Different theoretical approaches to school phobia/school refusal are reviewed briefly. A structural and strategic approach is presented in which school phobia and school refusal are viewed as two ends of a continuum of progression from “involuntary” symptoms on one end to “willful” refusal on the other. In later stages of school phobia/school refusal, the symptom becomes no longer a fear response, but takes on a protective function for the entire family. A treatment case is reported to demonstrate the strategies of reestablishing the proper parent‐child hierarchy, strengthening the sibling subsystem within the family and increasing the involvement of peripheral family members, and establishing positive links with the school system, as well as the principles of effective case management. A vigorous and intensive treatment of school phobia/school refusal is advocated.

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