Most people believe the spiritual life and journey to be a stress protector and a health enhancer, as witnessed by the many recent books and articles heralding the health advantages of participation in religious activities and spiritual practices. In other words, the spiritual journey is considered a safe path. Actually, the spiritual journey involves a number of dangers and risks. One of these is a sense of exaggerated self-importance or ego-inflation, particularly the belief that one is holier and better than others. But there are a number of spiritual crises and spiritual emergencies that can be experienced on the spiritual journey, and clinicians are faced with the prospects of differentiating these from major psychopathology. Furthermore, when individuals seek psychotherapy, their spiritual and religious issues predictably reflect their unique personality dynamics. This chapter describes the DSM-IV-TR diagnostic category relevant to religious and spiritual problems, as well as details the most common spiritual crises and spiritual emergencies noted in psychotherapy clients. It then describes the importance of differential diagnosis and provides useful criteria for differentiating spiritual crises and emergencies from severe psychopathology. Finally, it discusses the unique religious and spiritual dynamics and issues operative in individuals seeking psychotherapy and counseling.