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Motivational determinants of interpersonal distress:How interpersonal goals are related to interpersonalproblemsAndrea Thomas a , Helmut Kirchmann a , Holger Suess b , Sonja Bräutigam a & BernhardMichael Strauss aa University Hospital Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena,Germanyb Burg-Klinik, Stadtlengsfeld, Germany

Available online: 08 May 2012

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Motivational determinants of interpersonal distress: How interpersonalgoals are related to interpersonal problems

ANDREA THOMAS1*, HELMUT KIRCHMANN1, HOLGER SUESS2,

SONJA BRAUTIGAM1, & BERNHARD MICHAEL STRAUSS1

1University Hospital Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany & 2Burg-Klinik,

Stadtlengsfeld, Germany

(Received 14 April 2011; revised 27 February 2012; accepted 13 March 2012)

AbstractThis study aimed to link interpersonal goals with interpersonal problems and psychological distress and to investigatechanges in these variables during an inpatient psychotherapeutic treatment. Two hundred and fifty-eight patients treated ina psychosomatic hospital completed the German versions of the Circumplex Scales of Interpersonal Values, the Inventory ofInterpersonal Problems, and the Outcome Questionnaire before and at the end of their treatment. Patients initially reporteda strong need for bonding in the CSIV. Especially interpersonal goals related to avoidant, submissive, and altruistic behaviorwere associated with a wide range of different interpersonal problems, and were associated with more psychological distress.At the end of treatment, patients showed no substantial changes in their predominant communal goals, but significantlyreduced submissive goals. Additionally, changes of these goals were associated with changes of various interpersonalproblems and psychological distress. Focusing the value patients place on submissive experiences could help to improveinterpersonal problems.

Keywords: outcome research; interpersonal goals and problems; circumplex model

Interpersonal problems provide a common source of

distress and are therefore focused in psychotherapy

(Horowitz, 2004). In addition, interpersonal pro-

blems affect the nature of the therapeutic alliance

since patients’ interpersonal styles interact with

personal and role characteristics of the therapist,

setting ‘‘complementary’’ forces in motion that

either promote or inhibit therapeutic change

(Gurtman, 2004). Accordingly, current concepts of

almost all psychotherapy traditions more or less refer

to the patient’s interpersonal distress and highlight

the patient’s adaptive and maladaptive relationships

inclusively the therapeutic relationship, e.g. object

relations theory (e.g. Fairbairn, 1952), Relational

Psychoanalysis (Mitchell, 2003), Interpersonal

Reconstructive Therapy (Benjamin, 2003), Schema

Therapy (Young, Klosko, & Weishaar, 2003), or

Integrative Cognitive Therapy for Depression (ICT;

Castonguay, 1996).

In psychotherapy research the Inventory of Inter-

personal Problems (IIP; Horowitz, Alden, Wiggins,

& Pincus, 2000) is a common measure of inter-

personal distress. Findings based upon the IIP relate

to the interpersonal content of a large proportion of

patients’ presenting problems and treatment goals

(e.g. Cain, Pincus, & Grosse Holtforth, 2010; Salzer

et al., 2010). Interpersonal problems have also

shown to predict psychotherapy process and out-

come (e.g. Borkovec, Newman, Pincus, & Lyte,

2002; Ruiz et al., 2004). Changes of interpersonal

problems during psychotherapy are commonly seen

as an indicator of psychotherapy effectiveness

(e.g. Huber, Henrich, & Klug, 2007; Luyten, Low-

yck, & Vermote, 2010; Salzer et al., 2010). Given the

central importance of interpersonal distress in

psychotherapy, it seems reasonable to focus on

factors which might cause interpersonal problems.

In the interpersonal circumplex tradition, a recent

reformulation of the interpersonal circumplex model

(Horowitz et al., 2006) emphasizes interpersonal

motives, which are seen as relevant intraper-

sonal determinants directing an individual’s inter-

personal behavior in order to establish, maintain or

modify interactions with an impact on wellbeing of

the interactants. In this framework, interpersonal

problems are assumed to reflect enduring frustrations

Correspondence concerning this article should be addressed to Andrea Thomas, University Hospital Jena, Institute of Psychosocial

Medicine and Psychotherapy, Jena, Germany. Email: andrea.thomas@med.uni-jena.de

Psychotherapy Research,

2012, 1�13, iFirst article

ISSN 1050-3307 print/ISSN 1468-4381 online # 2012 Society for Psychotherapy Research

http://dx.doi.org/10.1080/10503307.2012.676531

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of interpersonal goals which are associated with

negative affect, e.g. anger, sadness, anxiety or lone-

liness (Shechtman & Horowitz, 2006). In their over-

view of interpersonal motives in psychotherapy,

Grosse Holtforth, Thomas and Caspar (2010) as-

sumed that insufficient satisfaction of important

interpersonal goals might be an essential origin of

the development and maintenance of psychological

disorders. Accordingly, they consider interpersonal

goals of relevance for the practicing psychotherapist.

A therapist understanding a patient’s problem from a

motivational perspective can help the patient modify

interpersonal goals which consequently may contri-

bute to change the patient’s problematic interpersonal

behavior. On the other hand, a therapist can also

encourage behavior that helps a patient satisfy im-

portant goals that have previously been frustrated.

Furthermore, attuning the therapist’s behavior to the

patient’s goals may foster a maximally beneficial

therapeutic relationship (Grosse Holtforth et al., 2010).

Interpersonal motives refer to motivation that is

directed towards other people. According to current

motivational concepts (e.g. Austin & Vancouver,

1996), interpersonal motives are considered to vary

hierarchically in their level of abstraction. The term

‘‘motive’’ generally describes a higher level of ab-

straction, whereas the term ‘‘goal’’ depicts a more

specific category or narrow level of abstraction

(Horowitz, 2004). Interpersonal motives are con-

ceptualized related to the two broad abstract cate-

gories, agency and communion, at the top of the

hierarchy (Bakan, 1966). An agentic motive empha-

sizes the self as a distinct unit, striving for influence

and control over other people. In contrast, a com-

munal motive is directed towards connection and

solidarity with other people. In this article we will use

the term interpersonal ‘‘goals’’, even if goal con-

structs at a higher level of abstraction are referred.

As an interpersonal measure, the Circumplex

Scales of interpersonal Values (CSIV; Locke, 2000)

was developed to assess interpersonal goals. Follow-

ing the typical structure of common interpersonal

circumplex measures, Locke constructed the CSIV

focusing on the hierarchical organization of goals: 64

items refer to different interpersonal goals and are

organized into eight subscales (or octants) which

assess higher-order categories of interpersonal moti-

vation. The octants are described along the two

dimensions Agency and Communion. Respondents

have to indicate the importance of the particular

interpersonal goal using a 5-point Likert scale from

0 ‘‘not important’’ to 4 ‘‘extremely important’’. Figure

1 shows the circumplex model of interpersonal values

including subscale denominations and item examples.

As reflected in Figure 1, the octants of the

interpersonal circumplex are commonly described

using rotated alphabetical abbreviations (counter-

clockwise), where P/A marks the beginning (A) and

the end (P) of the circle.

There is some evidence that motivational goals

relate to psychopathology and interpersonal pro-

blems. Recent research has distinguished between

approach and avoidance motivation (Elliot & Cov-

ington, 2001). Approach goals are assumed to target

need satisfaction, and avoidance goals the prevention

of need frustration. The Inventory of Approach and

Avoidance Motivation (IAAM; Grosse Holtforth &

Grawe, 2000) is a standardized self-report measure

to assess the intensity of approach and avoidance

goals with some of the subscales also referring to

interpersonal goals. Seven of 14 approach goals (e.g.

Intimacy, Affiliation, Status) and six of nine avoid-

ance goals (e.g. Separation, Deprecation, Humilia-

tion) are considered to be interpersonal in nature.

Using the IAAM, Grosse Holtforth and colleagues

(Grosse Holtforth, Bents, Mauler, & Grawe, 2006;

Grosse Holtforth, Pincus, Grawe, Mauler, & Cas-

tonguay, 2007) determined the associations between

approach and avoidance goals and interpersonal

problems. Results indicated that both strong

approach and strong avoidance goals were related

to interpersonal problems: strong approach goals

(e.g. wishing for greater intimacy, striving for status)

Figure 1. The German version of the Circumplex Scales of

Interpersonal Values. Octants, scales and item examples related

to an octant schema according to Gurtman and Balakrishnan,

1998.

2 A. Thomas et al.

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were related to interpersonal problems ranging from

being overly nurturant (LM) to being overly dom-

ineering (PA). In contrast, strong avoidance goals

(e.g. avoiding feelings of vulnerability or humiliation)

were related to friendly submissive/submissive

problems ranging from being overly socially avoidant

(FG) to being overly exploitable (JK). However, the

authors only found significant associations with

subscales predominantly describing interpersonal

motivation, and higher associations with interperso-

nal avoidance goals than with approach goals.

Correlation coefficients varied between r�.38 and

r�.35, indicating that there are at least moderate

connections between interpersonal goals and inter-

personal problems.

Berking, Grosse Holtforth, and Jacobi (2003)

examined psychotherapy effects with regard to

changes of motivational goals. To test the

assumptions, 64 inpatients undergoing cognitive

behavioral therapy were assessed using the IAAM

pre�post therapy and diverse outcome measures.

The authors showed that approach and avoidance

goals of predominantly interpersonal content nor-

malized after therapy. Effect sizes ranged from

d�.19 to d�.64. Furthermore, only changes of

avoidance goals were associated with better therapy

outcome indicated by correlations ranging from

r�.18 to r�.42. These findings indicate that

psychotherapy has an impact on changes of motiva-

tional goals, and that changes of specific goals are

relevant for therapy outcome since, at least in part,

outcome depends on changes of specific intentions.

In this study those approach and avoidance goals

predominantly interpersonal in nature turned out to

be the significant ones.

However, the IAAM does not claim to cover the

full range of interpersonal motivation. Converging

the German versions of the IAAM and the CSIV, as

described by Thomas, Locke and Strauss (in press),

each of four interpersonal approach and avoidance

goals referred to CSIV segments. Of the approach

goals, two converged with octant LM, one with

octant PA, and one with octant JK. Of the avoidance

goals, two goals converged with octant LM, one with

octant JK, and one with octant DE. The IAAM

especially did not cover the left segments of the

CSIV circumplex (e.g. ‘‘agentic and separate’’

(octant BC), ‘‘separate’’ (DE), ‘‘submissive and

separate’’ (FG), and ‘‘submissive’’ (HI)). Therefore,

focusing the full range of interpersonal goals could

help to discover specific association patterns between

interpersonal goals and problems.

Based upon the recent interpersonal model

describing interpersonal interactions with a focus

on interpersonal motives (Horowitz, 2004; Horowitz

et al., 2006), the aim of the present study was to

address salient interpersonal goals of psychotherapy

patients, and to examine whether interpersonal goals

determine interpersonal and non-interpersonal

distress as well as changes of interpersonal goals

during psychotherapy.

Specifically, the study intended to replicate and

extend the findings of Grosse Holtforth et al. (2006,

2007) and Berking et al. (2003) addressing the

following research questions: (1) What are the pre-

dominant interpersonal goals of psychotherapy pa-

tients? We assumed patients were indicating

predominant goals of the lower and the right-hand

segments of the circumplex, e.g. valuing the subscales

‘‘submissive and separate’’ (FG), ‘‘submissive’’ (HI),

‘‘submissive and communal’’ (JK), ‘‘communal’’

(LM), and ‘‘agentic and communal’’ (NO). (2)

How are interpersonal goals related to psychological

and interpersonal distress? We expected relationships

between the patients’ predominant interpersonal

goals and general psychological distress; these goals

should also predict psychological distress. Further-

more, there should be differential associations be-

tween interpersonal goals and interpersonal problems

congruent to the appropriate counterpart circumplex

structure: the respective subsets of interpersonal

goals should be positively associated with the appro-

priate counterparts of interpersonal problems. In

addition, we expected that the respective goals would

also predict the appropriate interpersonal problems.

(3) Do interpersonal goals change during psychother-

apy? We assumed that the patients’ predominant

goals should be reduced at post treatment (e.g.

‘‘submissive and separate’’ (FG), ‘‘submissive’’

(HI), ‘‘submissive and communal’’ (JK), ‘‘commu-

nal’’ (LM), and ‘‘agentic and communal’’ (NO)).

Compared to the means of a reference sample, the

patient sample should at least show a tendency to

‘‘normalize’’during psychotherapy. (4) Do changes of

interpersonal goals associate with changes of psycho-

logical and interpersonal distress? We assumed rela-

tionships between pre�post changes of the

patients’ predominant goals and pre�post changes

of interpersonal problems and psychological distress.

Method

Design and Procedure

The study was designed as a naturalistic pre�post

survey within a psychosomatic rehabilitation hospital

(Burg-Klinik Stadtlengsfeld) providing inpatient

psychotherapy. Usually, psychosomatic patients

spend a 6-week treatment in the unit. Based on

informed consent and after the study was approved

by the Ethics Commission of the University of Jena,

the patients filled out an assessment battery

Interpersonal goals and interpersonal problems 3

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including the German Circumplex Scales of Inter-

personal Values (CSIV), the short version (32 items)

of the German Inventory of Interpersonal Problems

(IIP-32), and the German version of the Outcome

Questionnaire (OQ-45) at the beginning and at the

end of their treatment.

Samples

At baseline, the clinical sample consisted of 258

consecutive patients undergoing inpatient

psychotherapy (cf. Figure 2). According to the

ICD-10 criteria, 137 patients (53%) were primarily

suffering from affective disorders, 41 patients

(15.9%) from adjustment disorders, 24 patients

(9.3%) from anxiety disorders, 13 patients (5%)

from somatoform disorders, seven patients (2.7%)

from eating disorders, four (1.6%) from neurasthe-

nia, and five patients (1.9%) from personality

disorders. Eight patients (3.1%) suffered from

psychological problems related to non-psychological

disorders, and for 21 patients (8.1%) diagnostic data

were not available. Patients had an average of 1.32

(SD�0.61) different diagnoses at admission; 191 of

them had only one chapter F diagnosis, 58 had two,

seven patients had three diagnoses, and four patients

had four diagnoses.

A non-clinical reference sample served as a

reference to identify specific interpersonal goals of

the psychotherapy patients. This sample was

matched with regard to sex and age using individuals

from an existing representative sample, which was

recruited in order to collect normative data for the

German IIP-32 and CSIV. The data collection was

conducted by the German polling company

USUMA (Berlin; for details see Thomas, Brahler,

& Strauss, 2011). A sample of 2515 individuals with

an average age of 47.2 years (SDage�18.7, range

14�98 years) were asked to complete the German

IIP-32 and CSIV. The matched references are

described in Figure 2.

Treatment

The inpatient treatment program consisted of weekly

individual psychotherapy sessions, group therapy

sessions that were provided three times per week

and additional specific treatments, i.e. disorder-

specific therapy groups for depressive patients,

anxiety patients, pain or tinnitus coping, psychoe-

ducation for patients with headache, and job-related

stress management, relaxation training (progressive

muscle relaxation, autogenic training, yoga), body-

oriented treatment (dance therapy, pilates, Qi gong),

sports (nordic walking, jogging), mindfulness-based

stress reduction and several medical services. Each

additional treatment component was chosen on the

basis of informed consent between a therapist and

the patient according to therapy goals and diagnoses.

All treatments were performed by experienced

physicians and/or clinical psychologists with different

therapeutic orientation (cognitive behavioral,

psychodynamic, systemic, or client-centered).

Measures

Circumplex Scales of interpersonal Values

(Locke, 2000). The CSIV provide a self-report

Figure 2. Study flow diagram.

4 A. Thomas et al.

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measure of interpersonal motivation assessing the

full range of agentic and communal values as

described above. The eight 8-item subscales of the

measure were shown to have good internal consis-

tency (range .76�.86) and test�retest reliability

(range .76�.88). The CSIV showed circumplex

structure as well as convergent and discriminant

validity. Thomas et al. (in press) were able to

demonstrate that the subscales of the German

version (Inventar zur Erfassung interpersonaler Mo-

tive, IIM) also show good internal consistency (range

.71�.86) and test�retest reliability (range .82�.87), a

circumplex structure, and convergent and divergent

validity with measures of interpersonal traits (Inter-

personal Adjective List, IAL; Jacobs & Scholl, 2005),

interpersonal problems (32-item version of the In-

ventory of Interpersonal Problems Circumplex, IIP-

32; Thomas et al., 2011), and interpersonal goals

(Inventory of Approach and Avoidance Motivation,

IAAM; Grosse Holtforth & Grawe, 2000). The

measure also revealed discriminative validity with

IIM profiles differentiating social phobic patients

and healthy controls.

Inventory of Interpersonal Problems

(Horowitz et al., 2000). The 32-item version of

the IIP (IIP-32; Thomas et al., 2011) is the German

short version of the IIP-C and assesses maladaptive

behavioral styles associated with each octant of

the interpersonal circumplex as described above.

The measure consists of eight 4-item subscales.

The items are divided into two sections: issues one

‘‘finds hard to do with other people’’ and issues that

one ‘‘does too much’’. The authors showed that the

subscales have good internal consistency (range .60�.85), a circumplex structure, and convergent and

divergent validity with German measures of symp-

tom distress (Symptom Checklist, SCL-27; Hardt,

Egle, Kappis, Hessel, & Brahler, 2004; Outcome

Questionnaire, OQ-45.2; Lambert, Hannover, Nissl-

muller, Richard, & Kordy, 2002).

Outcome Questionnaire (German version:

Ergebnisfragebogen; Lambert et al., 2002).

The Outcome Questionnaire (OQ-45.2) was origin-

ally developed by Lambert et al. (1996) as a

standardized measure for assessing psychotherapy

outcome. The measure includes items relevant to

three domains central to mental health: subjective

discomfort, interpersonal relations, and social role

performance. The OQ-Total score is computed by

addition of the three subscale scores and appears

promising as a measure of general psychological

distress (Umphress, Lambert, Smart, Barlow, &

Clouse, 1997). The OQ-45.2 appears to have high

reliability (internal consistency between .71 and .93),

evidence to suggest good concurrent and construct

validity of the total score and sensitivity to change

(Haug, Puschner, Lambert, & Kordy, 2004).

Power Analysis

Because patients were treated by different therapists,

the design of the study implicated a possible nested

therapists’ effect. Checking for this effect, the

intraclass correlation coefficients (ICC, see Hedges

and Hedberg, 2007) were calculated for all subscales

of the measures. The ICC varied between ICC�.00

and ICC�.08 (MICC�.02, SDICC�.03), with most

of the subscales containing an ICCB.05, and two

subscales containing ICCs between .07 and .08.

MICC was used to adjust the real sample size to

take account of the possible therapists’ effect in

power analysis. Following Kish (1965), the design

effect (DEFF) is computed by: DEFF�1�ICC *

(average cluster size 1). We used DEFF to correct

our sample size as follows: Nadjusted�N/DEFF. With

an average cluster size of n�13 patients per thera-

pist, Nadjusted�211 patients resulted. Accordingly,

assuming an alpha error of 5% (significance

level�.05; two-tailed) pre�post differences with

small effects of d�0.2 by Cohen (1988) were

detected with a power of 89% using G-Power 2.0

(Erdfelder et al., 1996).

Statistical Analysis

Differences in interpersonal goals between the two

samples were calculated using t-tests to account for

failures of variance homogeneity. The alpha level was

adjusted according to Bonferroni. Effect sizes (Co-

hen’s d) were calculated using the means and the

pooled standard deviation of the two samples.

Pearson correlations and stepwise regressions were

calculated to analyze the associations of interperso-

nal goals with interpersonal problems, and psycho-

logical distress. Changes of interpersonal goals were

tested using General Linear Modeling (GLM) with

the within-subject variables ‘‘time’’ and ‘‘subscale’’,

as well as post hoc analyses. Because the ICC did not

exceed the threshold of ICC�.10 (Raudenbush &

Bryk, 2002), we did not apply hierarchical analyses,

but accounted for the possible design effect in the

power analysis and the computation of t-values

following the GLM analysis (see Table II). In order

to test the hypothesis that improvement of inter-

personal problems and psychological distress are

related to changes in interpersonal goals, we

computed Pearson correlations and stepwise regres-

sions with reliable change indices of all the CSIV and

IIP subscale scores and the reliable change index of

the OQ total score. Reliable change indices were

Interpersonal goals and interpersonal problems 5

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calculated according to the Gulliksen-Lord-Nowick

(GLN) method described by Hsu (1989). The GLN

method takes regression to the mean into account,

implying that more extreme scores will tend to

become less extreme over repeated measures,

because of imperfect reliability. The GLN method

attempts to control for this potential confound by

including a reference mean toward which scores

would tend to regress. In the present study, the

means and standard deviations of the reference

sample were used as hypothesized population scores

towards which the patients’ scores would be regres-

sing. The alpha level was adjusted according to

Bonferroni. All statistical calculations were

performed using the SPSS program (version 16.0).

Results

Identification of Specific Interpersonal Goals

Relevant for Psychotherapy Patients

Table II summarizes the average CSIV subscale

scores of the patients and the reference sample.

In Figure 3 the CSIV scores of both groups are

mapped within the circumplex structure. Regarding

interpersonal goals, the patients’ profile is slightly

shifted into the communal part of the circumplex

(cf. Figure 3). The clinical and reference samples

differed in some of the average scale scores of the

CSIV (cf. Table II). Patients reported significantly

stronger intensities of ‘‘communal’’ (LM, t�3.48,

df�510, p�.001, d�.31) and ‘‘agentic and com-

munal’’ goals (octant NO, t�5.99, df�509,

pB.001, d�.52) than references as well as on the

dimensional score of communion (COM, t�7.03,

df�509, pB.001, d�.62), indicating the patients’

predominant need for bonding. Accordingly, they

reported a significantly weaker subjective impor-

tance of ‘‘agentic and separate’’ (octant BC,

t�7.39, df�516, pB.001, d�.65) and ‘‘separate’’

goals (octant DE, t�5.40, df�516, pB.001,

d�.47). However, goals related to the subscales of

‘‘submissive and separate’’ (octant FG), ‘‘submis-

sive’’ (octant HI), and ‘‘submissive and communal’’

(octant JK) were valued as important as valued by

the reference sample.

Associations of Interpersonal Goals with

Interpersonal Problems and Psychological

Distress

Table I summarizes the correlations of interpersonal

goals, interpersonal problems, and overall psychological

Figure 3. Profiles of patients (pre/post) and references concerning interpersonal goals. Profiles reflect unipsatized stanine scores.

6 A. Thomas et al.

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distress. As shown by the bold diagonal coefficients,

the respective subsets of interpersonal goals and the

adjacent located goals were meaningfully correlated

with the appropriate counterparts of interpersonal

problems, e.g. ‘‘agentic’’ (octant PA), ‘‘agentic and

separate’’ (octant BC), and ‘‘separate’’ goals (octant

DE) were mainly associated with interpersonal

difficulties ranging from ‘‘overly domineering’’ (PA)

to ‘‘overly cold’’ behavior (DE), and ‘‘submissive and

separate’’ (FG), ‘‘submissive’’ (HI), and ‘‘submissive

and communal’’ goals (JK) were associated with

problems related to ‘‘overly socially avoidant’’ (oc-

tant FG), ‘‘overly nonassertive’’ (HI), and ‘‘overly

exploitable’’ (JK) behavior. However, goals of the

lower octants of the circumplex model concerning

the subscales of ‘‘submissive and separate’’ (FG),

‘‘submissive’’ (HI), and ‘‘submissive and communal’’

(JK) were also associated with a wider range of

different problematic behaviors ranging from ‘‘overly

cold’’ (DE) and ‘‘overly socially avoidant’’ (JK) to

‘‘overly nurturant’’ (LM) and ‘‘overly intrusive’’

(NO) behavior. It is noteworthy that these goals

were almost exclusively associated with psychologi-

cal distress.

Results from stepwise regression analyses are also

summarized in Table I. Each second line in the table

represents one regression including the goal-scores

as independent and the problem scores and overall

psychological distress as dependent variables. Multi-

collinearity was controlled using multicollinearity

statistics: Tolerances of the regressors determined

from the data ranged between .35 and .97, and the

variance inflation factor (VIF) for multicollinearity

ranged between 1.01 and 3.09 (critical values of

Table I. Pearson correlations of interpersonal goals, interpersonal problems and psychological distress, and stepwise regression analyses

predicting IIP-D subscales, and OQ-total-score.

CSIV

PA BC DE FG HI JK LM NO

Agen

tic

Agen

tic

an

dS

epara

te

Sep

ara

te

Su

bm

issi

ve

an

dS

epara

te

Su

bm

issi

ve

Su

bm

issi

ve

an

dC

om

mu

nal

Com

mu

nal

Agen

tic

an

dC

om

mu

nal

R2

IIP PA Domineering .22 .43 .21 .10

.49 �.13 .20

BC Vindictive .29 .22

�.23 .43 .12

DE Cold .10 .37 .27 .13 .10 �.13

�.14 .44 .15

FG Socially avoidant .36 .47 .25 .25

�.26 .16 .56 �.28 .17 .31

HI Nonassertive �.14 �.10 .40 .42 .28

�.14 �.22 .35 .25 .27

JK Exploitable .46 .45 .33 .10

�.21 .44 .19 .26

LM Nurturant .10 .20 .28 .38 .25 .10

.38 .14

NO Intrusive .21 .33 .14 .24 .18 .17 .14

.46 �.30 .18 .19

OQ Total score .23 .25 .21 .14

.35 .12

Note. Only correlations r�.10 were reported. Bold diagonal correlation coefficients mark the associations of the respective counterparts of

interpersonal goals and interpersonal problems. Standardized regression weights significant on an alpha level pB.05 are represented in italics.

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multicollinearity are defined as follows:

toleranceB.20; VIF�5; O’Brien, 2007). Related

to interpersonal problems, interpersonal goals

explained 12�31% of the variance in each subscale

of the IIP, with the highest explained variance for the

lower octant IIP-D subscales (e.g. ‘‘overly socially

avoidant’’, octant FG), and the lowest for the

subscale ‘‘overly vindictive’’ (BC). All types of

interpersonal problems could be predicted signifi-

cantly by interpersonal goals; each of the 12 best-

fitting regression equations reflected a different

subset of interpersonal goals as predictors. Con-

forming to our hypothesis, especially interpersonal

goals located on the left side of the circumplex (e.g.

octants BC ‘‘agentic and separate’’, and DE ‘‘sepa-

rate’’) predicted interpersonal problems of the left

side (e.g. BC ‘‘overly vindictive’’, DE ‘‘overly cold’’);

interpersonal goals of the lower octants (e.g. FG

‘‘submissive and separate’’, and HI ‘‘submissive’’)

predicted the appropriate interpersonal problems

(e.g. FG ‘‘overly socially avoidant’’, HI ‘‘overly

nonassertive’’, and JK ‘‘overly exploitable’’), and

‘‘communal’’ goals (octant LM) predicted the ap-

propriate interpersonal problems of ‘‘overly nurtur-

ant’’(octant LM). In contrast, ‘‘submissive and

communal’’ (JK) and especially ‘‘agentic and com-

munal’’ goals (NO) did not explain a remarkable

amount of variance of any problematic interpersonal

behavior. Regarding psychopathology, psychological

distress was exclusively predicted by ‘‘submissive and

separate’’ goals (FG).

Changes of Interpersonal Goals, Problems and

Psychological Distress During Treatment

To assess changes of interpersonal goals during

treatment, General Linear Modeling (GLM) with

repeated measures was conducted. GLM revealed

significant main effects for the within-subject vari-

ables ‘‘time’’ (Hotelings trace: F(1,239)�13.85,

pB.001, h2�.06) and ‘‘subscale’’ (Hotelings trace:

F(7,233)�53.51; pB.001, h2�.62) as well as a

significant interaction effect (‘‘time�subscale’’,

F(7,233)�6.60, pB.001, h2�.17).

Figure 3 and Table II illustrate the average

changes of the interpersonal goals. Post hoc paired

t-tests showed that the clinical sample decreased

slightly but significantly with respect to ‘‘submissive

and separate’’ (FG), ‘‘submissive’’ (HI), and ‘‘sub-

missive and communal’’ goals (JK), with patients

even changing to lower scores than the references.

However, there were only slight changes of the

Table II. Interpersonal goals of the patients (pre/post) and the reference sample.

Octant CSIV subscale MPre (SD) MPost (SD) MR (SD) t-value (tcorrected) dPre/Post

PA Agentic 2.43 2.49 2.46 �1.90 .12

(.59) (.54) (.50) (�1.35)

BC Agentic and Separate 1.37 1.37 1.82 �.16 .02

(.67) (.62) (.68) (�.16)

DE Separate 1.29 1.27 1.62 .49 .03

(.68) (.69) (.72) (.47)

FG Submissive and Separate 2.16 1.98 2.14 4.46* .24

(.78) (.75) (.70) (4.21*)

HI Submissive 2.26 2.06 2.23 4.91* .26

(.80) (.73) (.60) (4.91*)

JK Submissive and Communal 2.60 2.40 2.52 5.70* .31

(.67) (.62) (.52) (5.39*)

LM Communal 2.92 2.85 2.74 2.50 .12

(.62) (.57) (.55) (2.36)

NO Agentic and Communal 3.13 3.07 2.84 1.93 .11

(.57) (.52) (.55) (1.73)

Dimension

A Agency �.08 .12 �.01 �5.96* .30

(.69) (.63) (.44) (�5.35*)

C Communion .50 .45 .09 1.89 .08

(.64) (.59) (.69) (1.70)

Mean Total score �.06 �.20 �.05 3.72* .20

(.71) (.67) (.65) (3.34*)

Note. Mpre (SD) �patients’ mean and standard deviation before treatment; Mpost (SD)�patients’ mean and standard deviation post

treatment; MR (SD)�mean and standard deviation of the reference sample; t�t-value of paired t-test, p�p-value; tcorrected accounted for

the design effect following the formula tcorrected�M/SE*�DEFF with DEFF �1� ICCsubscale * (average cluster size �1); dPre/Post �effect

size Cohen’s d of the differences between the means of the patients pre/post. * indicates significant group differences with Bonferroni

corrected pB.006.

8 A. Thomas et al.

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predominant ‘‘communal’’ (LM) and ‘‘agentic and

communal’’ (NO) goals.

Associations Between Changes of Interpersonal

Goals and Interpersonal Problems

Pearson correlations between the Reliable Chance

Indices of interpersonal goals (CSIV), interpersonal

problems (IIP) and psychological distress (OQ-45)

are summarized in Table III.

Analyses revealed only low correlations of con-

current pre/post changes of interpersonal goals and

problems as well as psychological distress with the

highest correlation of r�.26. In view of interperso-

nal problems, results indicated significant associa-

tions between changes in ‘‘agentic’’ (PA), ‘‘agentic

and separate’’ (BC) and ‘‘separate’’ goals (DE) and

problematic ‘‘overly domineering’’ behavior (PA).

Changes in ‘‘agentic and separate’’ goals (BC) were

positively associated and changes in ‘‘communal’’

(LM) and ‘‘agentic and communal’’ goals (NO) were

negatively associated with changes of ‘‘overly vindic-

tive’’ behavior (BC). Furthermore, almost all of the

changes in ‘‘separate’’ (DE), ‘‘submissive and sepa-

rate’’ (FG), ‘‘submissive’’ (HI), and ‘‘submissive and

communal’’ goals (JK) were significantly associated

with changes in ‘‘overly socially avoidant’’ (FG),

‘‘overly nonassertive’’ (HI), ‘‘overly exploitable’’

(JK), and ‘‘overly nurturant’’ (LM) behavior. None

of the changes in interpersonal goals were associated

with changes in problematic ‘‘overly cold’’ behavior

(DE). Additionally, changes in ‘‘communal’’ (LM)

and ‘‘agentic and communal’’ goals (NO) were not

related to changes in any type of interpersonal

problems except for ‘‘overly vindictive’’ (BC)

behavior.

Table III. Pearson correlations between the reliable change indices of interpersonal goals, interpersonal problems and psychological

distress, and stepwise regression analyses predicting changes in IIP-D scales, and overall interpersonal distress.

CSIV

PA BC DE FG HI JK LM NO

Agen

tic

Agen

tic

an

dS

epara

te

Sep

ara

te

Su

bm

issi

ve

an

dS

epara

te

Su

bm

issi

ve

Su

bm

issi

ve

an

dC

om

mu

nal

Com

mu

nal

Agen

tic

an

dC

om

mu

nal

R2

IIP PA Domineering .11 .26 .25

.18 .17 .08

BC Vindictive .12 �.12 �.11

.00

DE Cold .00

FG Socially avoidant .12 .14 .21 .15 .18

.27 .07

HI Nonassertive .12 .25 .13 .11

.26 .06

JK Exploitable .24 .19 .25

.15 .17 .07

LM Nurturant .14 .20 .22 .23

.26 .06

NO Intrusive .15 .11 .19

.19 .03

OQ Total .11 .21 .17 .12 �.13

.23 �.16 .06

Note. Only correlations r�.10 were reported. Standardized regression weights were reported on an alpha level pB.05.

Interpersonal goals and interpersonal problems 9

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With regard to changes in psychological distress,

there were significant positive correlations with

changes of ‘‘separate’’ (DE), ‘‘submissive and sepa-

rate’’ (FG), ‘‘submissive’’ (HI), and ‘‘submissive and

communal’’ goals (JK) and a negative association

with changes of ‘‘agentic and communal’’ goals

(NO).

Results from stepwise regression analyses are also

summarized in Table III, again with each line

representing one regression with interpersonal goals

as independent variables and interpersonal problems

and psychological distress as dependent variables.

Related to changes in interpersonal problems and

psychological distress, changes in interpersonal goals

explained a maximum of 8% of the variance, with

the highest explained variance accounted for by

changes of the IIP-D scale ‘‘overly domineering’’

(PA), and the lowest for changes of the subscales

‘‘overly vindictive’’ (BC) and ‘‘overly cold’’ (DE).

Corresponding to the low correlations, in general, bweights were only small in magnitude. According to

our hypothesis, changes in ‘‘agentic and separate’’

(BC) and ‘‘separate’’ goals (DE) were meaningful

predictors of changes in interpersonal problems of

‘‘overly domineering’’ (PA) behavior. Furthermore,

changes in ‘‘submissive and separate’’ goals (FG)

mostly predicted changes in different types of inter-

personal problems, e.g. changes in ‘‘overly socially

avoidant’’ (FG), ‘‘overly nonassertive’’ (HI), ‘‘overly

exploitable’’ (JK), and ‘‘overly intrusive’’ (NO)

behavior. Regarding ‘‘overly vindictive’’ (BC) and

‘‘overly cold’’ (DE) behavior, none of the changes in

interpersonal goals were shown as meaningful pre-

dictors. Furthermore, changes in ‘‘communal’’

(LM), ‘‘agentic and communal’’ (NO) and ‘‘sub-

missive’’ goals (HI) did not predict changes in any

type of interpersonal problems.

With regard to changes in psychological distress,

the best-fitting regression equation also identified

changes in goals of the octant ‘‘submissive and

separate’’ (FG) as the most relevant predictor.

Discussion

Interpersonal impairment has been shown to be of

therapeutic relevance in psychotherapy from theore-

tical and clinical perspectives (e.g. Benjamin, 2003;

Horowitz & Strack, 2010; Kiesler, 1996; McLemore

& Benjamin, 1979). Different theorists, such as

Leary (1957), Horowitz (2004) and or Benjamin

(2003), have emphasized adult psychopathology as

being primarily expressed through developmentally

induced dysfunctional interpersonal relationship

patterns. Recent empirical studies provide ample

evidence for the association between interpersonal

problems, psychopathological symptoms, psy-

chotherapy process, and outcome (e.g. Borkovec

et al., 2002; Hardy, Tracey, Glidden-Tracey, Hess,

& Rohlfing, 2011; Huber et al., 2007; Salzer et al.,

2010). Accordingly, many therapeutic interventions,

especially psychodynamic and interpersonal ones,

target the patient’s maladaptive interpersonal pat-

terns using specific techniques (such as interpersonal

feedback, cf. Kiesler & Van Denburg, 1993) in order

to understand the patients’ perceptions, needs, and

feelings (Benjamin, 2003; Strupp & Binder, 1984).

The major task of the therapist is to disrupt the

maladaptive interpersonal pattern of the patient by

responding in unexpected and surprising ways,

allowing for new interpersonal experiences, and

changing fundamental perceptions, needs and feel-

ings that shape the patient’s reactions in interperso-

nal situations.

A recent theoretical concept concerning interper-

sonal motivation assumes insufficient satisfaction of

important interpersonal goals as an essential origin

of the development and maintenance of psychologi-

cal disorders (Horowitz, 2004). According to this

concept, interpersonal problems can be seen as

frustrated salient interpersonal motives reflecting a

perceived discrepancy between individual goals and

the consequences of interpersonal interactions with

an impact on affective reactions to an interpersonal

encounter and psychological distress as well

(Horowitz et al., 2006). Accordingly, Grosse

Holtforth et al. (2010) consider interpersonal goals

of relevance for the practicing psychotherapist:

Focusing the motivational issues of a patient’s

problem could help to modify the patient’s inter-

personal goals and may contribute to change the

problematic interpersonal behavior. Additionally, the

therapist should encourage behavior that helps a

patient to satisfy important goals that have

previously been frustrated. Beyond these strategies,

attuning the therapist’s behavior to the patient’s

goals may foster a maximally beneficial therapeutic

relationship (Grosse Holtforth et al., 2010).

Related to this model, our study focused on the

relevance of interpersonal goals in psychotherapy

patients and the associations between changes of

interpersonal goals, problematic interpersonal

behavior, and symptomatology.

We were able to show that psychosomatic patients

undergoing inpatient psychotherapy in a psychoso-

matic rehabilitation hospital valued communal goals

significantly more strongly than individuals of a non-

clinical reference sample at onset. The patients

revealed a special need for bonding described by

strong intentions to receive harmony, support and

approval from other people. In view of the relation-

ship between interpersonal goals and interpersonal

distress, the results point to a substantial importance

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of specific goals for specific types of interpersonal

problems. However, especially separate and submis-

sive goals were also related to different types of

problematic interpersonal behavior. Moreover, they

were also associated with more psychological

distress, and predicted distress. In contrast, the

predominant communal goals reflecting the patients’

strong need for bonding did not predict any proble-

matic behavior except for overly nurturant behavior.

Consistent with the findings of Grosse Holtforth

et al. (2007), associations varied between r��.48

and r�.48 and explained low percentages of var-

iance (between 12% and 31%), both also indicating

other potential sources of interpersonal problems

and psychopathology, and the fact that specific

interpersonal problems might affect different goals in

different people. Furthermore, insufficient learning,

aversive circumstances, etc. may also cause inter-

personal problems and psychological distress.

Regarding changes in interpersonal goals during

inpatient treatment, we found only slight but

significant changes in submissive goal types.

In contrast, there were only slight changes of the

predominant interpersonal characteristics of the

patients, i.e. higher scores of ‘‘communal’’ (LM)

and ‘‘agentic and communal’’ goals (NO) before

treatment. Additionally, changes in specific inter-

personal goals were associated with changes in

specific types of interpersonal problems and psycho-

logical distress. Moreover, especially changes in

‘‘submissive and separate’’ goals (FG) almost exclu-

sively predicted changes in a wide range of different

types of interpersonal problems and changes in

psychological distress. Again, the associations and

explained variances were only small in magnitude,

suggesting other mechanisms to be more relevant in

reducing interpersonal problems and psychological

distress.

However, our results are consistent with the

empirical findings by Grosse Holtforth and collea-

gues (2006, 2007) and Berking and colleagues

(2003). They showed that strong approach goals

(referring to need satisfaction) and especially strong

avoidance goals (preventing need frustration) were

associated with different types of interpersonal

problems, e.g. approach goals related to friendly

and friendly-dominant problems, and avoidance

goals were related to friendly-submissive and sub-

missive interpersonal problems. Berking et al. de-

scribed changes of interpersonal avoidance goals as

being associated with changes of outcome measures

and Grosse Holtforth et al. (2007) assumed a

‘‘suppressive’’ influence of strong avoidance goals

especially on need satisfaction of approach goals.

Although not differentiating between approach

and avoidance goals, ‘‘agentic’’ (PA), ‘‘agentic and

communal’’ (NO), and ‘‘communal’’ goals (LM)

mostly seem to represent approach goals, whereas

‘‘separate’’ (DE), ‘‘submissive and separate’’ (octant

FG), and ‘‘submissive’’ goals (octant HI) may mostly

represent avoidance goals, because they directly

address the prevention of depreciation and abandon-

ment. Since we cannot draw causal conclusions, it

might be that a given interpersonal problem could

have acted as a trigger for the development of

specific interpersonal goals. On the other hand, it

could be hypothesized that a given problematic

interpersonal behavior might be a consequence of

the strengths of specific interpersonal goals, or

specific mechanisms that could explain the

relationship between goals and problems. Although

psychosomatic patients showed an even higher need

for bonding than healthy references, however, the

related ‘‘communal’’ (LM) and ‘‘agentic and com-

munal’’ (NO) approach goals did not turn out to be

meaningful determinants of problematic interperso-

nal behavior and did not substantially change during

treatment. Accordingly, the results indicate that

strong intensities of goals themselves might not cause

problematic interpersonal behavior but rather a

combination of intense goals with specific mechan-

isms, i.e. potential suppression mechanisms of goal

types, such as suppressing behaviors that directly

target the need for bonding. In this respect, ‘‘sub-

missive and separate’’ (FG) and ‘‘submissive’’ goals

(HI) seem to be important aspects of the patients’

interpersonal and overall psychological distress.

Although patients reported these goals with a similar

intensity as references, it could be hypothesized that

these goals might still affect the patients’ distress

because of interference. Given the patients’ need for

bonding, patients might show ambiguous amiable

behavior (e.g. overly withdrawn, submissive and

altruistic behavior) because of their fears of depre-

ciation, conflict and abandonment, underpinning the

potential impact of these fears as a source for

developing psychological distress, e.g. suppressing

behaviors that directly target the need for bonding.

As a consequence, they may invite others to respond

not with affiliating but rather with domineering

behavior. Therefore, in psychotherapy treatment

therapists should question the value patients place

on submissive experiences helping to improve inter-

personal problems.

Our results in summary suggest some extensions

of the interpersonal model to incorporate approach

and avoidance motivation as distinct classes within

the system of interpersonal motivation. The distinc-

tion and localization of interpersonal approach goals

and interpersonal avoidance goals may contribute to

a more detailed understanding of the mechanisms by

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which interpersonal motivation influences proble-

matic interpersonal behaviors.

Limitations and Perspectives

The present study has several limitations. The

generalizability of the results is potentially limited,

because our sample exclusively consisted of an

unselected group of inpatients from one hospital in

one country. Additionally, all constructs were only

operationalized by self-report measures. Future stu-

dies are needed to replicate our findings in similar

samples and across diverse samples (e.g. different

diagnostic subgroups). Larger sample sizes should be

used to further examine whether interpersonal goal

subtypes can be found among psychotherapy

patients, and whether they differ in the modification

of interpersonal goals and problems. Since other

studies (e.g. Haase et al., 2008) showed that

extensive changes on an interpersonal level could

not be observed immediately after treatment, but at

follow-up it can be assumed that modifications of

interpersonal goals and problems might occur with

some delay and that the relationship between the

variables might become evident when variations of

changes increase. Accordingly, future studies should

include longitudinal designs with control groups that

consider the delay of interpersonal changes and will

allow causal interpretations of the relationship be-

tween therapy outcome and changes of interpersonal

goals.

Another limitation might be related to the setting,

i.e. a rehabilitation hospital. The patients in our

sample were treated multimodally by different thera-

pists with a variety of therapeutic orientations. It

might be expected that psychotherapists and treat-

ment approaches using more interpersonal techni-

ques could be more effective in changing

interpersonal goals/problems than others which could

not be tested systematically within this study. Future

research should address changes of interpersonal

goals in different psychotherapeutic settings and

orientations. They would also allow for investigations

concerning the relations between specific psychother-

apeutic interventions as well as process variables and

changes of dysfunctional interpersonal issues.

Testing hypotheses related to interpersonal goals

and differentiated changes may help to provide a

clearer understanding of the causal and temporal

relationships between interpersonal goals and inter-

personal/psychological problems. If interpersonal

motivation turns out to have a significant influence

on therapeutic outcome, as Horowitz (2004) and

Grosse Holtforth et al. (2010) propose, effective

interventions should be identified to affect specific

interpersonal goals.

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