The courage to be by Paul Tillich is explored with a special emphasis on its dialectical ontology and the account of neurotic character and existential courage informed by it. Then, in turn, two more contemporary and more specifically clinical and secular approaches: dialectical behavior therapy (DBT) of Linehan and radically open dialectical behavior therapy (RO-DBT) of Lynch are analyzed in terms of the dialectical framework they employ to explain both the issues pertinent to personality psychopathology and the remedies required to alleviate them. As soon as the dialectical character of these approaches is elucidated, the ideas of radical acceptance (Linehan) and radical openness (Lynch) are brought to the fore and compared in light of different spiritual perspectives lying behind them: Zen Buddhism and contemplative Christianity for the former and Malâmati Sufism for the latter. Finally, some concluding remarks are made to emphasize the parallel conceptual structures existing in Tillich, Linehan, and Lynch and to make clinical, including nosological, sense of non-trivial differences between DBT and RO-DBT.

A significant number of people diagnosed with BPD experience emptiness. Service-users report that feelings of emptiness are intolerable, terrifying, and debilitating, and research shows that it is contributory to self-harming and suicidal behaviors including completion of suicide. Yet this criterion seems to be the least investigated of any of the nine criteria. This chapter examines what ‘emptiness’ is and whether current research reflects necessary and sufficient conditions for the concept. I describe prevailing thinking on the development of BPD and emptiness. The chapter then turns to experiences of emptiness that are found in other diagnoses, everyday life, and cross-culturally. I suggest that not all experiences of emptiness are signs of pathology. The second half of the chapter focuses on treatment possibilities, focusing on people diagnosed with BPD. I set out the main ideas in Dialectical Behavioral Therapy (DBT) and then work with one of the core methods in DBT for skill-building—mindfulness—to argue that some service-users may benefit from practicing Buddhist meditation. I conclude by discussing and responding to critics of such a position, after which I emphasize that Buddhist meditation is not for everyone and is only one option for treatment of feelings of emptiness.