Helping and human relationship theory is a theory of professional interaction developed by Robert R. Carkhuff. He began by forming definitions and observing the interactions during any helping behavior. He believed that all human interactions are helping behaviors. Some interactions are more equal than others. There are interactions where one person is the leader and attempts to give the other person reasons to change, usually to their point of view. Other interactions involve a trade, where each member of the interaction is seeking a specific goal. Carkhuff believed that most professional interactions are helping relationships. He included among these teaching, medicine, parenting, training and repairmen. In short, the helper skills are universal among human beings.

Nursing and Helping Theory

For those engaged in professions that center around interpersonal skills and support, Carkhuff drew up his helping and human relations theory to use to conclude successful interactions and to evaluate the success of the interaction. Nursing is one of the helping professions, involving an interaction that will improve the situation of the client. Nursing theory includes theory on the helper relationship. This nursing theorist framework for the art of helping and human relationship fits very well with the nurse-client relationship.

Robert R. Carkhuff’s theory begins around the four components of any helping relationship. These include:

• Attending
• Responding
• Personalizing
• Initiating

In each of these steps, there are behaviors that can increase the effectiveness of each step. Carkhuff explains these action in depth in his book, The Art of Helping. Let’s look at the goals of each of these steps, and the behaviors that assist the relationship to a successful conclusion.


Attending involves the initiation of the interaction. It includes a greeting, introduction by each member of the relationship and an attempt to put the client at ease. According to Carkhuff, the nurse must be physically present during the interaction. This means the nurse’s attention is all directed to the client, and he or she looks at, directs actions and words toward the client to make sure the client is aware that the nurse is there for the client’s benefit. The nurse should observe all the reactions of the client. Is the client withdrawing from the interaction? Is the client ready to be open about their problem? Are they talking about something else to put off the needed interactions? The nurse needs to listen to the client and verify that they fully understand what the client is trying to say. The nurse needs to let the client complete his or her version of the situation. The nurse should be trained in professional communication strategies to be able to verify that the client has communicated what the nurse believes she has heard. This process is crucial to the nurse-client interaction. Without completing the attending step properly, the interaction will be a failure.


Once the purpose of the interaction is established and agreed upon by the client, the nurse should begin to let the client know what the response will be and options available, if any. The helper begins to respond to the client. She looks for feelings to give a response to. She looks for content to fill in the reasons for the client needing help. Lastly, the nurse should be able to able to understand the meaning of the situation to the client. Together the client should work with the nurse in developing a way forward that they can both agree to undertake. First year nursing students usually complete attending and responding steps of this theory, apply the rest of the theory in their second year.


This is the step where the client agrees to take on the needed steps to complete the goals that have been established. The way to be most successful at this level is to relate these goals to a past action or situation. The more positive the situation is, the better the results. However, a situation that did not go well could be used to show how the client can change the results in the future. Perhaps an addict who was clean for a time returned to drug use due to pressures in his life. The focus of this interaction would be to examine options when he feels pressured and to develop new skills to deal with this situation.


Once the steps to change are agreed upon, the nurse then assists the client to implement or initiate these changes in their life. The part includes developing clear goals and checklists to reach these goals. The client should be aware of all of the steps and how to reach the nurse if they have a problem with completing the goals. The client should be made aware that many clients need to revise their treatment plan once they start fitting it into their lives and not feel like a failure for having to come up with a revised plan. The goal should be to succeed; not simply to follow one and only one set of goals and checkpoints.

Each professional should also include a feedback stage where they look at both their success with this client and any areas where they had problems. This will give the caregiver a guide to behaviors he or she needs to work on to improve their results with clients.

Carkhuff went on to specifically investigate what skills assisted with each of his four steps. This allows the helper to work on those skills that do not come naturally to them. Some of the four steps have more skill areas than the others.

Attending Skills

Here are specific skills that assist with the Attending stage:
• Noting both nonverbal and verbal behaviors
• Responding to basic messages by paraphrasing
• Focusing discussion by clarifying issues
• Review beliefs of client concerning their problem

Responding Skills

Like attending, responding has its own set of shills. Skill to emphasize are:
• Empathy with the client’s needs
• Respect the client’s opinions
• Use rephrasing to verify your understanding of the client

Personalizing Skills

Personalizing uses a different set of skills. Here are some to develop:
• Describing feelings
• Sharing personal feelings with client
• Confrontation skills with client
• Reflective phrasing to verify goals

Initiating Skills

This step sets up the path for success and for verification of the interaction. Skills needed here are:
• Ability to define useful goals
• Ability to provide options in case of problems
• Ability to conduct focused inquiries to verify goal completion

Another point about the helping professions is the nurse theorist felt that a person must be complete on their own to be able to truly help someone else. The reality is that all of us have different levels of skills and many are still working to perfect some aspect of ourselves. This does not prevent a helper/helpee relationship, but the helper needs to be self-aware of his or her abilities and their completeness of character.

If followed faithfully, Dr. Carkhuff feels that anyone can become expert at forming successful helping relationships with others. This nursing theorist continues to develop his helping and human relations theory for the information age.


Carkhuff, R. R. The Art of Helping, 9th Edition, PP, Inc. Amhurst, MA, 2009