Both clinician and patient consciously and unconsciously seek stabilization. When either becomes momentarily unmoored from preferred versions of self experience, the clinician can use her case formulation as a psychic tranquilizer against incoherence and dissonance. If the clinician holds her formulation as a parameter that will and should frustrate, she may still rely on concepts to orient her but is perhaps more willing to allow them to be dismantled by what is actually happening in the clinical dyad. In this talk, we will explore ways that Vajrayana Buddhism’s understanding of the dialectic between form and emptiness may shed light on case formulation. Within Vajrayana, emptiness points to the absence, in the self and all phenomenon, of inherent, uncaused existence. This tradition provides forms that invite a visceral experience of emptiness and radically challenge a preoccupation with labeling, mastery, and coherence. We will suggest some implications of this understanding of the self- as well as the meditative practices intended to reveal its nature- for case formulation.