Dealing with emotionally-based school avoidance clients
A look at emotionally-based school avoidance (EBSA) and how solution-focused hypnotherapy can help.
The number of children absent from school has increased since the Covid epidemic, with the DfE (Department for Education) reporting figures of 7.2 percent for the academic year 2023 to 24. A percentage of those will be children with what’s referred to as emotionally-based school avoidance (EBSA). The exact figure is unclear because EBSA is not a standalone DSM-5 diagnosis, although it may occur as a presentation associated with anxiety disorders, neurodevelopmental conditions, mood disorders, or trauma-related difficulties. Other terms that might be used include ‘school refusal’, ‘school attendance problems’, ‘emotionally based school non-attendance’ (EBSNA), and ‘extended school non-attendance’ (ESNA). EBSA is distinct from truancy because absence is driven by distress rather than deliberate avoidance. Whatever term is used by children and their parents, they are very likely to be seeking help – and that can bring them to see a solution-focused hypnotherapist.
Emotionally-based school avoidance is the term used by local authorities to describe a situation where a child or young person experiences significant difficulty attending school due to negative feelings (such as anxiety, fear, or overwhelm) rather than outright defiance or truancy. It’s not that the child won’t go to school, but that they feel they can’t. So, EBSA is an ‘umbrella term’ that can be associated with a range of difficulties, including mental health issues (eg anxiety or low mood), social difficulties (eg bullying), sensory overload, and physical health issues. EBSA is often linked to mental health difficulties or neurodevelopmental conditions like autism or ADHD (attention deficit hyperactivity disorder).
The emotional distress the child feels can manifest itself as physical symptoms such as stomach aches, nausea, headaches, fatigue, panic attacks, or behavioural challenges. Unlike truancy, which is often linked to delinquency or lack of motivation, EBSA is rooted in emotional difficulties, and the child typically wants to engage in education but feels unable to do so. This results in difficulty separating from a parent, avoiding certain parts of the school day, frequent absences, lateness, or complete school refusal by the child or young person.
In some cases, EBSA doesn’t reflects an internal deficit within the child but a mismatch between the young person’s needs and the educational environment. Identifying and addressing environmental contributors is often essential for sustainable progress.
The impact of EBSA
Emotionally-based school avoidance can have significant short and long-term consequences. For the child, there will be gaps in their learning, and they will gradually fall behind their peer group. This can reduce their access to future educational opportunities. The isolation from their peer group can lead to the youngster having difficulties forming friendships and generally reduced social skills. And young people can develop increasing anxiety, lower self-esteem, or worsening mental health.
In terms of the family, EBSA puts a strain on relationships, increases parental stress, and leads to conflicts over attendance.
Recognizing EBSA
What does EBSA look like? As already mentioned, youngsters may miss part of the school day or all of it. They may show signs of low mood, anxiety, or distress that affects their ability to function in school. They may show emotional distress such as crying, panic, or anger when preparing for or discussing school. They may plead to go home, avoid certain areas or people, or have difficulties separating from their parents. Again, as mentioned above, their stress and anxiety can manifest as physical symptoms. And, EBSA can be accompanied by other behavioural changes.
The youngsters typically function normally at home or in non-school settings. However, they may be feeling guilty, isolated, or anxious about missing school.
Causes and contributing factors
EBSA is complex and can result from various factors, often with multiple contributing elements. As mentioned above, these include mental health challenges such as anxiety, depression, or other mental health difficulties such as emotional regulation. The anxiety may be social anxiety, separation anxiety, or generalized anxiety. Youngsters may have specific fears, such as a fear of failure, bullying, or public speaking. Also, neurodivergent children, for example with autistic spectrum disorder or ADHD, may experience significant challenges with emotional regulation and social functioning, making school attendance difficult. Mental health issues might include: depression, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD). And young people might have physical health issues such as chronic illnesses or undiagnosed conditions that can exacerbate their emotional distress.
There may also be environmental pressures such as bullying or social exclusion, difficulties with academic performance or fear of failure, general feelings of being overwhelmed by school (such as noise, crowds, or sensory overload), or worry about transitions (such as changing schools, changing classes, or moving up to a secondary school) that lead to EBSA.
Lastly, there can be family factors such as changes in family dynamics (for example parental conflict, financial strain, or loss), overprotective or anxious parenting styles, inconsistent routines or boundary-setting, parental health problems or mental health issues, or other family stress that can also play a role in the development of EBSA.
How solution-focused hypnotherapy can help
The first thing to do with the youngster is to explain what is happening inside their brain. This is what we usually do during the initial consultation and reinforce the information during subsequent sessions. The young person needs to know how their brain reacts to stress, and how that leads to the fight-or-flight response and triggers feelings of anxiety. And how that is almost the same as how the body feels excitement about something like a trip to the seaside, an upcoming birthday party, etc. It’s not all bad. It’s just a matter of degree. I would explain how hypnotherapy may help the young person develop greater physiological calm, cognitive flexibility, and confidence in approaching feared situations.
I would definitely explain that I don’t need to dwell unnecessarily on distressing experiences, although understanding what has happened may sometimes be important in ensuring the right support is in place. The youngster might be worried about revisiting all those unpleasant experiences they’d had about school. And I would go on to say that we are going to look to a positive future. And that’s where they can tell me their goal – which hopefully will be about re-engaging with education in a way that feels manageable and sustainable to the child.
I would always have the parents/carers sitting in during the initial consultation, but I would make it clear that I am talking to the child, and I want them to answer my questions, not the parents.
For younger children, I would characterize the rational brain in more childish terms – maybe as the wise owl. And the emotional brain as a guard dog – assuming they like dogs. Our mission would be to calm the guard dog, which is working too hard at the moment.
I would definitely talk about emptying their stress bucket.
For both parent and child, this takes the blame for their behaviour away from the child and puts it on a tiny part of their brain, which, together, we can change. A much happier child and their parents can now look forward to the next session, and have the language to talk about the problem they have been facing without anyone being to blame.
In the following sessions, I will be asking exception questions – when doesn’t it happen? So, for example I will ask when did the child go to school recently? And I will celebrate success, even if the child only stayed for a short while. If they haven’t attended, then I will ask about when they were less anxious about the idea of school. I will ask the strengths questions – eg “What strengths do you have that allowed you to attend all afternoon (for example)?” Of course, the way I ask the question will change depending on the age of the child. With younger children, I might ask what superpower they used to be able to stay in school.
I would also ask questions like: “What’s better on the days that feel easier?”, “What would be a small sign that things are improving?”, “What helps you to feel calmer or more confident?” These questions move the focus away from the problem and towards achievable progress, which reduces the youngster’s feelings of helplessness and alters their thinking to expecting positive changes. I might also ask, “What would be the first small sign that things are getting a little better?”
In terms of scaling, I would ask how happy they are generally, and I would ask how confident they feel generally about going into their school in the morning. This is a number between zero and ten that we can use to track the success of the sessions. If they are above five on the scale, I would ask what would have to be different for them to be one number higher. If they had a very low number, I would express my surprise at how marvellous they were because from what they had told me, I would probably have been one lower than their score. I would be reinforcing the idea that they already have great strength.
I would also use and be interested in their answers to the miracle question. What they would first notice was different if, overnight, a miracle had happened and things had improved.
From there, we would move into a comfortable position to go into trance. I would have explained about trance and how nice it can feel and that I won’t be able to make them do anything that they don’t want to. TV and movie versions of hypnosis are not the same as clinical hypnotherapy!
The scripts and metaphors I would use would have to be age-appropriate, but I would begin by simple bucket emptying relaxation and confidence scripts. The metaphors I choose would involve people doing something or having the power within themselves to do something.
After a couple of sessions, I might use hypnotherapy for mental rehearsal – something like a reframe where they have told me how they’d like things to be, and I am reflecting that back to them. I would help them to imagine feeling comfortable walking into school, greeting their friends and teachers, and engaging in lessons with interest and confidence – I would be simply building their preferred future.
If the child seems robust and up to it, I might set homework. I always refer to this as experiments to see what happens if… If the experiment doesn’t work, there’s no sense of failure. It simply leads to the next experiment. I talk a lot about Edison and his many attempts at creating a working lightbulb that lasted a useful period of time.
Working with the child, I would identify small, realistic goals for them to try to achieve during an experiment. These might be: getting dressed for school without distress; standing at the school gate; or attending one class or club.
Children with autism, aphantasia, language-processing differences, or high anxiety arousal may well struggle with traditional guided imagery. In that case, I would adapt the trance work so that I was using sensory-neutral language, felt-sense focus, metaphors without any visualization demands, brief permissive trance, or movement/breath-based regulation.
The basic ideas underlying this methodology are to:
Teach the child (and the family) about the brain.
Normalize the child’s behaviour – everyone’s brain tries to protect them.
Help the youngster to relax (and reduce stress) and visualize positive experiences.
Help the youngster to recognize their own strengths and successes and improve their confidence and self-esteem.
Agree achievable small goals leading to success with the main goal.
Equip the child with lifelong coping skills to give them lifelong resilience.
And, of course, all this will be done with as much appropriate humour as possible to make the sessions enjoyable for the young person.
It can also be helpful to have some conversations with the parents or carers because they often unintentionally maintain EBSA through their very understandable accommodations, such as repeated reassurance, negotiating endlessly, allowing escalating avoidance, or inconsistent morning expectations. Progress can often be made gently addressing these issues. The idea is to help parents move from thinking they are rescuing their child to them providing regulated support.
It’s worth noting that solution-focused hypnotherapy is most effective when integrated with wider educational and clinical support rather than viewed as a standalone intervention.
References:
Kearney C. A. (2008) Helping School Refusing Children and Their Parents: A Guide for School-Based Professionals. New York: Oxford University Press.
Kearney C. A. and Albano A. M. (2007) ‘When children refuse school: a cognitive-behavioral therapy approach’, Therapist Guide. New York: Oxford University Press.
Department for Education (2024) Working together to improve school attendance. London: Department for Education.
BMJ Mental Health (2024) ‘Emotionally based school avoidance: understanding prevalence, mechanisms and intervention pathways’, BMJ Mental Health, 27(1), e300944. Available at: https://mentalhealth.bmj.com/content/27/1/e300944 (Accessed: 16 May 2026).
Tina Rae (2021) Addressing Emotionally Based School Avoidance: Guidance for Educational Professionals. London: Routledge.
https://mentalhealth.bmj.com/content/27/1/e300944
https://www.cambslearntogether.co.uk/cambridgeshire-send/cambridgeshire-send-oap-toolkits/primary-and-secondary-send-oap-toolkit/social-emotional-and-mental-health-semh/resources/emotionally-based-school-avoidance-toolkit
https://www.supportservicesforeducation.co.uk/page/20029
https://www.tandfonline.com/doi/full/10.1080/02667363.2025.2486161#d1e180