The Challenge of Balance: Exploring Structure, Adolescents' Participation and Relations With Staff in Milieu Therapeutic Settings in Therapeutic Residential Care

ABSTRACT This article explores two distinct approaches to milieu therapeutic structures within Norwegian therapeutic residential care facilities (TRCFs) for youth with severe behavioural problems. One emphasizes structure as essential for guiding behaviour and development; the other uses structure as a flexible framework supporting autonomy and self‐realization. Employing theories from Larsen, Hart, Baumrind and Rogers, we examine how these approaches shape adolescents' participation and relationships between staff and adolescents. Thematic patterns were identified through the analysis of treatment documents from 20 TRCFs, but this article draws on in‐depth fieldwork and thematic document analysis conducted at a subset of seven of these institutions. The thematic analysis identified key differences in how structure, relationships and participation were practiced across the selected institutions, revealing tensions between maintaining control and fostering autonomy. Our findings suggest that TRCFs' care and treatment may be better supported when structural frameworks are both consistent and adaptable, allowing staff to respond flexibly to individual needs while maintaining clear boundaries that support safety, trust and adolescent development.