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Understanding the perceptions of direct care staff of their reciprocal relationships at work and levels of burnout may help us improve not only their psychological health but also the service they provide. A cross-sectional survey was undertaken with direct care staff who worked with children, older people and people with intellectual disabilities in residential settings. Staffs were asked to report their levels of burnout and perceived reciprocity in the relationship they had with service users, other staff and the organisation they worked for. Significant relationships were found between some burnout and reciprocity measures. 'Under benefit' in relationships with service users, colleagues and the organization was related to emotional exhaustion. 'Under benefit' in organizational and staff relationships was related to increased depersonalization. Reciprocity is a potentially useful concept for understanding differences in relationships across a broad range of staff and use of the reciprocity questionnaire in this study allows for comparison between diverse groups. The importance of relationships with the employing organization is highlighted in this sample and suggests that burnout is not solely linked with lack of reciprocity in the caregiving relationship per se. Copyright © 2010 John Wiley & Sons, Ltd. • Direct care staff are important intermediaries for the work of many clinical psychologists and research suggests that their well-being can influence the quality of care they provide. • There are similarities between care staff who work across different client groups. • This paper describes the development of a methodology that examines reciprocity in relationships with service users, staff and organization. • This framework is shown to be useful in exploring staff relationships and concerns that may facilitate clinical work with staff and stimulate research. [ABSTRACT FROM AUTHOR]