O R I G I N A L P A P E R‘‘It just crept in’’ The Digital.docx

O R I G I N A L P A P E R
‘‘It just crept in’’: The Digital Age and Implications for Social
Work Practice
Faye Mishna • Marion Bogo • Jennifer Root •
Jami-Leigh Sawyer • Mona Khoury-Kassabri
Published online: 11 February 2012
� Springer Science+Business Media, LLC 2012
Abstract Today’s generation of youth and adults relies
on communication technologies for entertainment, infor-
mation, and social connections and more and more, for
personal help and advice. With cyber technology having
permeated the ways in which individuals seek support for a
wide range of issues, the purpose of this paper is to report
on a study that examined practitioners’ experiences and
views of whether and how online communication has
entered their face-to-face practice and of the implication
for the therapeutic work. Using qualitative methodology,

15 social work practitioners participated in focus groups
and interviews exploring their perspectives about the
impact of cyber technology on their traditional face-to-face
social work practice. The prevailing finding was that cyber
communication has dramatically changed the nature of
professional relationships. This key finding was supported
by four major inter-related themes arising from the data:
(1) client driven practice; (2) Pandora’s box; (3) ethical
grey zone; and (4) permeable boundaries. Implications for
practice are provided.
Keywords Cyber technology in therapy � Cyber
communication in traditional social work � Cyber
technology and ethics � Online technology and social work
practice
Introduction
Long before the rise of the Internet generation, Marshall
McLuhan (1964) asserted, ‘‘the medium is the message.’’
This prophetic and timeless statement is particularly rele-
vant in today’s society, in which online technology shapes

how individuals communicate. Communication technology
is growing exponentially with each successive generation
as a central fixture within our society and has radically
changed individuals’ social interactions, learning strate-
gies, and choice of entertainment. In response to this dra-
matic growth of electronic communication and information
sharing, practitioners have offered treatment through com-
munication technology since the 1990s (Huang and Alessi
1996; Murphy and Mitchell 1998; Smith and Reynolds
2002) and, more than ever, offer interventions online.
Several benefits have been identified including greater
flexibility and accessibility (Chester and Glass 2006;
Glasgeen and Campbell 2009).
Today’s generation of both youth and adults relies on
communication technologies for entertainment, informa-
tion, and social connections and more and more, for per-
sonal help and advice. Indeed, cyber technology has
permeated the ways through which individuals seek sup-

port for a wide range of issues. The purpose of this paper is
to report on a study that examined practitioners’ experi-
ences and views of whether and how online communica-
tion has entered their face-to-face practice and of the
implication for the therapeutic work.
The Internet, specifically social networking sites are
widely used by youth and adults alike. Approximately three
quarters (77%) of adults in the United States use the
Internet (Pew Internet & American Life Project 2009) and
similarly, about 72% of Canadians used the Internet in
2007 (Middleton et al. 2010). Ninety-eight percent of
F. Mishna (&) � M. Bogo � J. Root � J.-L. Sawyer
Factor-Inwentash Faculty of Social Work, 246 Bloor Street
West, Toronto, ON M5S 1V4, Canada
e-mail: [email protected]
M. Khoury-Kassabri
Paul Baerwald School of Social Work and Social Welfare,
The Hebrew University of Jerusalem, Mount Scopus,
91905 Jerusalem, Israel

123
Clin Soc Work J (2012) 40:277–286
DOI 10.1007/s10615-012-0383-4
Canadian youth access the Internet and communication
technologies daily (Cassidy et al. 2009; Mishna et al.
2010), and 95% of American youth between 12 and
17 years go online, 80% of whom use social media sites
such as Facebook, Myspace and Twitter, often on a daily
basis (Lenhart et al. 2011). Three quarters of American
youth own a cell phone, and 88% text message (Lenhart
et al. 2010). The use of social networking sites in particular
is increasing throughout the US, Canada, and internation-
ally, and has become one of the most popular activities
among college students (Jones and Fox 2009; Rideout et al.
2010). Sites such as Facebook and MySpace report an
estimated 970 million and 41 million unique visitors
worldwide respectively (Google 2011a, b). Twitter has also

become a significant contributor to social networking with
an estimated 160 million unique visitors (Google 2011c).
Online interventions are typically offered on a one-to-
one basis through modalities such as email or instant
messaging (Barak et al. 2009). Online counseling requires
guidelines regarding matters such as the frequency of
giving feedback and the immediacy of responding (Barak
et al. 2009). Similar to traditional therapy, setting guide-
lines is imperative for maintaining a positive professional
relationship and avoiding abuse of the modality (Kraus
2004).
The rapid increase in the use of communication tech-
nologies presents unique complexities for social work
practitioners. In addition to providing a forum through
which practitioners can more easily distribute information,
network with others, and communicate with colleagues
(Lehavot et al. 2010), cyber communication allows clients
to access and communicate with practitioners with a

newfound ease, regardless of whether the practitioner
provides the client with their contact information. The use
of social networking sites and Search Engines such as
Google gives clients access to personal information about
the practitioner that they would not otherwise share
(Gabbard et al. 2011; Lehavot et al. 2010).
Unlike cyber counseling, for which guidelines and rules
are established and for which online communication is the
primary and perhaps only mode of therapy, instances now
arise whereby social work practitioners and clients interact
through cyber communication, although their primary
focus is face-to-face counseling. Such cyber communica-
tion can range from practical purposes such as rescheduling
appointments to intense therapeutic discussions for exam-
ple a client communicating online to the practitioner about
feeling suicidal. Although this cyber communication may
not be a planned component of the intervention, it never-
theless becomes part of the therapeutic exchange and is

therefore important to understand and address (Gabbard
et al. 2011). According to recent research findings, many
counselors struggle to sort out the meaning of email
communication with clients in their face-to-face counseling
(Bradley and Hendricks 2009). Bradley and Hendricks
(2009) differentiate email communication related to the
counseling from online communication that is chiefly
administrative or practical.
There is a growing body of research on online coun-
seling. While early research critiqued online therapeutic
practice as ‘‘the space between the two parties becomes
filled with hardware’’ (Robson and Robson 1998, p. 40)
recent studies have found a positive working alliance, with
online working alliance scores equivalent to those reported
for face-to-face counseling (Cook and Doyle 2002; Hanley
2009; King et al. 2006; Prado and Meyer 2004; Reese et al.
2002).
There has been a significant increase in the use of cyber

communication among a number of professions even when
cyber communication is not the primary mode of treatment,
thereby creating issues for practitioners (Bradley et al.
2011). There is a dearth of research however, on online
communication such as texting or email entering or
‘‘creeping’’ into traditional face-to-face social work clinical
practice, along with the implications of such permeation
for practice and policy. A survey of social workers was
conducted in the US (Finn 2006), about their views of
using email and issues that arose in using email with cli-
ents. Findings revealed that very few social workers (3.7%)
used email frequently in communicating with clients
whereas almost one third (31.7%) reported communicating
with clients at least once through email. Over half of the
participants believed that email communication should be
limited to practical and administrative use. Given the dra-
matic growth in the use of online communication (Bradley
et al. 2011) there is reason to believe that these numbers

have significantly increased.
Online communication has transformed and challenged
the ways service users and care providers connect and the
way service providers conduct their work with clients
(Midkiff and Joseph Wyatt 2008; Rafferty and Steyaert
2009; Whitaker et al. 2010). A study by Santhiveeran
(2009) evaluating compliance with the National Associa-
tion of Social Workers (NASW) Code of Ethics regarding
e-therapy websites revealed a lack of compliance with
respect to maintaining professional boundaries as a result
of the online communication. Indeed, in response to the
prevalence of communication technology within social
work practice NASW and the American Association of
Social Work Boards set guidelines regarding the use of
current and future technologies (NASW/ASWB 2005;
Rafferty and Steyaert 2009).
Although there is a growing body of research on online
therapy, there is little research that studies the phenomenon

of cyber technologies entering or ‘‘creeping’’ into tradi-
tional face-to-face social work practice. The research
278 Clin Soc Work J (2012) 40:277–286
123
studying email communication within treatment typically
examines such communication that occurs in therapeutic
practice in which the email interchange has been negotiated
as part of the process and for which there are guidelines.
For example, one study examined an Internet based self-
help program for clients with social phobia, in which the
therapist sent emails to supplement the cyber therapy
(Carlbring et al. 2006). Another study compared an email
based intervention to a manual based smoking cessation
program for college students, in order to examine the
effectiveness of counsellor emails as a smoking cessation
strategy (Abroms et al. 2009). Findings revealed that the
participants responded positively to counsellor emails as

they felt they benefited from the counsellor’s support and
encouragement through the email exchange.
With a somewhat different focus, Lehavot et al. (2010)
conducted a study to examine how the Internet intrudes
upon professional relationships between psychologists-in-
training and their clients. The focus was the counsellors’
use of the Internet, for example social networking sites, to
post personal information, which could be accessed by
clients. Findings revealed that 81% of the psychology
graduate students used a social networking site (e.g.,
Facebook). While most utilized security measures to limit
access to their personal information, a surprising number of
the students (21%) did not make use of security measures.
These findings highlight the new era in which communi-
cation technologies enable clients to have access to their
counsellors and information about their counsellors which
was not previously accessible.
The purpose of the current study was to better under-

stand cyber communications ‘‘creeping’’ into clinical
practice, by obtaining the perspectives of social work
practitioners whose primary mode of therapy is traditional
face-to-face counseling, in social service agencies or pri-
vate practice in a major Canadian metropolitan area. The
aims were to understand the nature and scope of online
communication between clinicians and clients, and to
explore the clinical, practical, ethical and legal issues that
arise. Findings will inform the development of professional
capacity and expertise related to cyber communication and
implications for face-to-face practice.
Method
This study employed an inductive qualitative design
(Merriam 2002) utilizing focus group data gathered in
2010, to identify social work practice and policy needs
related to the presence of technology in social work prac-
tice. The primary research questions guiding this study
were: (1) how do practitioners use technology to interact

with clients? and (2) what are the clinical, practical, ethical,
and legal issues associated with the use (or not) of cyber
communication in practice? To develop a conceptual
understanding of the research problem, this study utilized
inductive techniques consistent with the constant compar-
ison method (Strauss and Corbin 1998) in order to examine
the deeper, subjective meanings and experiences of par-
ticipants. Differing from deductive methods, inductive
approaches to research focus on modifying emerging
concepts and tracking the relationship between concepts
throughout the process of conducting research. Through
this process, and the analysis of group level data, uni-
versal statements can be drawn together representing
new knowledge about the research topic. A secondary
framework, emergent-systematic focus group design
(Onwuegbuzie et al. 2009), was adopted to: (1) comple-
ment theoretical sampling; (2) simultaneously collect and
analyze focus group data; and (3) assist with determining

data saturation. This framework allowed the researchers to
determine whether themes emerging in one focus group
also emerged in other groups. This resulted in examining
themes across groups, rather than individual focus group,
thereby producing richer group-level data. Ethics approval
was obtained from the University of Toronto Research
Ethics Board prior to data collection.
Sample
Fifteen social workers participated in the study. In addition
to providing signed informed consent, the participants were
required to meet the following inclusion criteria: (1) pos-
sess a Bachelor of Social Work or Master of Social Work
degree; (2) registration with the local regulatory body for
social workers; (3) current employment in a practice setting
that involves working directly with agency clients or in
private practice; and (4) reside in the local area.
Recruitment
Several approaches to purposive sampling included

agency-based sampling, targeted e-mail recruitment, and
snowball sampling (Patton 1990). Participants were
recruited through e-mail advertisements sent through the
professional association to the approximately 700 local
members, and to the school’s partner agencies, alumni
association, and faculty listserve. The e-mail advertise-
ments included an information sheet/consent form detailing
the study and advised interested individuals to contact a
member of the research team. Participants were not reim-
bursed monetarily for their participation. Individual inter-
views were held with two participants who could not attend
scheduled focus groups. Another 10 individuals volun-
teered but due to schedules and despite numerous efforts to
Clin Soc Work J (2012) 40:277–286 279
123
include them in a focus group or interview they were not
able to participate.

Participants
Of the 15 social workers who took part in the study, 13
were female and 2 were male and ranged in age from mid
30s to late 50s. All participants held MSW degrees, and
one had a PhD. All were practicing social workers, mostly
in social service agencies. A significant percentage had a
small part-time private practice and a very small minority
was solely in private practice. The participants represented
diverse fields of practice, including health, mental health,
education, and child and family service sectors. Years of
experience ranged from 5 to over 20 years, with more than
half of the participants (56%) reporting more than 20 years
of social work experience.
Data Collection and Analysis
Through individual in-depth interviews (n = 2) and focus
groups (3 groups; n = 13) a range of clinical, practical, ethi-
cal, and legal issues, arising as a result of cyber communica-
tion between social work practitioners and clients, was

explored. Participants were asked about: (1) their experiences
communicating with clients electronically; (2) how they
conceptualize cyber communication; (3) issues (clinical,
practical, legal, ethical) arising as a result of the cyber com-
munication with clients; (4) practitioners’ reactions and
responses to issues (clinical, practical, legal, ethical) identified
in the literature; and (5) needs regarding professional devel-
opment related to cyber communication. The co-principal
investigators facilitated the 1.5 to 2 hours focus groups and in-
depth interviews, which took place at the university.
Focus group and key informant interviews were digitally
recorded and data transcribed verbatim. MAXQDA 10.0, a
qualitative software program, was used to organize and sort
the data including memos and field notes collected by the
research team. In keeping with the constant comparison
method, line-by-line open coding was used during the
inductive phases of data analysis. In an effort to remain as
close to the data as possible, the co-principal investigators

and a trained doctoral student met monthly to refine initial
codes, clarify emerging themes, and discuss the findings.
Inductive analysis involved describing and linking patterns
within the data, based on initial codes, to identify emerging
themes. Consistent and contradictory themes were identi-
fied and compared across each focus group and the inter-
views. During the more deductive phases of data analysis,
consistent with focused and axial coding methods respec-
tively, major conceptual themes were identified. Selected
quotations from the interviews are used to illustrate key
thematic findings from the study.
Findings
The participants indicated that cyber communication with
their clients occurred approximately weekly and that cli-
ents were more likely to initiate e-mail contact (50% vs.
38%). The prevailing finding was that technology and
cyber communication has dramatically impacted traditional
social work practice in clinical, practical, ethical, and legal

ways. As one participant remarked, ‘‘it is kind of a given
that it’s [e-mailing] part of the world. It’s not realistic for a
practitioner, an agency, or anybody to say we’re not going
to do it [e-mail].’’ Communication via e-mail, text mes-
sage, and other forms of cyber-based communication
‘‘creeps’’ into traditional face-to-face social work practice.
The respondents all considered the utilization of cyber
communication for general administrative purposes as
practical, efficient and as good practice. The key finding
was supported by four major inter-related themes arising
from the data: (1) client driven practice; (2) Pandora’s box;
(3) ethical grey zone; and (4) permeable boundaries.
Client Driven Practice
Many respondents explained that their clients initiated
cyber communication more often, more purposefully, and
more persistently than the social workers. Practitioners
described scenarios in which this ‘‘creep’’ occurred, which
they related to factors such as client age, preference and

perceived advantages and challenges related to cyber
communication.
Client Age
Several respondents reported that especially for youth,
technology is the preferred means of communication and
naturally crept into their work: ‘‘They’re used to the fast
pace, immediate responses—texting!’’ One respondent who
did not use e-mail with clients stated, ‘‘I know my col-
leagues e-mail and text with clients in high school. In my
private practice, younger clients are much more assuming
that we’ll set something up by e-mail. It just has to do with
age.’’ Another explained that an adolescent client ‘‘had
never texted me before but he had my number and I had
his. He’s a kid right? He knows that it’s my cell phone so
he texted me. He had been struggling with depression and
then sent a text talking about wanting to kill himself.’’
Client Preference
Several respondents referred to the practice principle ‘‘start

where the client is at’’ as a reason to accept client-initiated
usage of technology. As one participant explained, ‘‘To
make life easier for your client, my belief honestly is we
280 Clin Soc Work J (2012) 40:277–286
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need to go where our clients are and we have to go where
technology and communication is. I mean the world has
evolved. We have these wonderful modes of communica-
tion available and so for there to be new policies to really
grasp this and embrace this I think is important.’’ Another
respondent said, ‘‘I think most people choose e-mail
because it’s not quite as nerve-wracking. They don’t have
to speak to me right away so they seem to always choose
e-mail if they have e-mail.’’
Complements Traditional Face-to-Face Practice
According to a number of the participants, client-initiated
e-mail or text communication was a potential complement to

traditional face-to-face practice, especially for clients with
difficulty expressing themselves in person. As one practi-
tioner explained, ‘‘there was a student I would see in person
from our School Board who we had some of the most silent
appointments ever with a good 45 min of just me trying to
engage and him not. He would leave and then later that
evening, I would get a two or three-page e-mail about ‘these
are the things that I wanted to talk about.’ So I would keep
them and actually use them for the next face-to-face.’’
Referring to a youth and his father a participant stated,
‘‘where the teen has in-the-moment accessibility around the
texting, I see as a potential breakthrough moment that can
open doors. And the father being able to gradually express
himself in that slightly distant but also intimate way—the
kind of paradoxical thing that electronic communication
provides.’’ Another respondent said, ‘‘The whole act of
pressing ‘send’ for her is so relieving, to know that I’m
going to get this information and to know I now can fill in

the story she wasn’t able to tell me about.’’
Slippery Slope
Client initiated e-mails and texting emerged as creating a
dilemma for the respondents. When receiving what
appeared to be a practical and thus innocuous e-mail, the
respondents replied in kind, only to later often realize they
had unknowingly begun on a ‘‘slippery slope.’’ As one
respondent commented, ‘‘it might start with an e-mail to
change an appointment and then it can shift from that to
e-mails about issues to a crisis, with a client e-mailing a
practitioner saying they’re suicidal. The thing about the
slippery slope is that practitioners often don’t think about
that when it [cyber communication] starts.’’ E-mails can be
sent at any time of the day thereby extending the traditional
boundary imposed by organizations or practitioners. While
believing that replying to client-initiated cyber communi-
cation starts ‘‘innocently’’ practitioners soon recognized
that there are major practice and policy implications of

opening ‘Pandora’s box.’
Pandora’s Box
In contrast to using cyber communication for administra-
tive purposes, which was considered beneficial, incorpo-
rating cyber communication into social work assessment
and intervention was not necessarily seen as beneficial
according to the respondents. Once such communication
begins, it can be difficult to undo or limit. It emerged that
participants were concerned about opening a ‘Pandora’s
Box,’ comprising unexpected consequences of cyber
communication, and the potential for misinterpretation.
There could be positive, negative, or neutral unexpected
consequences of using cyber communication. Positive
unexpected outcomes included greater access for clients with
mobility or hearing challenges, increased connection for
isolated clients, and efficiencies such as quickly connecting
clients to supportive services. The challenging or negative
unexpected consequences related to issues of privacy and

confidentiality for both clients and social workers. Regard-
ing client privacy, one practitioner explained, ‘‘Some par-
ents, especially if they’re an English Language Learner,
don’t do the e-mail functions themselves. They rely on their
kids to do it. So the kids will log on for them and maybe read
the e-mail. I even had a kid who was responding to her mom’s
e-mail pretending she was her mother.’’
Another practitioner illustrated an unexpected negative
consequence related to wide dissemination of dissatisfac-
tion with services, reporting that ‘‘[a client] started a blog
about us and about how horrible we had treated him. This
is 4 years later and he still blogs about [the agency] reg-
ularly.’’ While previously, upset clients could also express
their dissatisfaction publicly (e.g., letters to the editor) it is
now dramatically easier to widely circulate such com-
plaints for example on a blogs, which then become per-
manent as they cannot be removed.
The respondents expressed a predominant concern about

clients misinterpreting their cyber communication, and
especially about the effect on the relationship. They were
concerned that due to factors such as the lack of non-verbal
cues clients might misinterpret a lack of timely response as
uncaring. One respondent explained, ‘‘I don’t have e-mail at
work so she was sending them to me during the day and I
couldn’t respond. Then she said ‘you’re not responding,
you’re not responding,’ that kind of thing.’’ Similarly,
another respondent said, ‘‘there was one time that I didn’t
respond right away [to e-mail]. She knows that I also get busy
and she knows the boundaries and all that but she had a very
difficult week because I hadn’t responded right away.’’
Ethical Grey Zone
Participants referred to the murky waters regarding the
ethical implications and possible dilemmas, created by
Clin Soc Work J (2012) 40:277–286 281
123

cyber communication in traditional social work practice. A
prime concern was not being able to ensure client (or
practitioner) privacy or confidentiality, along with the
associated liabilities. This finding stretched across domains
including client confidentiality, practitioner privacy/intru-
sion, liability, social networking and agency policy.
Maintaining client confidentiality and privacy was a
major concern in the respondents’ use of cyber communi-
cation. If ensuring or maintaining confidentiality was at all
uncertain, respondents reported feeling uneasy with this
method of communication, regardless of client preference
or perceived administrative or therapeutic benefit. One
respondent’s statement illustrated this concern: ‘‘It’s my
responsibility to protect the confidentiality and the thera-
peutic process but cyber space does not allow me to do
that.’’
Concern about practitioner privacy/intrusion emerged as
a significant theme. E-mail, text messaging, Skype, and

other forms of cyber communication were considered
major contributing factors to the growing perception of
social workers being available at any time of day. Findings
revealed that practitioners want to give clear messages
about their availability, office hours, role and responsibil-
ities, and want to maintain professional boundaries. The
respondents all voiced concern that cyber communication
can undermine these efforts. For example, one stated, ‘‘I let
kids know I won’t answer e-mails 24/7. I check e-mail a lot
but I don’t want to create the kind of open 24/7 because it’s
unrealistic and creates an expectation.’’
The respondents identified as a major theme the issue of
social worker liability due to cyber communication with
clients, referring to any infringement of confidentiality or
unethical practice. Without clear standards of practice
related to cyber communication, uncertainty about how to
best manage the cyber communication was palpable: ‘‘My
concern at this stage is the standards of the College in terms

of confidentiality, disclosure and the whole nine yards, not
only just protecting clients but protecting myself so I’m
careful with it [e-mail].’’
While the ethical implications of incorporating tech-
nology into their practice was consistently questioned in
terms of its impact on client confidentiality, the respon-
dents for the most part considered it important to grapple
with integrating these new forms of communication into
their practice. The use of blogs and social networking sites
however (e.g., Facebook, Twitter) was generally viewed
with more skepticism as a way to communicate with cli-
ents, even after termination. As one respondent stated, ‘‘I
had one young woman ask me to be a friend on Facebook.
I’m not on Facebook but I wondered. I mean we had fin-
ished but some months had gone by so was this her way of
wanting somehow to reconnect? Should I call her and
address it? What is it about when she says do you want to
be a friend on Facebook? I think these issues come up but

it’s not always clear how to respond to them.’’ Not all
participants thought contact with clients through social
networking sites should be controlled by standards of
practice or ethics guidelines. For example, one respondent
said, ‘‘There are already a lot of things regulated in terms
of therapy or counselling relationships. My concern is in
cases like Facebook or an e-mail account, my private life
intersects with my professional life. Facebook is a social
tool and a regulation in terms of how I decide to lead my
social life makes me really anxious.’’
Participants expressed the need for organizational poli-
cies and social work code of ethics regulating professional
behaviour in order to help them sort through the dilemmas
encountered related to cyber communication. At the same
time, respondents were doubtful this was fully possible. It
emerged that organizations vary a great deal regarding
policies related to cyber communication with clients. It
also emerged that workers made decisions about whether to

comply or circumvent agency policy in deciding how to
manage cyber communication. In some instances, practi-
tioners described clear agency policies either supporting or
discouraging the use of e-mail between social workers and
clients. Several participants in contrast, spoke about navi-
gating the use of e-mail in their practice without the benefit
of clear directives or policies. For example, a hospital
social worker indicated ‘‘the bioethics folks came out with
policies that you were only allowed to use client initials
and be careful of content but in fact it [e-mail] was used
much more freely. Once you start using e-mail, it’s kind of
easy to get in the habit, you know?’’ Another participant
described a ‘‘don’t ask, don’t tell’’ atmosphere related to
the use of e-mail: ‘‘they’re [the agency] telling us…’we’re
going to come up with a policy, we’re working on a pol-
icy’…it’s ‘don’t tell’ in a way.’’ Particularly important with
respect to the need for policy was how daunting it felt to
maintain records (e.g., tracking cyber communications, text
messages), without clear guidelines.

Since the relationship is central in social work practice,
the ethics grey zone inevitably intertwines with boundaries.
Permeable Boundaries
Permeable boundaries include behaviours that seemed to
stretch the usual boundaries. According to participants,
there are certain circumstances, behaviors, and requests
related to cyber communications that do not seem to
infringe on professional boundaries, but others that do. For
instance, as described by one respondent, ‘‘there is a kind
of chummy friendliness—so there’s a casualness—that’s a
bit different than in the session. It’s not that the sessions are
so formal but it feels different on e-mail. This person will
sign it, ‘we’ll speak soon’ or ‘how are you doing’? It’s a bit
282 Clin Soc Work J (2012) 40:277–286
123
friendlier so it’s in the direction of boundaries but it
changes or it introduces a new kind of dimension in terms

of how we relate.’’ Another respondent referred to the extra
time and space cyber communication can give clients fol-
lowing face-to-face sessions. This social worker believed
that e-mail let her client share feelings while extending the
session, albeit through a different means: ‘‘She wanted to
give me some feedback after the session, how she felt after
the session and kind of wanted to continue the session a
little bit [via e-mail].’’
According to the respondents, social workers are com-
fortable using e-mail in particular instances. For example,
sharing resources, scheduling appointments, or engaging in
other purely administrative purposes emerged as accept-
able uses of cyber communication and as not challenging
professional boundaries. Respondents were not comfort-
able or convinced however, of the benefit of engaging in
cyber communication in non-administrative ways particu-
larly due to the associated concerns such as boundary
issues. As one respondent stated, ‘‘it wasn’t part of a plan.

They just did it [e-mailed] spontaneously. When I got it, I
felt a little bit like a boundary had been crossed a bit for
me. I didn’t really welcome it.’’ E-mailing resources to
clients seemed to shift client expectations regarding cyber
communication in the therapeutic endeavour.
Managing a client’s infringement with a boundary,
especially when boundaries related to e-mail or texting
haven’t been clearly delineated, presented a considerable
challenge. Social workers are unsure how to re-establish
boundaries when they wish to pull back from the use of
cyber communication. One practitioner expressed dis-
comfort with the client e-mailing her material: ‘‘She’s now
literally this week started sending me these really abusive
letters that her husband’s been e-mailing her so she’s now
sending all this stuff to me. She’s asking me ‘tell me what
you think.’ My fear is, oh my gosh, what do I do?’’ Another
respondent voiced her ambivalence: ‘‘Re-scheduling was
getting quite complex and his comment was ‘e-mail it to

me,’ which I did because he sort of gave me consent but it
was really out of the ordinary and we hadn’t really done
that yet.’’
Cyber communication affects boundaries in practice
with couples and families. Generally, in systems oriented
practice social workers establish clear guidelines that
emphasize the importance of shared communication among
all members of the family and the social worker and the
importance of lack of secrets. Respondents discussed the
various ways they responded to one person’s individual
communication with the worker. Setting and finding
effective ways of maintaining the contract was illustrated
by a respondent who noted that even though she clearly
told the mother of a 17 year old daughter who was the
client that everything the mother sent by e-mail would be
shared with the daughter the mother persisted. When
receiving the e-mails at first the practitioner reiterated her
position, subsequently she only responded with ‘‘thank

you’’ and her contact information, and finally she did not
reply at all. Slowly, the mother stopped e-mailing her.
More complicated, in couple counseling a practitioner
described a husband who did not think his wife’s untidiness
was sufficiently addressed in the sessions. He ‘‘took pic-
tures of the house and he e-mailed that to me. The next
morning I go in and I told her that he had done this. I saw
that as if he wanted to share a secret with me but I had to let
her know. She was very, very uncomfortable with it. She
turned to him and she said, ‘you had no right to do that.’’’
Respondents gave examples in which information
obtained through cyber communication needed to be
shared because of the potential for harm. A respondent
described a father and teenage son dyad where text mes-
sages were used after the son gave permission. ‘‘It’s very
open, even though they don’t communicate that well
together, and they like me to be the bridge.’’ Alarmed late
on a Friday night by the son’s text, the practitioner

responded by text and still concerned, telephoned the cli-
ent. When it appeared the son was having suicidal thoughts
the practitioner said, ‘I need to talk to your dad.’ The dad
was sleeping already and I woke him up and, it started a
whole chain of events, but I don’t know what would have
happened had he not [sent a text] because I don’t think he
would have gone to his dad.’’
Discussion and Implications for Practice
This research represents one of the first studies to examine
the use and implications of cyber communication for tra-
ditional face-to-face social work practice. The over-
whelming finding was that technology and cyber
communication has not only ‘‘crept’’ into traditional social
work practice but indeed, signifies a turning point. Just as
cyber technology has shaped how people of all ages
communicate, it has revolutionized the communication of
practitioners and clients, even those engaged in traditional
face-to-face therapy. Core elements of the work have been

affected: boundaries (time and space); disclosure of infor-
mation (practitioners’ and clients’); therapeutic relation-
ship; ethical and legal issues and dilemmas; and policies
and procedures.
Cyber communication included e-mail, text messages,
and social networking sites. While the majority of
respondents reported typically using cyber communication
for practical purposes such as scheduling, many engaged in
cyber communication for matters relevant to the thera-
peutic work. Several respondents articulated a dilemma
with respect to the utilization of cyber communication in
Clin Soc Work J (2012) 40:277–286 283
123
their social work practice. On the one hand they recognized
the dominance of cyber communication and the need to
respect client preference to incorporate this way of com-
municating. Such recognition represents a central social

work tenet of respecting and starting where the client is
(Bogo 2006). The permeation into the practice of even
those practitioners who offer traditional face-to-face
treatment corresponds with the recent exponential growth
of cyber communication, radically altering social interac-
tions, learning strategies and choice of entertainment. In
particular, there is a rapid rise of social networking due to
the growing access and use of cyber communication tools
such as social media, text messages, e-mail, websites,
instant messaging, webcams and blogs (Hinduja and
Patchin 2009; Palfrey and Gasser 2008; Schrock and Boyd
2008). And, it is expected that the demand for and use of
cyber technology to access service will continue to increase
exponentially (Norcross et al. 2002; Rochlen et al. 2004;
Stamm 1998; Wright 2002).
An unanticipated effect was that in participating in the
focus group or interview, some respondents came to rec-
ognize just how much cyber technology had influenced

their practice. The research process itself thus offered
evidence that the utilization and influence of cyber com-
munication has become so common and entrenched that it
may go unnoticed.
The sheer quantity of information that is publicly
available demonstrates this dramatic shift in the landscape
of therapy. Stressing that information a client obtains on
the Internet is public and is thus his or her due, Gabbard
and colleagues conclude: ‘‘They cannot block certain
aspects of their lives from their patients, and they must
learn to adapt to the new world that cyberspace has cre-
ated’’ (p. 171–172). They contend that psychiatrists who
feel invaded because of such information being accessed
by a patient need to recognize and address their reactions as
countertransference for which supervision, consultation or
even therapy may be required.
There are some guidelines with respect to electronic
communication. The Health Insurance Portability and

Accountability Act (HIPAA), established in the United
States in 1996, ‘‘protects the privacy of individually iden-
tifiable health information’’ (HHS, n.d., ‘‘Health Informa-
tion Privacy,’’ para. 1; HHS 2003), including electronic
health information (HHS, n.d.). The Personal Health
Information Protection Act (PHIPA) first developed in
2004 and last amended in 2010, provides guidelines on
privacy and health information in Canada ‘‘in any medium,
whether in written, printed, photographic or electronic
form or otherwise’’ (Ontario 2010, Definitions section,
‘‘record’’). A primary purpose of this Act was to provide
protection for individuals’ privacy and confidentiality
(Ontario 2010). Nevertheless, the participants in the current
study made no reference to indicate knowledge of macro
policies and reported that within organizations, policies on
cyber communication are unclear, inconsistent, unrealistic,
or nonexistent, a finding that corresponds with literature
identifying a lack of guidelines on managing information

related to the Internet (Finn 2006; Gabbard et al. 2011).
Findings in the current study indicated that when
workers did not agree with an organization’s stance or if
there were no policies or guidelines, they made decisions
on a case-by-case basis which they did not necessarily
disclose to their supervisor or administration. Many of the
practitioners expressed the need for more direction and
policy development about this area. The lack of clarity and
disparity between organization policy and practitioner
behavior is not surprising, as practitioner and client cyber
communication is a relatively new occurrence.
Limitations
This study contains several limitations. Importantly, the
voluntary and self-selected nature of the respondents sug-
gests the need for caution in generalizing the findings to
social work practitioners. Participants with different
experiences may offer other insights and views. A related
limitation is that the sample largely comprised older,

experienced social work practitioners. As the younger
generation, those in 20s, have virtually grown up with
cyber communication as part of their world, their views
may have differed in important ways. In addition, this
study provides practitioners’ perceptions of their experi-
ences, which may differ (e.g., due to memory recall biases)
from their actual experiences. Despite these limitations, the
findings correspond with the literature and provide helpful
insight into the new phenomenon of cyber communication
between social work practitioners and clients.
Implications for Practice
The ascendancy of the new cyber world has significant
implications for practice. Cyber communication is practi-
cally universal among individuals of all ages and therefore
cannot be avoided. It is not feasible to adopt a policy which
prohibits cyber communication with clients. Regardless of
the practitioner’s preference or the organization’s policy,
clients can find and access practitioners—for example clients

might access their e-mail address, can find information about
them through search engines or contact them through social
networking sites. As Gabbard et al. (2011) explain, ‘‘Face-
book users may post photos and ‘tag’ or label another
Facebook user by name without the knowledge or consent of
the individual in the picture. Facebook users may discover
that they are tagged in a professionally unbecoming photo-
graph long after numerous others have seen it’’ (p. 169).
284 Clin Soc Work J (2012) 40:277–286
123
Practitioners and organizations must understand the
issues and implications and be prepared to respond
accordingly. Some age groups, particularly youth, are
highly dependent on communication technology. Children
and youth use technology such as the Internet more than
any other medium, with which to communicate (Kaynay
and Yelsma 2000). Indeed, young people’s use of the

Internet and other cyber communication is preferred over
watching television (Hinduja and Patchin 2009; Kowalski
et al. 2008).
There appears to be an over-arching category or theme,
which entails the changing nature of professionals’ rela-
tionships in the context of cyber communication. A sig-
nificant finding that emerged is that in permeating or
‘‘creeping’’ into social work practice, cyber communication
has extended the boundaries between social worker and
client. This extension is often client initiated, may occur
without the practitioner’s consent, is a slippery slope, and
may be beneficial or challenging, and has clinical, prac-
tical, ethical, and legal implications. Since a central legal
and ethical requirement consists of developing and main-
taining what are considered appropriate professional
boundaries, the impact of the cyber world on therapeutic
relationships must be acknowledge and addressed.
Until the advent of the cyber world, social work practice

was largely conducted in a fairly private manner, con-
trolled to a large degree by the social worker who deter-
mined what information would be communicated, how this
would occur, and with whom. The organization developed
policies for recording and sharing information with others
and the ways social workers and clients communicated
with each other was subject to prevailing ethical and
practice guidelines about consent, confidentiality, and pri-
vacy. In the case of couple and family work most social
workers communicated with all family members, avoided
secrets and alliances, and when there was reason to com-
municate across generation lines advised clients of this in
advance. Certainly the work between the client and prac-
titioner and within the agency was typically shielded from
public view. A striking finding of the current study is that
cyber communication has dislodged these firm expecta-
tions. As a result, clients, individually, and in couple and in
family relationships, reach out to practitioners through a

range of cyber communications and send various material
and information. Even agencies and organizations are
vulnerable. While most of the respondents did not report
having experienced negative consequences, some talked
about highly concerning communication from their clients,
for example the longstanding blog disparaging the work of
an agency. Since blogs do not have privacy settings or
features as do Social Networking Sites, they are particu-
larly easy to access and to distribute widely (Gabbard et al.
2011).
Individual practitioners and the social work profession
as a whole must accept that the choice to allow cyber
technology to infiltrate into traditional therapy is to some
degree out of the hands of practitioners or organizations.
The ubiquitous nature of cyber technology highlights the
inevitability that cyber communication will ‘‘creep’’ into
social work practice regardless of practitioner preference or
agency policy. The responsible position is to examine and

understand the consequences and implications in order to
inform practitioner behaviour.
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Catherine Stone, LCSW
Clinical Director
Branford Counseling Center
1. Focus on the social worker’s educational background and
training.
I went to undergraduate school and received a BA is
Sociology/Anthropology. I then went to graduate school about
8 years after receiving my BA. I received a Master’s degree in
social work with a specialty in clinical work. I have specialized
training and certification in Dialectical Behavioral Therapy,
Trauma Focused CBT, and Sand Tray Therapy. I have a
certificate in supervision and management.
2. Determine whether the social worker is licensed, and find
out about what brought him or her to the field as well as his or
her work history.
I am a licensed clinical social worker and have the title of
LCSW. In college, I was interested in other cultures and
customs. In my junior year, I studied abroad in Thailand where
I learned the language, lived with a Thai family, and then spent

a month in a remote hill tribe village. I loved learning about
the differences and similarities among people and cultures.
After college, I worked at Harvard University doing
administrative work at the East Asian Language Department. I
went on to work at a holistic health center and became licensed
as a massage therapist and energy worker. I loved doing body
work, but wanted to also work with people at the level of
thoughts and feelings. I wanted to better understand how one’s
environment impacted beliefs and overall sense of wellbeing. I
decided to explore social work and went on to receive my
Master’s degree. I completed two internships; one at a
specialized school for children with learning disabilities and
behavioral issues, and the other at a VA Hospital. The VA
placement was very challenging, as I worked on an amputee unit
with mostly WWII veterans who were not so keen on opening up
to a then young female intern. I also helped on the Hospice
unit, which was also very challenging.
My first job out of social work was at a residential treatment
center for adolescent girls in Baltimore. I learned so much in
my 2.5 years there, but the learning curve was steep and there
were so many extraordinary stories of tragedy and triumph. I
went on to work at a community mental health center were a
broadened my scope of practice to include adults. I also worked
for DCF for 2.5 years working at a children’s hospital for
children with mental illness. Currently, I am the clinical
director of an outpatient treatment center. I do about 85%
administration and about 15% direct care. I like the
administrative part of my work, and the supervision of other
clinicians and interns.
3. Inquire about the social worker’s job activities,
professional roles, and target client group, as well as services
provided by his or her organization.
Branford Counseling Center is a community mental health
center that has been providing outpatient mental health
treatment for over 40 years. We have a number of licensed
clinicians and psychiatrists. We provide individual, couples,

and group therapy to Branford residents from the age of 4 years
old and up. Our psychiatrists complete evaluations and provide
medication management to children, adolescents, and adults. In
terms of my job, I am the clinical director and assistant director
of our agency. I provide supervision to the majority of clinical
staff. I meet with my supervisees weekly to review cases,
discuss treatment interventions, provide support, and address
administrative issues as they arise. We have also just
implemented an electronic medical record and I have played a
large role in providing training in the new system. I assist the
Executive Director in planning, organizing, and initiating
comprehensive counseling and social service programs. This
includes developing and implementing mental health services in
the community of Branford.
4. Determine the social worker’s professional work
preferences (e.g., group, individual).
I like to work with clients individually. I especially like
working with folks with anxiety and trauma.
5. Ask about professional development and the social
worker’s strategies for self-care.
As part of my licensing requirements, I must complete 15
continuing education credits yearly. So, I am frequently
attending trainings and seminars. My profession requires that I
continue to learn and grow as a therapist. In terms of self-care,
I take advantage of my vacation time and try hard to not work
over my 40 hour a week schedule. I have clear professional
boundaries, which I believe benefits my clients and me. I take
recreational classes and seek out my own therapy when and if
needed.

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