Causal reasoning skills training for mental health practitioners: Promoting sound clinical judgment in evidence-based practice

Recent calls to action for competency-based training, evaluation, and credentialing of mental health professionals focus heavily on instilling the knowledge and skills needed for performing evidence-based assessment and treatment. We propose the content of a companion training curriculum in clinical decision-making that reflects the pervasive and indispensible role of causal reasoning in clinical practice. Contents of the proposed curriculum include review and discussion of the following areas: (a) domains in which practitioners are routinely required to make and evaluate causal inferences; (b) definitions of key concepts related to causality and errors in causal reasoning; (c) guidelines for evaluating the internal and external validity of findings in empirical studies; (d) guidelines for formulating and evaluating working theories of the origin and/or maintenance of client presenting problems; and (e) methods for planning, targeting, and evaluating interventions. This curriculum is designed to help mental health practitioners use causal modeling to enhance case conceptualization, develop intervention objectives, and prioritize and target foci of interventions that use evidence-based treatments or practice elements. Practitioners who use causal modeling to guide clinical practice are, in effect, deliberately generating causal hypotheses, implementing causal experiments, and evaluating outcomes as they monitor client response to intervention. Causal reasoning competencies may be enhanced through application of causal modeling diagrams to clinical case examples. Development and implementation of a causal reasoning curriculum will provide a basis for "value-added" research regarding its benefit to practitioners in terms of enhanced clinical competencies, decisions, and improved client outcomes.