Assessment. risk management, and treatment
Assessment and risk management is an ongoing process, because specific risk factors and motivations for stalking often change over time.20,21 The treating clinician may wish to refer the suspected stalker to a forensic psychiatrist or another mental health professional with expertise in stalking to assist in the formulation of a risk management plan and periodic reassessment of potential risk.20,22 An evaluator may also speak with collateral sources; review available treatment and police records; and collaborate with law enforcement personnel, attorneys, and victim advocates to help establish, implement, and enforce effective strategies to minimize risk.22,23
It is important for the evaluator to use a nonjudgmental, empathic interactional style throughout the assessment and treatment process. Aside from its therapeutic value, this approach increases the likelihood of gaining insight into the stalker’s motivations, objectives, core values, and pathological defense mechanisms.22 The evaluator should investigate the nature, extent, and duration of the current (as well as any previous) stalking behavior. This includes ascertaining the types and number of stalking behaviors exhibited; level of physical approach behavior; history and nature of threats; time devoted to stalking behaviors; escalation of behavior over time; consequences experienced by the stalker; and willingness to die to accomplish his goals.23
Similarly, the evaluator should inquire about the victim’s characteristics and interactions with the stalker; harm caused to the victim; and legal measures taken against the stalker.21 Equally important is the need to review the stalker’s current support system, strengths, and protective factors; previous relationships; past reactions to limit-setting; history of menacing, violence, abuse, and criminality; and tendency to act on threats.23 In addition, the standard components involved in violence risk assessment (eg, ownership of weapons, formulation of a plan, access to the victim, prior violence, use of substances, failure to recognize or consider alternatives, and magnitude and imminence of potential harm) need to be explored.23 Identifying the stalker’s subtype and obtaining psychological testing can also help elucidate motivating factors, personality style, risk for harm to the victim, and amenability to treatment.21,23 Currently, there are no empirically validated actuarial instruments designed to assess the risk of violence among stalkers.
From a risk management standpoint, the evaluator should document all incidents of stalking, encourage a total ban on contact between stalker and victim, and ensure that the stalker is cognizant of the potential consequences of his actions.21 A specific set of intervention strategies should be developed and modifiable risk factors addressed.21,22 Heightened vigilance is required when events anger or humiliate the stalker.23 Similarly, signs of psychiatric decompensation and/or intensification of stalking behaviors need to be recognized, with consideration given to emergency hospitalization when clinically indicated.22 Likewise, the evaluator should possess sufficient knowledge of his or her state’s duty-to-protect statutes and relevant case law.
To date, there are no reliable outcome studies that address therapeutic interventions for stalkers, for whom treatment is usually court-mandated.21 Identification of the stalker’s hopes and desires may serve as a therapeutic starting point.22 Subsequently, the therapist can use one of many therapeutic options (eg, cognitive-behavioral, supportive, motivational, psychodynamic) to increase the stalker’s awareness of the counterproductive nature of his behavior and the resultant harm to both victim and stalker.21
The therapist might highlight the inordinate amount of time the stalker has devoted to his stalking behavior at the expense of other aspects of his life, the potential criminal sanctions, and the psychological distress incurred by both stalker and victim.22 For some stalkers, providing insight into underlying motivating factors driving the stalking behavior can be helpful.21 Another therapeutic tool involves redirecting the stalker’s preoccupation with the thoughts and feelings of the victim to his own thoughts and feelings (typically involving loneliness and other unpleasant emotions), which can then be explored.22
While it is essential for the treating clinician to exhibit empathy, it is critical to avoid colluding with the stalker’s minimizations, justifications, and self-deceptions.24 Techniques aimed at increasing empathy for the victim (eg, through role-playing or use of victim statements/impact reports) can be used, as can measures aimed at improving social skills.22,24 Modifiable risk factors should always be addressed, and underlying mental illness adequately treated.22,24 The exact techniques and paths of therapeutic intervention will vary based on factors such as the stalker’s subtype and level of social skills and the therapist’s experience with, and preference for, particular treatment modalities.