Intrinsic and Extrinsic Skills in Mental Health Clinicians

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Early in my career as a psychotherapist, I was laser focused on acquiring as much psychological knowledge as possible. Studying theories and data and learning a variety of different skills and prescribed interventions, I felt the more I “knew” the more competent I would feel and the more impactful a therapist I would be. But it didn’t always work out that way.

Through gaining direct clinical experience as a therapist and witnessing others as a clinical supervisor, I’ve come to appreciate how external knowledge and skills become most useful when they are filtered through one’s intrinsic skills and unique nature — namely, our personal history and the social, emotional, and cultural dimensions that have shaped us.

Understanding the Difference Between Extrinsic and Intrinsic Skills

Extrinsic skills can be described as anything external we take in and absorb. This can include different theories and therapeutic models of treatment, interventions, assessment tools, documentation guidelines, and treatment planning, as well as observable behaviors and interactions occurring in the therapeutic encounter with our clients.

Intrinsic skills include the therapist’s personality, personal history, cultural and racial background, spirituality, thoughts, feelings, associations, memories, impulses, values, and inherent creative and unique nature. It can also include one’s doubts, fears, insecurities, history of trauma, and the level of awareness a therapist has with their internal process.

Learning to be aware of, manage, and respond appropriately to our internal dynamic process is a vital component of any continued training, growth, and evolutionary process. It is especially important when working as a mental health clinician.

Supporting the Synergy of the Extrinsic and Intrinsic Skills

It is the way one’s intrinsic nature digests, distills and makes sense of all of the extrinsic knowledge, techniques, and skills — as well as input from their client — that guides the therapeutic process, giving it life, direction, and efficacy.

Another way to think about this synergy is that it is the way the hardware of who we are runs the software of what we take in.

While focusing on the software by increasing one’s knowledge base and skill set pertaining to different theories and models of practice is always a good idea, I have come to hold in higher value the process of focusing on our intrinsic nature and supporting synergy. I do this with the clinicians I have the honor to support, and I offer the following suggestions for how you can do it too:

1. Work with a supervisor or a peer supervision group: It is important to find a supervisor or a peer consultation group that you trust and feel safe with and who can challenge you when needed. As with clients, we also depend on a trusting other for our continued growth and to be able to synthesize our knowledge, develop our unique wisdom, and provide a powerful bridge between our hardware and software.
2. Embrace your vulnerability: Learn to lean in to it and listen with compassion to challenging emotions, thoughts, doubts, and behaviors as they appear in the therapeutic process. Our most important growing and learning experiences can be from bringing those dark, shameful, and guilt-inducing thoughts to light. Developing vulnerability allows for the integration of different skill sets and helps us to avoid the urge to react without awareness and intention.
3. Develop an awareness of the various psychosocial and environmental elements that form your unique identity. Social positioning, gender identity, spiritual beliefs, socioeconomic status, significant and transformative moments, life events, family/cultural history, and transgenerational and/or racial trauma all form the basis of our identity. Being able to hold your identity with acceptance and compassion will allow you to hold your clients' identity with the same compassion, sensitivity and care. Using the diversity wheel or genogram can be a helpful method to assist with this task (please see references).
4. Nurture yourself and care for your needs. Caring for your medical and mental health, your spiritual, social, educational, physical, and financial needs while learning how to pace yourself and balance your work is an ongoing lifelong process. Identifying what type of clients and issues you enjoy working with, and setting limits with yourself if you’re approaching the emotional threshold of what you can give, is essential. Caring for others entails first and foremost caring for ourselves.
5. Develop awareness of what brings you joy and meaning in the way that you practice psychotherapy, and use that as a guide for how you want to practice and develop as a mental health clinician. I would refer to this as your practice orientation. For example, some therapists may derive joy from a more somatic approach to care, while others may connect more with a cognitive, psychodynamic, or an eclectic approach. One orientation is not better or worse than the other. The key is discovering, connecting to, accepting, and embracing the orientation for which you feel most joy, meaning, and authenticity.
6. Choose models and interventions that nurture your orientation style and provide support for how you are practicing psychotherapy. When learning a new model, please ask yourself: how does this model or intervention support my orientation? What do I like about this model/intervention? Is there anything I would change/tweak to make it fit my orientation (without jeopardizing the integrity of the model/intervention)? Is there anything about this intervention and/or model which I struggle with?
7. Provide your clients with a therapeutic container. Providing space for your clients to explore, cultivate, and strengthen their access to, acceptance of, and power of their innate nature is the hallmark of this work. We can sometimes struggle with knowing when to speak up and insert information and when to sit by and allow things to emerge. As a therapist, before talking you can use the acronym WAIT, which stands for Why Am I Talking? Am I saying something because I genuinely believe that this can be helpful for the client, or because I am struggling with sitting in this space. Being directive can have its place, but clients also have a natural inborn inner healing wisdom, and allowing it to emerge requires patience, empathy, acceptance and trust in the ability for the client to use the container in the way that is helpful for them.
8. Develop the ability to think eclectically and creatively by integrating and synthesizing various models and interventions. Thinking eclectically does not mean that we have to give up on our preferred approach or model of care, but it does help us to be creative and open up more ways to engage and support our client.
9. Expand your “toolkit.” As noted throughout this article, increasing our awareness of and exposure to different models of care is important for our growth, for honing our unique voice as mental health clinicians, and for increasing our ability to respond effectively to the needs of the clients we meet.

One of the beautiful aspects of this field and vocation as a mental health clinician is the unlimited potential for growth and evolution. Extrinsic and intrinsic skills are both essential for the therapeutic process. It is important that as clinicians we focus on how to nurture each of those skills while also developing our ability to integrate and synthesize those skills so they work in a growth-promoting way for us and our clients.