BACKGROUND: Relationships develop through social interaction and assist with participation and inclusion. Little is known about how relationships develop between people with severe intellectual disability who have limited communication and others. METHOD: Interactions were observed between 6 adults with severe intellectual disability and paid workers or family members with whom those adults had positive relationships. Workers and family members were interviewed. The data were analysed through a grounded theory approach. RESULTS: Data analysis led to the identification of 5 processes that underpin positive relationships: recognising individuality, sharing the moment, connecting, feeling good, and sharing the message. CONCLUSIONS: A relationship model with clearly identified processes and sub-elements provides a framework for teaching others how to have positive relationships with people with severe intellectual disability. The model could be applied in training to support relationships between workers and people with a disability and more widely with other community members.