The purpose of this qualitative study was to explore how clinical social workers think about and work with two distinct worldviews: the diagnostic perspective of the DSM focusing on the internal psyche, and the person-in-environment perspective focusing on the individual in context. A purposive sample of 30 clinical social workers, recruited from chapters of two professional organizations, took part in individual interviews during October-December 2010. Follow-up interviews with 10 participants in January 2011 served as a member check; an additional peer review was conducted with a second group of clinicians. Interviews were coded using hyperRESEARCH and analyzed thematically. Findings indicate that clinical social workers utilize the two perspectives interactively and holistically, with the role of the DSM moderated by severity of the disorder and practice setting. Ethical choices and dilemmas emerged as a central principle to organize participants' experience, which they viewed as a dance, balancing act, or "tightrope."
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