can best approach these triggers to better regulate their emotions and employ DBT skills.

DBT Offers Skills to Help Teens Flourish

With your teen’s efforts and yours combined, you will be able to create a structured re-entry to regular school attendance. Your teen will use their DBT skills to stay in the moment, accept and process distress, and to develop and maintain solid, healthy relationships with the people around them. You will create a home environment that is structured enough (and boring enough during the school day) to encourage your teen to use their skills to resume a regular school schedule.

You’ll be able to see success in your teen’s efforts to employ skills. You’ll see them be able to stay in school longer, to have fewer health complaints with no source, and to potentially increase the number and quality of friendships they have in school. DBT can serve your teen well, with structure and family involvement, to get them back to regular school attendance.

DBT Skills Your Child/Teen Will Learn to Overcome School Refusal


Your child will be asked to observe what they’re doing and be in the moment with the experience. They will be encouraged to release judgment, and to focus on what they’re doing. They’ll be asked to recall their focus away from anxious thoughts and back into the moment.

Interpersonal Effectiveness

Your child will practice relating to others, be it members of their family, other children, or adults in school, with active listening and respectful communication. They’ll be offered ways to cultivate self respect as well as respect for others.

Emotion Regulation

Your child will be asked to notice their emotions and name them. They may be encouraged to practice beforehand to see what you’ll need to cope in a tough situation, and to be mindful when engaging with their emotions too. Non-judgement of emotions will be practiced, as well as options to change the situation, like taking opposite action to what an emotion might tell them to do.

Distress Tolerance

Your child will learn about radical acceptance of distress, as well as planning some crisis survival skills. Nervous system regulation skills can help (temperature, exercise, breathing, body scans/muscle relaxation), as well as distraction from the distress, to give you space to deal with it. Self soothing options will be explored too, that suit the personality of your child.

Common Concerns about DBT for School Refusal

My teen or child does not want to attend therapy.

If your child has attended therapy before and found it unhelpful, it can feel pointless to them to try again. We understand this, and want to do things differently. We welcome your child into therapy, and offer a warm, positive space to let them get to know us and how we work. We also know that DBT’s structure and setup means it works differently from a lot of other therapies, making it a good fit for many children who do not get enough out of other therapy models.

If therapy hasn’t worked before, fear not. We offer a different way, a way that can help.

I don’t think I can make the time for DBT for my child.

The commitment to regular, often twice-weekly sessions of therapy is not small. But neither is the impact that school refusal has on your family, or your child. The power struggles, the lost time to days of your child being home when they should be in school, the disrupted mornings and evenings, are not trivial. This commitment now will free up that time to a much smoother, more predictable routine for your family. You’ll be more connected to your child, as you work together to cultivate skills to cope. And your child will grow into a more capable teen, and a more emotionally well adult. All of these outcomes, when you consider the time commitment you’re already putting into coping with school refusal, can easily outweigh any difficulty with rearranging your schedule for therapy.

Are group sessions really necessary?

DBT requires group sessions, either with parents for younger children, or with other families for teens. These group sessions are a key component of proper DBT, as they give your child or teen a sense of community and belonging in the DBT process. The support of the group is critical. Your teen in particular will see their peers dealing with the same struggles they’re working on. This ability to relate to kids their own age is invaluable, as they can feel supported and seen while processing emotions.

Anger Management Therapy:

Regain Control and Embrace a Better Life

Trauma is defined as any distressing or frightening event that results in sustained, negative effects on a person’s daily functioning resulting in a reduced quality of life. Trauma can be the result of a one-time event, such as a car accident, or from prolonged exposure to stressful, violent, or invalidating environments.

Suffolk DBT is Here to Help With School Refusal

Suffolk DBT proudly provides quality dialectical behavior therapy, a form of cognitive behavioral therapy, at their offices in Nassau County, Suffolk County, and Manhattan, New York, and online. Dialectical behavior therapy (DBT) skills and treatment can help your child return to a regular school attendance schedule, allowing them to manage their emotions and navigate the challenges of school in a way that lets them grow and flourish.