Social workers in mental health face a complex climate where they encounter value-laden intervention choices daily. Examples of these choices may include deciding to initiate treatment in spite of a client's wishes to the contrary, making a decision to break confidentiality, feeling pressured to diagnose a client with a reimbursable condition despite a treatment philosophy that may be to the contrary, or feeling the need to “pick and choose” therapy topics in light of severe shortages in benefit coverage. These and other scenarios put social work clinicians at risk for professional dissonance or what has been called a feeling of discomfort arising from the conflict between professional values and expected or required job tasks. The current article explores professional dissonance as a pertinent concept for social work in general, and mental health social work in particular. The theory base of the concept is explored as well as its utility for understanding burn-out in a deeper way.