Gestalt Therapy's "Topdog-Underdog" Dialogues As a Treatment for Depression

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Lillian M. Range

Advisor Department



This treatment analog study was designed to assess the efficacy of Gestalt Therapy's "topdog-underdog" dialogue with depressed individuals and to systematically explore its dimensions as a treatment technique. Selected from an initial pool of 204 volunteers on the basis of Scale 2 (Depression) elevations on the MMPI-168 and randomly assigned to four groups, 44 adults completed the four week treatment program. Three treatment groups met for one hour a week employing Gestalt Therapy's "empty chair" technique to enact dialogues which differed in content (Relevant-Irrelevant) and affective tone (High-Low). A "Topdog-Underdog" Group (Relevant Content-High Affect) enacted "empty chair" dialogues portraying Gestalt Therapy's "topdog-underdog" conflict, a hypothesized source of neurotic depression. An "Affect Expression" Group (Irrelevant Content-High Affect), based upon Lazarus' (1968) prescription of affect stimulation for depression, enacted situations in which strong emotion was expressed. An attention-placebo group enacted situations that were irrelevant to the "topdog-underdog" conflict and low in affect. Control subjects were seen for data collection only. All subjects were pretested, posttested following treatment, and followed-up a mean of 7.3 weeks later utilizing the MMPI-168, Depression Adjective Check Lists (DACL), and experimenter devised questionnaires. A series of 4 x 3 ANOVA's revealed no significant differences among treatment conditions, thus, failing to provide support for experimental hypotheses. DACL, sum of MMPI-168 clinical scales and Scales 1, 2, 7 and 0 of the MMPI-168 evidenced significant decreases for all groups from pretesting to subsequent testings with no significant differences between posttesting and follow-up. The results suggest that mild depression tends to dissipate over time without psychotherapeutic treatment. While the results fail to provide support for either the "topdog-underdog" dialogues or affect expression as treatment approaches for depressed individuals, several factors, discussed by the author, appear to limit the degree to which findings can be generalized.