Child and adolescent school refusal is a complex problem that can paralyse parents and professionals alike. Families often present in desperation, often after the problem has become well established. The literature concerning ‘what works’ is clear: addressing the problem early relates to better prognosis, and supporting the child to return to school is the primary priority. In practice, however, the ‘how to’ is often complicated by parental anxiety or complacency, complex family dynamics, therapist uncertainty about how to help, and poor partnerships between family and school. In this paper, I will present a framework for intervention informed by Structural and post‐Milan ideas, developed from practice‐based evidence – witnessing what works for families in everyday practice. A model for family therapy intervention is presented and discussed, illustrated with a case vignette.