Although precise laboratory methods for measuring psychopathology are not available, interviewer-rated instruments developed to assess symptomatology can be used to monitor schizophrenic patients undergoing rehabilitation. By regularly assessing patients, rehabilitation staff can improve the effectiveness of their interventions. Patients can be screened for high levels of symptomatology which might preclude assignment to rehabilitation programs with high levels of social stimulation. Monitoring the prodromal symptoms of relapse can sometimes prevent florid relapses and sustain a rehabilitative trajectory. Standardized instruments for measuring positive symptoms (e.g., hallucinations, delusions, and conceptual disorganization) and negative symptoms (e.g., affective blunting, amotivation, and asociality) are available. Monitoring target symptoms may be particularly cost effective in the rehabilitation milieu. Use of suggested operational criteria for defining clinical states such as relapse would improve outcome studies on rehabilitation interventions.

It is clear from polls of the general public that religion and spirituality are important in most people's lives. In addition, the spiritual and religious landscape is becoming increasingly diverse, with nearly a fifth of people unaffiliated with a religion, and increasing numbers of people identifying themselves as spiritual, but not religious. Religion and spirituality have been empirically linked to a number of psychological health and well-being outcomes, and there is evidence that clients would prefer to have their spirituality and religion addressed in psychotherapy. However, most often, religious and spiritual issues are not discussed in psychotherapy, nor are they included in assessment or treatment planning. The field of psychology has already included religion and spirituality in most definitions of multiculturalism and requires training in multicultural competence, but most psychotherapists receive little or no training in religious and spiritual issues, in part because no agreed-on set of spiritual competencies or training guidelines exist. In response to this need, we have developed a proposed set of spiritual and religious competencies for psychologists based on (1) a comprehensive literature review, (2) a focus group with scholars and clinicians, and (3) an online survey of 184 scholars and clinicians experienced in the integration of spiritual and religious beliefs and practices and psychology. Survey participants offered suggestions on wording for each item, and a subset of 105 licensed psychotherapists proficient in the intersection of spirituality/religion and psychology rated clarity and relative importance of each item as a basic spiritual and religious competency. The result is a set of 16 basic spiritual and religious competencies (attitudes, knowledge, and skills) that we propose all licensed psychologists should demonstrate in the domain of spiritual and religious beliefs and practices.

In this prospective, longitudinal study, 11 recent-onset schizophrenic outpatients who met criteria for psychotic relapse or significant psychotic exacerbation during a 1-year period of standardized maintenance medication, and 19 patients who did not relapse during this follow-up period, were interviewed monthly regarding life events. As hypothesized, for relapsing patients, a significantly higher number of independent life events (those not the result of symptomatology or personal influence) occurred in the month preceding relapse. This increase was apparent relative to either the analogous month of a "nonrelapse" period in the same patient or the average number of independent events per month during a 1-year standardized medication period for nonrelapsing patients. The methodological advances of this design as well as the consistency of these findings with those of previous retrospective studies supports the hypothesis that life events may sometimes "trigger" schizophrenic episodes.

Religious or Spiritual Problem is a new diagnostic category (Code V62.89) in the 1994 Diagnostic and Statistical Manual of Mental Disorders. Although the acceptance of this new category was based on a proposal documenting the extensive literature on the frequent occurrence of religious and spiritual issues in clinical practice, the impetus for the proposal came from transpersonal clinicians whose initial focus was on spiritual emergencies-forms of distress associated with spiritual practices and experiences. The proposal grew out of the work of the Spiritual Emergence Network to increase the competence of mental health professionals in sensitivity to such spiritual issues. This article describes the rationale for this new category, the history of the proposal, transpersonal perspectives on spiritual emergency, types of religious and spiritual problems, differential diagnostic issues, psychotherapeutic approaches, and the likely increase in number of persons seeking therapy for spiritual problems. It also presents the preliminary findings from a database of religious and spiritual problems.

Religion and spirituality are important aspects of human diversity that should receive adequate attention in cultural competence training for psychologists. Furthermore, spiritual and religious beliefs and practices are relevant to psychological and emotional well-being, and clinicians who are trained to sensitively address these domains in their clinical practice should be more effective. Our research team previously published a set of 16 religious and spiritual competencies based on a combination of focus group and survey research with the intent that they could be used to guide training. In the present study, we conducted a survey to determine whether these competencies would be acceptable to a broader population of practicing clinicians. Results indicate a large degree of support for the proposed competencies. Between 73.0 and 94.1% of respondents agreed that psychologists should receive training and demonstrate competence in each of the 16 areas. The majority (52.2%-80.7%) indicated that they had received little or no training, and between 29.7% and 58.6% had received no training at all, in these competencies. We conclude with recommendations for integrating these religious and spiritual competencies more fully into clinical training and practice.