navigating complexity, building resilience

Middleton Psychology Services, LLC

Approach to Treatment


The Clinicians

We, Drs. Roseanne and Carl Middleton, completed Ph.D.'s in Clinical Psychology at Texas Tech University in 1993, with pre-doctoral internship training at the Institute of Pennsylvania Hospital.  Our education and training emphasized Behavior Therapy, Cognitive Behavioral Therapy, Interpersonal Psychotherapy, Group Therapy, and Psychodynamic Psychotherapy.  We've participated in continuing education workshops and seminars over the years on Psychoactive Substance Use Disorders, Personality Disorders, Suicide Prevention & Intervention, Modified Therapeutic Communities, Eye-movement Desensitization & Reprocessing, Cognitive Processing Therapy, Dialectical Behavior Therapy, EEG Biofeedback, clinical supervision, multicultural issues in treatment, gender identity, Recovery Oriented CBT for Psychosis, correctional psychology, ethics, and others.  We have provided direct services in a variety of settings for over two decades.  


Figuring Out What to Do

We employ a predominantly cognitive-behavioral approach to psychotherapy, beginning with the following areas of exploration: 


  • motivation, 
  • learning/reinforcement history and present maintaining factors, 
  • passions/desires,
  • attributions, 
  • beliefs,
  • intelligence and imagination,
  • cognitive processing ability and style, 
  • cognitive & emotional strengths and weaknesses,
  • relevant contextual schemata (unlike beliefs, these cognitive structures likely operate outside our awareness and may prove difficult to articulate), 
  • relevant medical/physiological factors/overall health,
  • emotional functioning/regulation,
  • personality,
  • interpersonal relationships/social support,
  • ​the apparent function of symptoms within various social systems, and
  • expectation​s


Understanding these characteristics enables the patient and therapist to arrive at a formulation or understanding of how that particular person, the patient, might have developed and continues to experience the difficulties that lead him or her to seek treatment.  Putting the pieces of this investigation together provides a rough initial picture of how the patient operates in the world, as well as likely factors contributing to his or her concerns.  Using this theory as a starting point, the patient and psychologist may develop a road map for treatment (sometimes delineated as a written treatment plan).  


Course of Treatment

The treatment plan can help articulate a therapeutic destination and guide our work toward those goals, but it's a living document, subject to modification as needed.  It is not a prescription.  Psychotherapy differs from visiting a medical doctor.  A psychologist cannot take a few objective measures, like temperature and blood work, recognize a common pathogen and prescribe something to cure it.  Because of the complexity of human beings, we must tailor psychotherapy to the unique characteristics of a particular person. That is, we don't have "one size fits all" treatment.  Over many decades though, courageous patients, brilliant scientists, and astute clinicians have developed a wide and deep array of treatment interventions for personal growth and for addressing mental health concerns.  So, we have many psychological "tools" in the shed.  The psychologist knows many of the tools and has experience with when, where, and how to use them.  The patient knows him- or herself better than anyone else.  Through the therapeutic alliance, the patient and psychologist figure out what tools to try and how to use them.  So, psychotherapy requires the patient’s active, honest, willing involvement with courageous effort to identify, understand, and modify or manage problematic thoughts, perceptions, beliefs, attributions, feelings, and behaviors; otherwise, who knows what tools we need, because we're going in blind or with the wrong information.  Many of the patient's ways of being and perceiving have been active a long time and he or she may not even be aware of them, much less identify them as a source of concern.  This is where the psychologist helps.  She or he brings education and experience in recognizing patterns of thinking, feeling, and behaving; understanding complex motivation; facilitating the process of human change; and deftly helping people gain insight, manage symptoms, improve relationships, strengthen resilience, and develop empathy.  Nevertheless, we don't lightly say it takes “courageous effort" on the part of the psychotherapy participant.  Challenging long held views, beliefs, and ways of being in the world can sometimes take a person into unsettling, personally uncharted psycho-social territory. For many of us, this is not an easy thing to do since we often continue thinking, feeling, and behaving the same way because at some time in our life it worked or served some important function for us.  We became who we are for good reasons, but often, we stay that way simply out of habit. Fortunately, if we're not happy in life, psychotherapy provides a social laboratory where we can gently explore our ways of being and safely experiment with new approaches to thinking, feeling, and interacting.  And as a bonus, psychotherapy patients often find In addition to modifying habits to address a specific concern, psychotherapy leads to unanticipated benefits in other areas of live, like health, well-being, relationships, happiness, and success at work.

Therapeutic Setting

As clinical psychologists, we work to establish and maintain an emotionally and physically safe space for patients to share emotional, behavioral, and interpersonal concerns.  We carefully protect our objectivity as therapists by avoiding dual-relationships; otherwise, the interpersonal needs/wants/motivations of the therapist become entangled with those of the patient. Psychotherapy works, in part, because of an objectivity inherently absent in our other relationships, such as those with friends, family, or coworkers.  Outside of psychotherapy, relationships include mutual expectations of one another and some kind of emotional or behavioral exchange; that is, there’s something we need or want from the others in our lives and something that others want or need from us.  With our friends, it’s generally warmth and respect; with family members, it’s love and fulfillment of parent, child, sibling, or spousal role responsibilities; with neighbors, it’s cordiality and clear boundaries; with co-workers or teammates, it’s saying and doing what’s necessary to achieve a common group goal; with clergy, it’s a moral imperative. In each of these types of relationships, people work to maintain a mutually beneficial balance--even though it may be unhealthy in some cases--so, we censor our interactions to maintain cordiality, to facilitate the likelihood of sex, to avoid rejection, to work together congenially, to make a good impression, or to unintentionally maintain a less healthy situation (as with an identified patient in a dysfunctional family). Psychotherapy works best when our therapist needs nothing from us other than full participation in the treatment process and prompt payment for services. At MPS, we work to protect the therapeutic relationship through the establishment of clear expectations and interpersonal boundaries. In this way, psychotherapy becomes a special place for us to talk in a special way to a special person who can help with our most intimate concerns

Is Psychotherapy for Me?

If considering psychotherapy, we might ask:  can I use some help to enrich my life, get along better with others, become happier, feel better, achieve greater success in life, or might there be skills or practices that would help me better manage my concerns?  If so, psychotherapy can help.  Likewise, one might ask are my habits, my way of being in the world, satisfying, fulfilling, and meaningful to me (essentially, is this how I want to be)?  If not, then (2) what would I change if I could? and (3) what will it be like if I make these changes?  As a corollary of question (3), consider how the important people in my life will respond if this change happens.  We do not exist in isolation, but within a number of interpersonal contexts (e.g., family, family of origin, work).  People sometimes expect us to stay the same because we serve some function or role in their lives and when we change, it means they have to change too (i.e., they must adjust to accommodate the disruption in their respective social world when we stop serving a particular function or filling some role for them).  Both within ourselves and socially, it's like we have psychological gyroscopes that work to keep us on an established course (typically set in place through the experiences of our formative years).  This is a good thing if we're heading where we want to go; but if we want to change course, it helps to anticipate the corrective responses we may encounter from others in our lives. However we are at a particular time, we initially became that way for good reasons; for example, it helped us accommodate to our world at the time.  Our world, though, may have changed over time such that how we are doesn't work so well anymore.  Psychotherapy helps here.  Again, psychotherapy participants may face some push-back from people in their lives. Generally, though, the healthy people in our lives appreciate when we make healthy changes in our own lives.  And, therapists can help with some strategies that might ease the adjustment of others to the changes we're making. Of course, there can be no promises that psychotherapy will benefit you or any other specific person; we are too complicated for guarantees of success.