Comprehensive Treatment of Stalking Victims

Education

Patients benefit from education about stalking. It helps them understand the fear and humiliation they often feel and to realize that stalking is, indeed, a crime.^14,15 This labeling and education serves to validate the victim’s feelings, reduce self-doubt, and helps to mobilize him or her into taking action. Learning about the pathology of offenders may help victims realize that the stalking is not their fault. It focuses the attention on the criminal behavior of the stalker rather than the “bad choices” of the victim.

It is also helpful for victims to understand that, as ex-partners, it is common for them to feel ambivalent toward their stalker. Such ambivalence can affect their behavior and confuse others, including those in law enforcement. Helping the patient understand that ambivalent feelings and actions toward the stalker are normal may reduce self-blame and help her stay in therapy. Likewise, assisting a patient to understand that feelings of helplessness are natural reactions to the persistence of the stalker and to the frequent problems in enlisting the support of others helps dissolve feelings of ineffectiveness.¹⁵

Psychotherapy

Supportive therapy can increase a victim’s self-esteem and sense of control by helping her assert herself with the stalker and the authorities, as needed. Despite any ambivalent feelings she may have, she must understand the importance of sending clear messages to the stalker. It is essential that the therapist avoid giving the message that the victim has created the problem herself or the patient may feel revictimized.^14,15

Even if a woman has a history that results in her being vulnerable to choosing or remaining with an abusive partner, she must realize that she is not to blame for the stalking and does not deserve to be abused. Therapists should focus on the current stressors: delving too quickly into a woman’s history of poor choices may merely reinforce her self-blame and sense of worthlessness. Cognitive-behavioral therapy can help victims deal with their feelings of extreme vulnerability.¹⁴ Because many victims avoid reminders of their stalking, exposure therapy with relaxation training may treat avoidance symptoms.

In addition to obtaining collateral information, involving relatives and new partners in the process should be encouraged. Family members benefit from some support, as well as from education about stalking and its impact, and a discussion about safety issues and the harm that may come from blaming the victim.

Knowledge of community resources is essential in case the victim needs a referral to supports such as groups for stalking victims, victim advocates, or shelters. These resources help victims learn coping and safety strategies while validating feelings and reducing their sense of isolation. Online sources of information and support such as the Web site www.stalkinghelp.org can be helpful.

Therapists need to help victims deal with depression, anxiety, fear, shame, and guilt. Occasional use of medication may provide some relief, improve patient functioning, and increase the benefits of individual or group therapy by relieving severe anxiety symptoms. Both SSRIs and tricyclic antidepressants have been reported to be helpful in alleviating symptoms of posttraumatic stress disorder, as well as depression and insomnia.^16-18 Occasional use of benzodiazepines may also relieve anxiety symptoms and insomnia. Keep in mind the potential for the development of substance abuse with these agents.

Countertransference

Therapists who treat stalking victims need to be aware of countertransference.¹⁵ The therapist may share the victim’s feelings of helplessness and hopelessness, which may interfere with empowering the victim and helping her regain a sense of control. Therapists may hesitate to treat a stalking victim, fearing for their own safety and what might happen to their patient. Having taken on the case, anxiety and ambivalence may interfere with the therapist’s work.

If patients are physically or sexually assaulted by their stalker, therapists may experience grief, guilt, self-doubt, anger, and powerlessness. Over-identification generates feelings of anger on the part of the therapist that are overwhelming for the victim. Therapists must avoid becoming judgmental and impatient with patients who continue to try to reason with their stalker. A female therapist may also defend against anxiety stemming from her own sense of vulnerability by unconsciously blaming the female patient with whom she has identified or by focusing on early developmental issues. Male therapists may experience different feelings, including identification with perceived feelings of rejected love in the stalker, thereby unconsciously diminishing the patient’s anger and increasing her guilt.

Practical approaches

It is important that the therapist help the victim address practical matters and issues of safety while, at the same time, discouraging the stalking behavior if at all possible. The stalker should be told once, in clear and unequivocal terms, that his behavior is unacceptable. Beyond this, advise the victim to avoid any contact with the stalker and not respond to him at all. Returning letters or replying to unwanted e-mail with a short angry response maintains some sort of relationship and therefore, only reinforces the unwanted behavior.^6,19

Rather than changing phone numbers, victims should acquire an answering machine to record messages from the stalker while getting a new unlisted number for family and friends. The answering machine captures evidence of contact and threats from the stalker on the old number without having to reinforce the behavior by answering the phone.⁶ Because the ringing of a telephone often becomes a trigger for anxiety symptoms, this approach may also prevent the development of phobic symptoms related to the phone.

Victims should keep all evidence such as letters, emails, answering machine recordings, and photos of destroyed property. Even when there is no concrete evidence, victims should document the details of all incidents and unwanted intrusions, recording dates, times, and what was said or threatened by the stalker. The police should be informed as soon as possible about the harassment. Early intervention by the police (ie, speaking to the stalker) may send a clear message that the behavior is not acceptable. This may stop the behavior before it becomes entrenched.

If available, a “Threat Assessment Unit” within the police department can evaluate the specific stalking situation and make recommendations. The value of a restraining order is controversial and may depend on the particular case, but many believe that they are generally ineffective and cannot be enforced.^6,20,21 Patients can get information about their region’s stalking laws from resources such as legal aid and victim support organizations.

Friends, family, and neighbors should be informed so that they can warn the victim if they see the stalker. Alerting security and colleagues at the workplace can prevent unwanted contact and preclude them from inadvertently disclosing personal information to the stalker.

Victims should avoid fixed routines and keep addresses private. They can consult with a security company to evaluate the security of their homes. Victims should also consider taking self-defense classes.

Summary

Severe emotional, social, and occupational consequences are associated with the ongoing pursuit and harassment experienced by stalking victims. Therapists must provide a supportive and empathic environment, avoid revictimizing the patient, and be aware of countertransference reactions that can potentially interfere with therapy. Stalking victims need education, counseling, possible medications, and an understanding of practical safety issues.