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HELPING AND HUMAN RELATIONSHIPS THEORY

ROBERT  R. CARKHUFF

This page was last updated on 16-03-09

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Introduction

When adults have reached full maturity, they can communicate fully, they have satisfied their needs for fullness in all aspects of life and become full persons. They are now prepared to help others to achieve their own levels of wholeness. They will not only communicate fully with others struggling to grow and develop, they will also teach the others the skills they need to grow and develop themselves. They will become the models and the agents for the growth of others. They will give their lives meaning  through their productivity in living, learning and working arenas. They will create new life through their helping skills. The cycle of life continues.

Helping

Helping is a process leading to new behavior for the person being helped . An effective helper is initially nourishing or responsive. This nourishment   prepares the person being helped for the more directionful or initiative behavior of the helper.  Children as they become capable of both nourishing and directionful behavior, they assume the mantle of adulthood and later perhaps parenthood. They can act constructively in the lives of their own and others thus we call them fully adults or they are now helpers for they are capable of helping others as well as themselves. Persons who are fully alive help other persons to become fully alive. Responsive and initiative behaviours are the basic dimensions of helping and development.  

Potentially all relationships are helping relationships. It depends upon the helping skills one has, the effects of skills depend upon how we sequence them. Thus  helping in real sense is a developmental process like child rearing. Effective parenting involves both responsive and initiative skills.  Helpers who are fully responsive and fully initiative teach their helpees to be fully responsive and fully initiative.

Human Relationships

Human Relationships may be facilitative   or retarding effects. Like a marriage, the consequences of all human relationships may be for better or for worse. Consequences may be constructive or destructive, may produce persons and non persons; health care provider-patient; employee-employer etc. The effects may be positive or negative or any of the degrees in between these extremes.  The effects are seen in physical, emotional and intellectual functioning. With facilitative agents  the recipients may be physically energetic, emotionally expansive and intellectually acute; with retarding agents the recipients may be physically listless, emotionally shallow and intellectually dull. 

Power and human relationships

The effects of human relationships depend upon the power relationship. If the person is ceded the power in the relationship is functioning at a high level, then all parties involved can benefit from the relationship.  Eg. Parents. Unfortunately power relations are developed for reasons other than functionality like tradition, politics etc.  It makes good sense that if people have not discovered themselves they can only handicap others in finding their own way of life. The effects of the power relationships depend upon the skills.

Skills

Most fundamentally, it is the powerful person’s level of functioning in basic human relations skills that determines the effects of relationships. There are two sets of skills which are the basic ingredients of all human relationships in the areas of endeavor.

Responding and initiating skills

These skills are cycled in an individual’s personal development before his or her interpersonal development. A person must respond to understand himself before initiating an action program or product. There is no effective  action that is not based upon a depth of understanding.

Responsiveness

Responsiveness is the basic ingredient of human relations, which involves empathy. Responsiveness is the most profound variable in the human condition. To know more than that person does of her own experience, to be able to describe and predict and influence that experience constructively, is the test of responsive skills. Responsive  skills thus involve experiencing another’s condition and communicating to her own experience. It involves the other person in a process leading to her own self-exploration and self-understanding.

Initiative

Initiative is the basic ingredient of human functionality. It involves operationalizing the goal or breaking it down into it’s components. It involves developing the steps and systems to achieve the goal, it is more than a mechanical process. It begins with a vision of the possible, building upon our own experience to see a goal, further it stimulates the other person to take action to achieve the goal.

• When people share their problems, what skills do you have to truly show that you are responding to their experience?

• How do you physically show this? Emotionally? Intellectually?

• What do you do and say that will assure the people that you are sensitively attuned to their experience? How do you show you heard them? What feedback do you give?

• When you are wrestling with their problems, how do you share your experience to help them to develop achievable goals that solve their problems?

• Now that you have responded to their experience, how do you help them to initiate steps to get to their goals.

New Behaviour

Before we can acquire the skills of helping, we must understand the goals of helping. New behavior is the overall goal of helping. One must explore where she is, explore herself in relation to herself and in relation to her world. We must know the problems before we can change the behavior. In exploring herself, the person seeking help is attempting to understand where she is in relation to where she wants to be. Self understanding is not real until the individual has acted upon it. In acting the person acts upon how to get from where she is to where she wants to be.  The more accurately a person understands herself, the more constructively she can act for herself and others.

Evolution of dimensions

Before we understand the dimensions, we must understand four things.

i. Helping Sources: There are two approaches to helping -insight and action. The insight approach was supported by many traditional therapeutic schools, emphasized the client’s insight as the basis for the development of an effective set of assumptions about his or her world. The action approach has been promulgated by the learning theory and behaviour modification schools as well as the trait and factor school, which matches people to jobs and vice versa, who emphasized the client’s development and implementation of rational action plans for managing his or her world. In order to effectively help human beings to change  behaviour the insight and action approaches must be integrated into one effective helping process.

ii. Helping Process: In order to demonstrate gain in behaviour, the helpees must act differently from the way they did before. Thus they must have insights or understand accurately the gaols and ways to achieve them; in order to understand their goals, the helpees must explore their world experientially. Finally they must act to get from where they are to where they want to be. With the feedback they can recycle the learning process

     Exploration -----------Understanding------------Action-----------Feedback

     Feedback-------further exploration----self understanding--------real understanding

     Real Understanding-----------modification of action (effective action).

iii. Helper Skills: The historic dimension of empathy was complemented by unconditional positive regard and genuineness, which were then operationalized into accurate empathy, respect and genuineness. These were in turn complemented by other dimensions including specificity or concreteness, self disclosure, confrontation and immediacy; then factored into responsive and initiative dimensions. The responsive dimensions (empathy, respect, specificity of expression) responded to the helpee’s experience and thus facilitated the helpee’s movement towards understanding. The initiative dimensions (genuineness, self disclosure, confrontation, immediacy and concreteness) were generated from the helper’s experience and stimulated the helpee’s movement toward action. The initiative dimensions were later extended to incorporate the problem solving skills and program development skills needed to fully help the helpee's to achieve appropriate outcomes.

iv. Helpee Outcomes:  emphasized the emotional changes or gains of he helpee's. Since the helping methods were insight oriented, the process emphasized helpee exploration and outcome assessments measured the changes in the helpee’s level of emotional insights, which were restrictive because they were assessing only one dimension of the helpee’s functioning. These were later extended to incorporate the interpersonal functioning of the helpee's. The dimension of physical functioning was added, to measure fitness and energy; intellectual  dimension to measure the intellectual achievement and capabilities.

Levels and styles of functioning

Carkhuff and Berenson(1967) described five levels of dimensions.

The dimensions are empathy, respect or regard, genuineness, concreteness, warmth. Levels:

First: no empathy is taking place( no evidence of the helper characteristic)

Second: Empathizing very little and at a level that detracts from helpee functioning(10% of time)

Third: minimum level of feeling response necessary to be efective(50% of time)

Fourth and fifth: Higher levels of helper empathy(4^th – 75%; 5^th – consistently present)

The responsibility continuum:

Helping skills

The responsive and initiative factors of helping dominate the helping process facilitating E+ U+A

That culminate in the physical, emotional and intellectual helpee outcomes. As a result of attempts to teach they are further refined into concrete helping skills (A+R+P+I). The attending skills are transitional between responding and initiating.

Attending : “Being attentive to to the helpee” is made up of attending physically, observing and listening to the helpee. The function of attending is to give them the feelings of security that make their involvement in the helping process. By attending physically  the helper communicates interest in the helpee’s welfare, by observing and listening, helper learns from and about the helpee. By communicating interest in the helpee, helper establishes the conditions for the helpee’s involvement in the helping process.

Responding: Responding to the helpee’ s expression of her experience, involves responding to content, feeling and feeling and content together. The function of he responding to the helpee’s experience is to facilitate self exploration. T thus she signals her readiness for the next goal of helping- understanding, which signals the helper to begin personalizing. They serve to stimulate the helpee’s exploration of where he or she is in his or her experiences of the world and that the helper is fully in tune with the helpee’s experience.

Personalizing: “To enable the helpee to understand where she is in relation to where she wants or needs to be”, involves building a base of interchangeable responses before personalizing the meaning, the problem, the feelings and the goal. The purpose is to facilitate helpee self understanding in the areas of concern to her, thus she signals readiness for using initiating. They are used to provide a transition from responding to initiating and from exploring to acting. Personalizing skills culminate in the helpee’s personal experience of the problem as the inability to handle difficult situations.

Initiating: ”Finding direction in life or acting in following the direction, bringing direction to culmination – giving life meaning in productivity and creativity”. It involves operationalizing goals and initiating steps, schedules and reinforcements to achieve these goals. These goals resolve helpee’s problems. Fosters the development and implementation of the mechanical steps required to achieve the personally meaningful goals that the helpee has developed. Initiating skills conclude the first cycle of helping process in which helper facilitate helpee’s acting to get to where he or she wants to be in the world.

If you have attended to to the helpee’s needs and responded to her experience, you have facilitated her exploration of where she is. If you have personalized your understanding of the helpee, you have facilitated her understanding of where she is in relation to where wants to be. If you have initiated to help the helpee achieve her goals have facilitated her acting to get from where she is to where she wants to be. Thus you have helped her solve  her problems and achieve her goals. You have seen her grow and develop.  But growth is not static, is life long learning. Life long Learning is recycling exploring, understanding and acting. A growing person is constantly involved in the learning person.

Growing is more than learning and helping. It is helping others to learn, which means to explore, understand and act plus recycle. E.g. All people can do with each other in their daily contacts, first and foremost by attending and making an effective response to the other.

Having begun by attending and responding, over an extended period of time each person can learn to personalize and initiate with the people with whom they are involved

At the highest level people communicate with immediacy, which means understanding and interpreting in the moment what is going on between you and the helpee (highest levels of responsive and initiative behaviour). It means being simultaneously aware of both the helpee’s and one’s own experience. 

A less than whole person is never actually talking about what she seems to be talking about, may talk in comparison or relation to other people. A whole person is always talking about what she seems to be talking about, communicates fully. As helpers our tasks is to become whole people.  Thus helping is a process of teaching people who do not communicate fully to communicate fully with themselves and others. Whatever the effective helper or the whole person is doing, she is always checking back with the helpee accuracy of the responses. She makes this  by making responses that are interchangeable with the feeling and content expressed by the helpee, no matter how advanced is the stage of the helping relationship. The helper is fully alive, concerned and capable of communicating thierliving energy, concern and capability to those who are most in need.

In  fully alive communication each person may be helper to the other. But one must initiate the helping process by communicating her openness to understanding the other. In doing so she establishes the model for the other to imitate, Mutual problems are resolved.  There is no edge in helping. The helpee informs us that she is ready to function as a helper by her behaviour. One clear demonstration of the helpee’s readiness to terminate the helping process, to go out on her own is her ability to respond to the experience of the helper.  THE CLEAR DEMONSTRATION OF THE ABILITY TO FUNCTION AS A HELPER WILL BE ONE’S ABILITY TO RESPOND AND INITIATE EFFECTIVELY.

The Assumption

The only assumption made in developing the helping skill programs involves one’s motivation.   Other assumption is that one wants to grow, want to be like the facilitative helpers and teachers one has experienced, one wants to become involved in a life long learning process.- CARKHUFF

Brammer and Macdonald-

• The basic interpersonal communication processes implied by the specialized helping relationships are similar

• People know their needs

• Basically it is a process of enabling the person to grow in the directions that person chooses, to solve problems and to face crises.

• Voluntary quality of the helping process is a crucial point since many persons wanting to help others have their own helping agenda and seek to meet their own unrecognised needs.

• The act of helping people with the presumed  goal of doing something for them or changing them in some way  has an arrogant quality too.

• The aim of all help is self help and self sufficiency.

• Each individual behaves in a competent and trustworthy manner if given the freedom and encouragement to do so.

• Helper must assume some responsibility for creating conditions of trust whereby helpeescan respond in a trusting manner and help themselves.

• Helper must be alert to the impact on the helpee of other people and of the physical environment.

• Helping takes place over the lifespan.  Each developmental period and the transitions between usually require some form of outside help to make life more effective and satisfying. .  

• The nature of the informal agreement implies a growth contract, that helpees will try to change under their own initiative, with minimal helper assistance.

Basic Helping scale

I + E + U + A = New learning (behaviour)

5.0 Initiating steps

4.5 Initiating goal operationalization

4.0 Personalizing problem, feelings and goal

3.5 Personalizing meaning

3.0 Responding to feeling and content

2.5 Responding to feeling

2.0 Responding to content

1.5 Attending

1.0 Non attending

Non attending covers all behaviours, both verbal and non verbal that are unrelated or irrelevant to the helpee’s situation or expressions.

Attending: includes the verbal and non verbal behaviours that are directly related to involving the helpee, but do not respond to what the helpee has shared about where she is.

Responding to content: involves summarising what the helpee has shared concerning her situation.

Responding to feeling: involves accurately identifying a feeling word that is interchangeable with the helpee’s experience of the situation.

Responding to feeling and content: involves the clear communication of helper understanding of both the content and feelings expressed by the helpee.

Personalizing meaning: involves responding to identify the personal significance or implications of the expressed situation for the helpee.

Personalizing problem, feelings and goal: involves responding to identify the personal deficits (assets) of the helpee that are contributing to the problem or situation, the feelings that the helpee is experiencing about her deficits (assets) and the goal that the helpee wants to achieve.

Initiating goal operationalization: covers responses that express a clear understanding of the helpee’s personalized problem, feelings and goal in behavioural terms.

Initiating steps: involves responses that identify specific steps toward accomplishing the operationalised goal.

Ingredients to secret of success

a. Skills of helping: Apply the skills then only you recognise the need for more skills. The most of basic of all skills is learning how to learn.  N ext is the basic skill of teaching.

b. Discipline: Employ skills with discipline. The accuracy of the discriminations and communications is the effective ingredient.

c. Work: Our real learning in life comes from working very hard, applying skills with disciplines in a variety of human experiences.  While working hard they must protect themselves by receiving the maximum return for the minimum investment. e.g. Once you understand the response deficits of the helpees they will tend to employ teaching in groups as the preferred mode of treatment.

Evaluation of theory

i. 1960’s: (Eysenk, 1960, 1965; Levitt 1963; Lewis 1965) stated that psychotherapy and counseling   did not make a difference. They discovered that both adults and children who were in control groups  that were not assigned to professional practitioners, gained as much on the average as people assigned to professional counselors and therapists. About two thirds of the patients improved and remained out of the hospital a year after treatment whether they were treated or not.  This research was updated in longitudinal studies in more than 50 treatment setting by Anthony(1979) who studied lasting effects of counseling, rehabilitation and psychotherapeutic techniques. Within 3-5 years after treatment  65-75% of the patients were once again patients. The gainful employment of patients was below 20%. Conclusion was that psychotherapy  has lasting positive effects in 17-22% of the cases.

ii. Naturalistic studies: (Rogers et al 1967, Traux and Carkhuff 1967) The clients and patients of professional helpers demonstrated a greater range of effects than those in professionally untreated groups. But study revealed a very distressing conclusion that counseling and psychotherapy have a two edged effect- they may be harmful or helpful. The effects could be determined by the levels of functioning of the helpers on certain interpersonal dimensions such as empathy/empathetic understanding. One who offered high level of core interpersonal dimensions facilitated the process movement.

iii. Predictive studies: involved manipulating  the levels of helpers functioning on interpersonal dimensions such as empathy and its effects both within the helping process and upon the helping outcomes. (Carkhuff and Alexik 1967, Holder et al 1967; Piaget et al 1968; Traux and Carkhuff 1967). Helpees  of helpers functioning at high levels of these interpersonal dimensions moved towards higher levels of functioning (explored their problems in meaningful ways)

iv. Generalization Studies: To study the effects of teacher’s levels of interpersonal functioning upon learner’s development. The students of teachers offering high levels of these interpersonal dimensions demonstrated significant constructive gains in areas of emotional, interpersonal and intellectual functioning (Aspy and Roebuck, 1977) These effects have been generalised in all areas of helping and human relationships where the more knowing person influences the less knowing person, parent child relations (Carkhuff 1971, 1976); Student teacher relations (Carkhuff 1969); counselor –client relation and therapist patient relations

v. Extension studies: Michelson and Stevic(1971) found that career information seeking behaviour was dependent upon the helper’s levels of interpersonal functioning in interaction with their reinforcement program Helping dimensions were validated in predictive studies of both helping process and outcome. The acceptance of the fundamental ingredients of helping has been widely demonstrated in the professional literature.

The applications:

i. With credentialed counselors and therapists: Trained counselors were able to demonstrate success rates between 74-91%. Aspy and Roebuck(1977) demonstrated positive effects of helping skills upon student physical, emotional and intellectual functioning.

ii. Functional Professionals: Staff personnel, such as nurses, hospital attendants, policeman, prison guards, dormitory counselors, community volunteers were trained and their effects in treatment studied. Lay helpers were able to elicit significant changes in work behaviours, discharge rates, recidivism rates and a variety of other areas including self reports, significant other reports and expert reports.

iii. Indigenous personnel: They can work effectively with the populations from which they are drawn. For example, new career teachers, drawn from the ranks of unemployed have systematically helped others to learn the skills they needed in order to get and hold meaningful jobs.

iv. Helpee population: in the kinds of skills which they need to service themselves. Thus parents of emotionally disturbed children were systematically trained in the skills which they needed to function effectively with themselves and their children. Patients were trained to offer each other rewarding human relationships. The results were significantly  more positive than all other forms of treatment.  The concept of training as treatment led  to the development of programs to train entire communities to create a therapeutic milieu.

v.  Science and art of helping: On implication of the research into helping  is to select persons as helpers who already possess the artful qualities and then quickly and systematically give them basic helping skills and behaviour concepts.

vi. Self Help Groups: Hurvitz (1970) studied many groups as participant observer and concluded saying much of their effectiveness was due to peer relationships, inspirational methods, explicit goals, fellow ship and a variety of helping procedures. They use many sources of help that are outside conventional helping methods.

Helping Relationship (Brammer)

The  third component of the helping relationship is described as the working alliance, which is the agreement of helper and helpee on the goals and tasks and the experience of an emotional bond in this mutual act. The working alliance is considered equal in importance to helper attitudes (Gelso & Carter, 1994). Helping relationship is dynamic at verbal and nonverbal levels, the relationship is the principal process vehicle for both helper and helpee to express and fulfill their needs as well as to mesh helpee problems with helper expertise. All authorities on the helping process agree that the quality of the helping relationship is important to effective helping(Sexton and Whiston 1994.)All agree that good working relationship established early, yield a helping relationship. Its dimensions are (Brammer, Abrego and Shostrom 1993) uniqueness-commonality and intellectual – emotional content. However helping relationship is different from friendship, is not a reciprocal relationship. The focus is on the helpee’s emotional and intellectual issues, the helper must resist the urge to move the focus to his or her experience.

Helping affiliations

Helping affiliations can be classified into formal and structured (professional, paraprofessionals and volunteer helper) to informal and unstructured (friendships, family, community& general human).

Stages in helping process

There are eight stages contained in the two basic phases of the helping process.

Phase 1: Building relationships:

• Entry: preparing the helpee and opening relationship

• Clarification: state the problem or concern and reasons for seeking help

• Structure: formulating the contract and the structure

• Relationship: building the helping relationship

Phase 2: Facilitating Positive Action

• Exploration: exploring problems, formulating goals, planning strategies, gathering facts, expressing deeper feelings, learning new skills.

• Consolidation: exploring alternatives, working through feelings, practicing new skills

• Planning: developing a plan of action using strategies to resolve conflicts, reducing painful feelings, and consolidating and generalizing new skills or behaviours to continue self-directed activities.

• Termination: evaluating outcomes and terminating the relationship.

Helping skills for understanding: of self and others

i. Listening skills

• Attending – noting verbal and nonverbal behaviours

• Paraphrasing – responding to basic messages

• Clarifying – self disclosing and focusing discussion

• Perception checking – determining accuracy of learning

ii. Leading Skills

• Indirect leading – getting started

• Direct leading – encouraging and elaborating discussion

• Focusing – controlling confusion, diffusion and vagueness

• Questioning – conducting open and closed inquiries

iii. Reflecting skills

• Reflecting feeling – responding to feelings

• Reflecting experience – responding to toal experience

• Reflecting content – repeating ideas in fresh words or for emphasis

iv. Confronting skills:

• Recognising feelings in oneself – being aware of helper experience

• Describing and sharing feelings – modeling feeling expression

• Feeding back opinions – reacting honestly to helpee expressions

• Self-confrontation

v. Interpreting skills

• INTERPRETIVE QUESTIONS – FACILITATING AWARENESS

• FANTASY AND METAPHOR- SYMBOLIZING IDEAS AND FEELINGS

vi.    Informing skills

• Advising – giving suggestions and opinions based on experience

• Informing- giving valid information based on expertise

vii.  Summarising Skills

• Pulling themes together.

Ethical issues in helping relationships: Informed consent

Worker self care- recognise own weak spots and work on prevention

Dual relationships- recognise them and manage them Ask following questions.

      Is there a a power difference between us?

      What other role obligations do I have in this situation?

      How will my knowledge about you change our relationship?

Physical contact with helpees: Sexual relationships of any kind are unethical

Touching clients for support, out of compassion or to express care is controversial.

Conclusion

Our task in life is to improve the quantity and quality of human experience, our own as well as others which is growth. Life is process, is growth and growth is learning skills. When we use the helping skills effectively, we can be healthy and we can help each other to actualize our human potential. The only meaning to life is to grow for growing is life.

References

1. Carkhuff R. The art of helping. 4^th ed. Amherst: Human Resource Development press; 1983

2. Brammer L M, Macdonald G. Helping relationship process and skills. 6^th ed. Boston: Allyn and Bacon; 1996.

3. Shea C A, Pelletier L R, Poster E C, Stuart G W, Verhey M P. Advanced practice nursing in psychiatric and mental health care. St. Louis: Mosby; 1999

4. Topalis M, Aguilera D C. Psychiatric nursing. 7^th ed. St Louis: C V Mosby; 1978.

5. Morrison M. Foundations of mental health nursing. St. Louis: Mosby; 1997.

6. Taylor C, Lillis C, Le Mone P, Lynn P. Fundamentals of nursing. 6^th ed. Philadelphis: Lippincott Williams & Wilkins; 2005.

7. Dexter G, Walsh M.  Psychiatric skills a pateint centred approach. 2^nd ed. London: Chapman & Hall; 1995.

8. Stuart G W, Laraia M T. Principles and practice of psychiatric nursing. St Louis: Mosby Harcourt  Pvt. Limited; 2001.

9. Boon NA, Colledge NR, Walker BR, Hunter JAA. Davidson’s principle and practices of medicine. 20^th ed. London: Churchill Livingstone Elsevier; 2006.

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