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Behavioral Sciences and the Law

Behav. Sci. Law (2011)

Published online in Wiley Online Library

(wileyonlinelibrary.com) DOI: 10.1002/bsl.980

Management and Treatment of Stalkers:

Problems, Options, and Solutions

Rachel D. MacKenzie, D.Psych.

and

David V. James, M.A., M.B.B.S.

Legal sanctions alone are often ineffective in preventing stalking because, in the absence

of treatment, the fundamental problems driving the stalker remain unresolved. Crim-

inal justice interventions can be problematic because of difﬁculties in framing anti-

stalking legislation and inconsistencies in their application. Civil remedies in the form

of restraining orders may be ineffective or counterproductive. Treatment of stalkers

involves pharmacotherapy when mental illness is present, but the mainstays of treat-

ment for non-psychotic stalkers are programmes of psychological intervention. These

depend on accurate assessment of the risks inherent in stalking and on the identiﬁcation

of psychological deﬁcits, needs, and responsivity factors speciﬁc to the individual.

Treatment can then be tailored to suit the stalker, thereby enhancing therapeutic

efﬁcacy. Developing a framework for identifying the risk factors and shaping the

delivery of treatment is crucial. Two service innovations developed speciﬁcally to work

with stalkers are presented as options to overcome current management deﬁciencies.

2011 John Wiley & Sons, Ltd.

Stalking is a problematic and damaging behavior which affects at least 8% of women

and 2% of men at some stage of their lives (Tjaden & Thoennes, 1998) with some

estimates being considerably higher (Dressing, Kuehner & Gass, 2005; Purcell, Pathe

& Mullen, 2002). The harm that it causes has been increasingly recognized in Western

countries over the past 20 years, amongst the public and in legal and clinical circles.

This has been reﬂected in increased media attention, the spread of anti-stalking

legislation and the expansion of dedicated research, and in the increasing number of

stalkers coming before the courts or being recognized by mental health professionals

(Mullen, Pathe & Purcell, 2009).

Stalking is a complex, heterogeneous phenomenon that varies in form, motivation,

impact and in characteristics of the perpetrator (Davis & Chipman, 2001; Mullen

et al 2009; Pinals, 2007). Options for dealing with stalking, other than victims

undertaking self-protection measures (Pathe, 2002), generally comprise police action,

criminal prosecution, civil legal action and/or medical intervention with the stalker.

Legal sanctions alone may be effective in bringing some stalkers permanently to

abandon their quest, but such interventions often fail because the fundamental

problems driving the stalking behavior remain unresolved. To ignore the underlying

Correspondence to: Rachel D. MacKenzie, D.Psych., Senior Clinical Psychologist, Problem Behaviours

Programme, Paul Mullen Centre, 505 Hoddle St, Clifton Hill 3068, Australia.

E-mail: [email protected]

Consultant Forensic Psychiatrist, Fixated Threat Assessment Centre, London, U.K.

2011 John Wiley & Sons, Ltd.

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R. D. MacKenzie and D. V. James

psychological or psychiatric factors that led to the intrusive behavior is unwise, as it may

place the same or other victims at risk of harm in the future and frequently results in

unwell stalkers receiving inappropriate sentences and failing to receive treatment.

There are undoubtedly cases in which the only effective way of bringing a halt to the

harassment is to incarcerate the perpetrator. However, this usually provides only

temporary relief for the victim as, in most jurisdictions, this form of offense typically

results in relatively brief periods of imprisonment. This leaves the victim dreading

a resumption of the harassment when their tormentor is released back into the

community. Such a fear is often warranted, as few stalkers receive any treatment whilst

in custody which might lead them to desist from stalking. This is generally due to a lack

of resources or professionals speciﬁcally trained in assessing the risks inherent in the

stalking situation and delivering the necessary interventions. These problems are not

unique to the custodial setting. Those who have been recognized as stalkers, but remain

in the community either uncharged for the offense or on bail awaiting the court hearing,

rarely undergo specialist assessment or commence treatment. The potential impact of

such omissions is exempliﬁed by cases in which victims have been killed by their stalkers

as they waited for the criminal justice system to deal with their cases: well-publicized

examples from the U.K. include Clare Bernal (Laville, 2007) and, from the US, Peggy

Klinke and Jennifer Paulson (Logan et al., 2006, p.1–2; Murphy, 2010). In these

instances, the stalkers also died, either by their own hand or shot by police. Fortunately,

fatal outcomes are rare in stalking situations (Mullen et al., 2009). But this offers little

comfort to those victims for whom the fear of violence is a genuine concern or who have

to cope with the psychological, occupational, ﬁnancial, and social sequelae of continued

harassment.

Whilst the failure to provide specialist services for stalkers usually arises from

ﬁnancial restrictions that lower its priority in already pressured services, it is our

contention that this is a false economy which ignores the full costs of persistent and

recurrent stalking. Even if one takes a purely pragmatic approach, the expense for

governments and the community runs into many millions of dollars in terms of police

resources, repeated court proceedings, the expense of housing prisoners and/or

patients, as well as a reduction in productivity in the workplace for both victims and

perpetrators due to a failure to concentrate on their duties or to taking time off as sick

leave or to attend to legal matters.

The purpose of this article is to explore the deﬁcits that often exist in the management

of stalkers and to offer suggestions as to how these shortfalls may be corrected. This

involves consideration of current practice in the legal, medical, and psychological

management of stalkers, as well as suggestions as to possible treatment strategies and

service innovations.

LEGAL MANAGEMENT OF STALKERS

Most stalkers initially come to attention as a consequence of the victim seeking advice

and protection from the authorities. As the ﬁrst point of contact, it is the police

who investigate and reach an initial evaluation as to whether the behavior constitutes

a criminal offense in the jurisdiction in question; and it is the police, in conjunction

with the prosecuting agencies, who decide upon the appropriate form of judicial

action. Stalking is, however, such a complex phenomenon, incorporating a wide range

2011 John Wiley & Sons, Ltd.

Behav. Sci. Law (2011)

DOI: 10.1002/bsl

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Management and treatment of stalkers

of behaviors that vary in intensity and severity, that it has proved a difﬁcult task for

legislators to deﬁne and codify stalking behaviors into legislation that will protect society

without being overly proscriptive (McEwan, Mullen, & MacKenzie, 2007; Sheridan,

Blaauw, & Davies, 2003). The advances in anti-stalking legislation over the last two

decades have certainly improved the protection available to victims. Nevertheless, the

value of any law depends upon how it is applied. For the police, interpreting the law can

be problematic in terms of determining the point at which patterns of behavior cross the

legal threshold and become a criminal offence. Such difﬁculties have been apparent in

the Australian state of Victoria, where the stalking legislation lists speciﬁc prohibited

acts engaged in as a ‘‘course of conduct’’, but does not deﬁne what needs to happen for

such acts to constitute a course (Victorian Crimes Act, 1958, Section 21A). At times,

this ambiguity has led to inconsistencies in how the law is applied, with some stalkers

avoiding prosecution despite protracted harassment of the victim and others being

charged for what can only be described as the most banal forms of behavior. One

such extreme case is demonstrated by a man who was charged and convicted of

stalking following the end of a ﬂirtatious text message relationship. After the ‘‘victim’’

sent a message saying she did not want him to contact her again, he sent two text

messages. The ﬁrst stated ‘‘you’re joking’’ and when he did not receive a reply, he sent

another text in which he accused her profanely of leading him on. Although the message

was undeniably offensive, it could not be construed as threatening and he did not

attempt to contact her again. Despite having no criminal history, he received a six-

month prison sentence, suspended for two years. His behavior technically met the

criteria for the offense of stalking in Victoria. However, it is not only the severity of the

sentence which might be questioned, but also the fact that he was charged with stalking

in the ﬁrst place.

When the victim can produce evidence of repeated explicit threats or overt acts of

aggression, it might be thought that the situation would be relatively straightforward.

Yet, in a signiﬁcant minority of cases, the police are still reluctant to become involved.

Repeated intrusive behaviors of a more bizarre or surreptitious nature may be deemed

innocuous gestures of affection, with the complainant eliciting dismissive, trivializing,

or insensitive responses. Such instances may arise from a failure to understand the

seriousness of the situation or the applicability of the law, or simply from an inefﬁcient

handling of the case (Baum, Catalano, & Rand, 2009; Pathe, 2002). As an example, in

one case, a police ofﬁcer attending the home of the victim of an erotomanic neighbour

kissed the victim as he departed, stating that if the stalker was watching, this might put

him off. This was not only inappropriate and a form of abuse in itself, but the ofﬁcer’s

apparently well-intentioned act potentially increased the risk of harm to the victim. The

tendency to underestimate potential harm to the victim is more pronounced when the

victim is a man being pursued by a female stalker (Abrams & Robinson, 1998; Pathe &

Mullen, 1997). Whilst anecdotal evidence and victim studies suggest that women are

less likely to be prosecuted for stalking, research has shown that female stalkers do often

engage in threatening and violent behavior (Hall, 1998; Meloy & Boyd, 2003; Purcell,

Pathe & Mullen, 2001). The failure to appreciate the risks posed by different types of

stalkers, whether male or female, can have serious consequences for all involved.

The police often suggest that the victim obtain a restraining or intervention order

(IVO) as the ﬁrst method of combating the intrusive behavior. Yet, the wisdom of

seeking this as a

carte blanche

solution to all stalking cases is questionable, given the

abundant examples in the literature of IVOs not only failing to protect the victim but,

2011 John Wiley & Sons, Ltd.

Behav. Sci. Law (2011)

DOI: 10.1002/bsl

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R. D. MacKenzie and D. V. James

in some cases, exacerbating the stalking behavior (Benitez, McNiel, & Binder, 2010;

MacKenzie, Mullen & Ogloff, 2006; Montesino, 1993; Pathe, 2002). The conﬁdence

in the protection afforded by these orders may be further diminished by a reluctance of

police to react to reported episodes of continuing stalking and breaches of orders

(Baum, Catalano, & Rand, 2009; Pathe, MacKenzie, & Mullen, 2004). IVOs can be

effective in bringing an end to harassment in suitably chosen cases (Meloy, Cowett,

Parker, Hoﬂand & Friedland, 1997), but in some situations they become ‘‘paper

shields’’ that provide a false sense of security, especially when they are not enforced.

The facts of each stalking situation and the characteristics of the individual stalker

should be given careful consideration before adopting this method of management. The

victim should also be made aware that it is not a substitute for adopting measures for

personal protection. It is important that all breaches of the order are reported, acted

upon and the matter taken before the courts.

Most courts are in a position to order mental health assessments, but the stage of

proceedings at which the court can exercise this power varies between jurisdictions.

Some jurisdictions allow the courts to call on the expertise of mental health

professionals as a condition of bail, but in many, the earliest point for such examinations

concerns the assessment of the defendant’s mental state for possible mental impairment

or in relation to competence/ﬁtness to plea (Mossman, 1998). As this is rarely

applicable to stalking cases, the forensic clinician’s involvement usually concerns

assisting the court with sentencing decisions or recommending interventions as a

condition of parole or a correctional order. Most frequently this will occur in situations

where the stalker is known to suffer from a serious psychiatric disorder or the stalker’s

behavior is so bizarre that the court suspects the presence of mental illness or is simply

bewildered that someone could act in the manner concerned. However, research

suggests that the courts often fail to refer stalkers for assessment even when they suffer

from severe mental illnesses (MacKenzie, Mullen, & Ogloff, 2006). It is unclear

whether this arises from a failure of the court to recognize the severity of the stalker’s

condition or a failure to recognize its importance in terms of initiating or sustaining the

stalking behavior. It has been suggested that mental health provisions should be

included in all anti-stalking legislation (Mullen et al., 2009) and even that all stalkers

should undergo mental health evaluations (Stocker & Nielssen, 2000). The large

number of stalkers coming before the civil or criminal courts would probably render

the latter suggestion impracticable. The question also arises as to whether there would

be sufﬁcient numbers of appropriately trained clinicians to provide expert reports on

stalkers to the courts.

In stalking cases that do reach court, the difﬁculties for the victim do not necessarily

end there. As Pathe, MacKenzie, and Mullen (2004) have highlighted, the legal system

can often be used or abused as a means of stalking by proxy. Court directives for the

victim to appear as a witness or attempt conciliation through mediation can result in the

legal process facilitating the stalker’s access to the victim. All too often, victims who

have escaped their stalkers by changing residence have had their new location revealed

to their pursuer in legal documents. Whether this occurs inadvertently or as a matter of

legal procedure, for the beleaguered victim it means their efforts at self-protection have

been in vain. The lengths to which the stalker will go is exempliﬁed in a recent case from

our practice in which the accused stalker entered a not guilty plea and forfeited legal

representation in anticipation that he would be able both to talk to the victim through

questioning her in court, and to gain full access to the legal documentation containing

2011 John Wiley & Sons, Ltd.

Behav. Sci. Law (2011)

DOI: 10.1002/bsl

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Management and treatment of stalkers

her new address. In the event, the court was sensitive to the victim’s plight and

instructed that any evidence given would be via video link from an undisclosed location

with the screen turned away from the stalker. It was also ensured that any information

that might disclose the victim’s whereabouts was removed from all material supplied to

the stalker. With these measures in place, the stalker changed his plea and the need for

the victim to give evidence was therefore avoided.

Given the problems that arise in applying anti-stalking laws, it is clearly naıve to

regard legal provisions as a panacea for dealing with all stalking cases, whilst ignoring

the psychiatric and psychological factors underpinning the behavior (Goode, 1995;

Mullen, MacKenzie, Ogloff et al., 2006). Indeed, it is of considerable importance that

police, prosecution lawyers and judges become more aware of the dangers and

complexities of stalking in terms of differences in motivation and the different domains

of risk and potential harm that stalking entails. Research from Europe has illustrated

wide variations in attitudes and understanding of stalking in frontline police (Modena

Group on Stalking, 2005; Kamphuis et al., 2005). Police forces in the U.K. are

introducing a checklist for police ofﬁcers of factors associated with the risk of serious

violence (Sheridan & Roberts, 2011); and new guidelines for prosecutors have been

issued by the Crown Prosecution Service, the body in the U.K. responsible for initiating

and conducting criminal prosecutions (Crown Prosecution Service, 2010). The latter

includes some detail of stalker types, with reference to the role of the Fixated Threat

Assessment Centre (James et al., 2010:

vide infra)

and to the Stalking Risk Proﬁle

(MacKenzie et al., 2009), a specialized structured professional judgement tool for the

assessment of all domains of risk in stalking cases.

ASSESSMENT OF STALKERS

It is important that the criminal justice system is able to call upon a pool of psychiatric

and psychological experts to advise on risks and management in stalking cases, both at

the investigation stage and when perpetrators are brought before the courts. It is

generally accepted that, in assessing the risks that a given perpetrator may constitute, an

expert must make use of standardized risk assessment tools to aid in reaching a

judgement. This ensures that the expert has covered all the bases and is making use of

the most up-to-date evidence and clinical practice. In the case of stalking, the issue then

arises as to which tools can be used that are suited to this particular constellation of

behaviors. Given the wide variation in stalking behaviors and underlying motivations, it

is not surprising that standard risk assessment tools prove inadequate when applied to

stalkers, both in terms of accurately assessing the risk of violence and in terms of their

failure to address other domains of stalking risk. For violence is not the only risk that

stalking victims face. Other domains of risk comprise persistence, escalation,

recurrence, and psycho-social damage (MacKenzie et al., 2009), and risk factors for

these domains differ from those for violence and indeed differ from each other. Serious

violence is fortunately uncommon in stalking, but psychological damage is ubiquitous

(Blaauw et al., 2002; Kamphuis & Emmelkamp, 2001; Pathe & Mullen, 1997; Purcell

et al., 2002). The questions that concern stalking victims are as follows. Is it ever going

to stop? Is it going to get worse? If it stops, is it going to come back again? Answers to

these questions are simply not provided by the use of generic assessment instruments

which focus almost exclusively on violence. In addition, risk factors for each domain of

2011 John Wiley & Sons, Ltd.

Behav. Sci. Law (2011)

DOI: 10.1002/bsl

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R. D. MacKenzie and D. V. James

risk vary according to the type of stalker being assessed. To remedy this position, new

tools have been developed, speciﬁcally for assessing risk in stalking situations (see

McEwan et al., (2011) in this volume, for a comprehensive review). Such specialized

risk assessment is a crucial ﬁrst step in dealing with stalkers in that it identiﬁes the factors

that increase the risk posed by that particular individual which can then be used to guide

management plans and serve as targets for intervention. The question next arises as to

precisely how to intervene to manage risks, once they have been identiﬁed.

THERAPEUTIC INTERVENTIONS

It would be a mistake for clinicians to assume that stalking cases are all referred by the

criminal justice system. Stalking is still stalking, even when it has not led to police action

or criminal prosecution. Its harmful effects and the risks it carries remain present. In

countries with comprehensive social care systems, stalking cases may ﬁrst be identiﬁed

by public services, in particular by health services, but also by social and housing

services and by other community organizations or private clinicians. Ideally,

identiﬁcation will lead to referral to a specialist service for assessment and treatment

and, in the case of mental health services, this may involve compulsion. For many

stalkers, compulsion is an essential aspect in allowing treatment to be initiated and, in a

proportion, in allowing it to continue once it has been initiated. The main source of

compulsion, however, still remains criminal sanction – as a bail condition, as part of a

community sentence, or as a condition of parole following a prison sentence.

There are some cases of stalking in which simply educating the perpetrator as to the

illegality of their behavior is sufﬁcient to bring the harassment to an end. However, for

the majority of stalkers, the behavior is underpinned by more serious and pervasive

problems and treatment can be a difﬁcult and challenging endeavor. It is the authors

contention that the provision of optimal interventions requires a multidisciplinary

approach which, at a minimum, encompasses both psychiatric and psychological

components. It is beyond the scope of this article to provide a comprehensive manual

of treatment options (see Mullen et al., 2009; Pinals, 2007). Rather, the authors will

provide here a summary of the extant treatment research, an account of the most

pressing therapeutic concerns, and suggestions as to how many of the existing deﬁcits in

treatment and in overall service provision could be overcome.

CURRENT RESEARCH INTO TREATMENT

It should be stated at the outset that there is a dearth of outcome research on treatment

interventions in stalking. Treatment trials require consideration not only of attitudinal

and behavioral change, but also of recidivism and conviction or reconviction over

a period of follow-up that is measured in years rather than months. The offence

of stalking is relatively new in many jurisdictions, and such trials have yet to be

undertaken.

The only empirical research to date that has investigated the efﬁcacy of treatment was

conducted by Rosenfeld and colleagues (2007). Their study evaluated a six-month

treatment program adapted from dialectical behavior therapy (DBT), a technique

developed by Linehan (1993) for working with people with borderline personality

2011 John Wiley & Sons, Ltd.

Behav. Sci. Law (2011)

DOI: 10.1002/bsl

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Management and treatment of stalkers

disorder. The program focused on the DBT component which addresses the

development of behavioral control. It retained the basic format of DBT with a weekly

one-hour skills group followed by a 45-minute individual session, and between-session

telephone coaching. Of the 29 male stalkers referred, none of the 14 who completed the

treatment engaged in ofﬁcially recorded recidivistic stalking behavior in the 12-month,

post-completion, follow-up period. This was in marked contrast to the 27% of

treatment drop-outs who reoffended. Whilst one cannot dismiss the possibility that

those who dropped out of treatment were those most likely to reoffend, the results do

suggest that DBT may be an approach worth exploring in some stalkers.

There are, however, serious difﬁculties with placing such diverse offenders as stalkers

into group programs. Group therapy is contraindicated in some stalkers, for instance

the overtly aggressive, those with serious mental illness or cognitive impairment, or

individuals with psychopathic or severe narcissistic traits. Group therapy would also be

unsuitable for those individuals who feel resentful and justiﬁed in their pursuit of their

victim and for whom placement in a group with like-minded individuals would provide

an opportunity for reinforcement of their perception of injustice. Such a situation would

be disruptive to group dynamics and limit overall efﬁcacy. Group work is sometimes

seen as a desirable treatment mode for reasons of reduced cost. However, attendance

failures are disruptive to all participants, and may result in important elements of the

treatment being omitted. As regards the DBT model, the wisdom of giving between-

session telephone access to some stalkers is also open to question.

It has been suggested that psychodynamic psychotherapy might have a place in

the treatment of stalking (J. Reid Meloy, personal communication, January 2010). The

efﬁcacy of short- and long-term psychodynamic psychotherapy as treatments for

psychological and emotional problems has recently been supported through meta-

analyses (Leichsenring & Rabung, 2008; Shedler, 2010), although their methodology,

study samples and conclusions have been criticized (Beck & Bhar, 2009; Gerber,

Kocsis, Milrod et al., 2011). Such therapies, whilst they have a considerable number

of advocates, particularly in the U.S.A., are not available everywhere as part of

contemporary mainstream psychiatric practice. At least in our jurisdictions, there

are few correctional settings where such therapies are available, and criminal courts

are generally unsympathetic to psychodynamic psychotherapy as a court-mandated

treatment (Grounds, 1996). The use of the psychodynamic approach as a treatment

in offender populations has been criticized on the basis that many offenders lack

the necessary verbal intelligence and motivation, and that treatment fails to focus on

developing pro-social contingencies (Andrews & Bonta, 2007). Diagnostically, a

substantial proportion of non-ex-intimate stalkers suffer from psychotic disorders

such as schizophrenia, in the treatment of which psychodynamic psychotherapy is

said to have ‘‘no current place’’ (Cunnigham Owens & Johnstone, 2009, p. 583).

Psychodynamic concepts are certainly of use in formulating an understanding of

individual stalking cases, particularly in relation to attachment issues (MacKenzie,

Mullen, Ogloff, McEwan, & James, 2008). But evidence as regards a role for

psychodynamic psychotherapy in the treatment of stalkers is currently lacking.

Although there is little empirical data regarding the treatment of stalkers, research

and clinical experience show us that the factors underlying stalking behaviors

encompass a wide range of psychiatric and psychological issues. These vary between

and within the different stalker motivational types. In consequence, we advocate a

multidisciplinary team approach to the clinical management of stalkers which employs

2011 John Wiley & Sons, Ltd.

Behav. Sci. Law (2011)

DOI: 10.1002/bsl

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R. D. MacKenzie and D. V. James

a range of treatment methods to address the individual’s speciﬁc needs as determined

through assessment (Warren et al. 2005).

PSYCHIATRIC MANAGEMENT

The literature provides strong evidence that mental disorders are common among

stalkers and, as with any group of offenders, the types of disorder vary widely (James &

Farnham, 2003; Kienlen, Birmingham, Solberg, O’Regan, & Meloy, 1997; Meloy,

1996; Meloy & Gothard, 1995; Roberts, 2002). Stalking behaviors may be concurrent

with or driven by serious mental illness. Delusional disorders, schizophrenia, bipolar

affective disorder, and major depression have all been found to occur frequently in

forensic stalker populations (Kienlen et al., 1997; Meloy & Gothard, 1995; Mullen,

Pathe, Purcell, & Stuart, 1999; Roberts, 2002; Schwartz-Watts & Morgan, 1998;

Schwartz-Watts, Morgan, & Barnes, 1997; Zona et al., 1993). Such conditions, when

present, offer an obvious focus for psychiatric intervention. In these cases, the stalking

usually ceases when the disorder has been controlled and the delusional beliefs

regarding the victim abate. The manifestations of some forms of illness may change over

time, (e.g., a manic episode reverting to a period of depression), or spontaneously

resolve (e.g., a substance-induced psychotic illness settling with abstention from the

causative agent). However, in most instances delusional symptoms are likely to persist

unless treated with antipsychotic medications, and pharmacotherapy must be the initial

treatment in such stalkers.

The content of delusions that underlie the harassment of the victim is most

commonly persecutory or erotomanic. Delusions of jealousy – the belief that one’s

spouse or lover is unfaithful – are also relevant in stalking but only after the dissolution

of the original relationship (Mullen, 1990). When these beliefs occur as a part of a

schizophrenic illness, treatment may be relatively straightforward, although some cases

will inevitably be more resistant to treatment than others. Matters are more problematic

when delusions occur in an otherwise organized individual (e.g., in delusional disorder),

who tends to be high-functioning in all areas beyond the delusional belief. The serious

nature of their condition is often missed by the courts and, in some cases, by clinicians

(MacKenzie, Mullen, & Ogloff, 2006). Yet, if left untreated, the delusions (and

therefore the stalking) will persist. Even where a positive result is obtained with the use

of antipsychotics, low-grade residual beliefs may often remain, albeit in a muted form

(Myers & Ruiz, 2004). Given that psychotic stalkers rarely have insight into their illness,

they are unlikely to comply with treatment, and therefore to desist from their intrusive

behavior unless compelled to do so by the courts or through the use of civil mental

health legislation. In such cases, involuntary commitment to a psychiatric hospital may

be necessary in the ﬁrst instance. This usually requires the use of a secure facility. In

addition, detention is almost always necessary for a longer period than is usual in an era

of managed care. Particular problems may arise in this respect with cases of delusional

disorder or organized schizophrenic presentations, as prolonged treatment in hospital in

the absence of behavioral disturbance is unusual outside of forensic psychiatric services.

Consequently, in jurisdictions where forensic hospitals also treat civilly detained

patients, this may prove the best option when in-patient treatment is not mandated by a

court. The potentially serious consequences of the stalker relapsing through non-

compliance determine that depot antipsychotic preparations are the formulation of

2011 John Wiley & Sons, Ltd.

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DOI: 10.1002/bsl

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Management and treatment of stalkers

choice in treating stalkers with psychotic illnesses and that community treatment

orders, where available, should follow on from involuntary commitment. The

therapeutic negativism with which cases of delusional disorder are sometimes met

by clinicians is to be avoided. Early recourse to the use of clozapine in cases of

treatment-resistant psychotic disorder is advisable.

In practice, there are often difﬁculties in obtaining comprehensive treatment for

stalkers who suffer from serious mental illness. The pressures of resource limitations

in many jurisdictions determine that the primary concern of mental health services

becomes the risk of self-harm or the risk of violence to others. It is, of course,

essential that both of these issues are considered with every stalker. Serious violence

is the ultimate fear in many stalking situations, and too often the eventual outcome.

Stalkers appear to be at greater risk of committing suicide than other types of offenders

or general psychiatric populations (McEwan, Mullen, & MacKenzie, 2010), and the

possibility that suicidal ideation may lead to desperate acts such as killing the victim

and/or family members before killing themselves cannot be discounted. However, the

taking of such a restricted perspective results in the other domains of risk inherent in the

stalking situation being given low priority or completely ignored as assessment and

treatment concerns or responsibilities. This does little to alleviate the anxieties of

victims who are left to cope with persistent or recidivistic stalkers and the concomitant

fear and the detrimental personal, social, economic and psychological impacts

associated with the continuing harassment.

Despite these potential difﬁculties in the treatment of psychotic disorders, the

psychotic stalker may be viewed as a straightforward case in which to intervene, in that

services whose purpose is to treat major mental disorder are widely developed. This is in

stark contrast to services available to deal with the majority of stalking cases, in which a

major mental disorder is conspicuously absent and the harassing behavior is

underpinned by psychological factors or dysfunctional personality traits. Many stalkers

have a diagnosable personality disorder, with the most frequent types being the

borderline, the histrionic and the narcissistic (Harmon et al., 1995; Meloy & Gothard,

1995; Mullen et al., 1999; Zona et al., 1993). Antisocial personality disorder has also

been identiﬁed in stalkers, albeit at a lower prevalence than is found in general

populations of incarcerated males (Meloy, 1996: Reavis, Allen, & Meloy, 2008).

Finding appropriate avenues of treatment for stalkers with personality disorders is

challenging as they often require long-term intervention and appropriate treatment

programs are in short supply in the majority of mental health services. A similar problem

arises for those perpetrators whose pursuit of the victim is driven by a paraphilic

disorder (Mullen et al., 2009). Whilst many jurisdictions provide treatment for sex

offenders, these programs are typically conﬁned to the correctional setting. In addition,

they are usually in a generic group format that does not cater for the needs of those who

require tailored individual therapy or who would beneﬁt from treatment with anti-

libidinal medication. Furthermore, there is little on offer for those who experience

deviant fantasies in the absence of a serious mental illness and have not been convicted

of an offense.

As the situation stands in most countries, psychiatric services are poorly equipped to

address the psychological and behavioral factors that underpin stalking, either through

lack of resources or through a lack of expertise or therapeutic conﬁdence. In

consequence, there is often an understandable fear of taking on the responsibility

for treating stalkers beyond pharmacological treatment of psychotic drive. Yet the

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risks to victims and stalkers do not disappear because the treatment role is abdicated.

These gaps in service provision raise important questions as to how and by whom

psychological interventions for stalkers should be conducted.

PSYCHOLOGICAL INTERVENTIONS

Psychological interventions form the mainstay of the treatment of non-psychotic

stalkers, and provide a second stage in the treatment of psychotic stalkers, once their

symptoms have been sufﬁciently stabilized for the therapeutic focus to be moved to

addressing other aspects of the problem behavior.

It is clear from the literature that there is no one ‘‘type’’ of stalker, but rather a variety

of motivations and stalker types (Mullen et al., 2009; Pinals, 2007). However, it is our

experience that stalkers share some common attitudinal states and skills deﬁcits that are

fundamental to the development and perpetuation of stalking behavior. It is these

factors that undermine their ability to adopt more adaptive and appropriate methods of

interpersonal interaction, and it is these factors that need to become the targets for

treatment.

The common dominator in all stalking episodes, no matter what the motivation, is

the stalker’s strong sense of entitlement concerning the victim – the belief that they have

a right to the fulﬁlment of their own desires and that they deserve the victim’s time and

attention in furthering their goals. Some stalkers have the egocentricity and grandiose

sense of self characteristic of the narcissist and psychopath (Storey, Hart, Meloy &

Reavis, 2009). But, in the majority of stalkers, their sense of entitlement is a more

circumscribed trait that only becomes problematic in a particular context. In the

stalking situation, this sense of entitlement generally manifests itself in rationalizations

and justiﬁcations of their behavior. These are based on the belief that they have a

‘‘right’’ to be heard, to receive an explanation, to have their grievance addressed, to

express their love or to be treated with respect. The stalking evolves when their rights

take precedence over all other concerns related to the victim.

In addition to their sense of entitlement, stalkers typically show a marked

indifference to their targets’ desires and fears. In some, this is a conscious disregard

for the victim’s feelings, even pleasure in the victim’s fear and distress. For others, there

is either a lack of comprehension or reckless disregard of the harmful consequences of

their behavior. In some, misconstruing or misrepresenting the victim’s actions may be

based in delusional beliefs, in which overt rejection is interpreted as evidence of

romantic interest. Yet, in other cases, there appears to be a wilful lack of concern for the

victim’s feelings in the absence of obvious psychopathology.

The ﬁnal common element in stalking cases is the presence of skills deﬁcits that lead

the stalker to adopt maladaptive means of pursuing their goals and desires. These deﬁcits

often concern verbal skills, social skills, conﬂict resolution, problem-solving and reason-

ing skills, and problems with emotional regulation. In addition to becoming offense-

speciﬁc treatment targets, these may also serve as particular responsivity issues – factors

that may impede treatment and serve as potential barriers to response to interventions.

Responsivity Factors

In exploring how to increase the efﬁcacy of offender treatment, Andrews and Bonta

(2007) suggested a model based on the individual’s risks, needs and responsivity

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(RNR). They propose that the best outcomes regarding recidivism are achieved when

treatment is delivered to high-risk offenders, addresses speciﬁc criminogenic dynamic

risk factors and uses cognitive behavioral interventions that take the individual’s

personal characteristics into account. These characteristics, which include personal

strengths, learning style, personality and motivation to change, are referred to as

responsivity factors. The core of the RNR model is that an individual’s various strengths

and deﬁcits have a strong bearing on the overall beneﬁts they derive from therapy.

These individual traits are crucial to the efﬁcacy of treatment, as they have the potential

to impact negatively on the course of treatment, or to provide areas of strength on which

to draw to help effect change (Ogloff & Davis, 2005).

Responsivity factors frequently encountered with stalkers include anti-social

attitudes, values, and beliefs; low or inﬂated self-esteem; cognitive rigidity; and

problematic anger. The stalker’s intellectual functioning also warrants attention, as it is

fundamental to the design and delivery of any treatment intervention. Research

suggests that, while most stalkers have average non-verbal intellectual abilities, they

often have relatively poor verbal skills (MacKenzie, James, McEwan, Ogloff, & Mullen,

2010). This not only raises the possibility of receptive or expressive communication skill

deﬁcits, but also highlights potential issues with the manner of treatment delivery. By

understanding the cognitive strengths and weaknesses of the stalker, the clinician will be

in a better position to determine the optimal approach to treatment. Through

identifying responsivity factors, the clinician will be able to maximize the gains that the

individual can achieve from treatment by exploring potential barriers to treatment that

will need to be addressed and tailor the style of therapy to best suit the client.

Readiness to Change

The efﬁcacy of any psychological intervention is reliant on the individual having the

desire to change, as well as willingness and ability to engage. These issues have been

addressed in the Multifactor Offender Readiness Model (MORM) proposed by Ward,

Day, Howells, & Birgden (2004). The MORM is based on the premise that therapeutic

change is enhanced when the offender is ready for treatment. The offender’s ‘readiness’

is determined by individual, program and context factors. (For a full description of the

model see Day, Casey, Ward, Howells & Vess, 2010.) The approach we take in treating

stalkers adopts the fundamental principles proposed in the MORM in that we tailor the

content and delivery of treatment according to the individual’s internal and external

needs, fragility and issues of responsivity as well as their cognitive style and ability. The

context of the treatment (mandated as opposed to voluntary) is also taken into account

with a focus on the development of therapeutic rapport that is conducive to change and

the stalker’s involvement in the establishment of speciﬁc treatment goals. Without these

essential elements, it is unlikely that the stalker will be willing or able to make the

changes necessary to end their pursuit and reduce the risk of recidivism.

A useful framework to assist in considering the stalker’s motivation to change their

behavior and in shaping the delivery of treatment is the transtheoretical model of

intentional behavior change (DiClemente, 2003, 2005; DiClemente & Prochaska,

1998). This model, which is widely used in changing health-related behaviors (Casey,

Day & Howells, 2005), conceives the process of behavioral change as comprising ﬁve

stages with identiﬁable goals that must be attained in order to instigate, consolidate, and

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maintain the desired change: pre-contemplation, contemplation, preparation, action,

and maintenance. The transtheoretical model has been shown to be useful when

incorporated into the treatment of a range of problem behaviors, including sex

offending (e.g., Tierney & McCabe, 2005), addictions (DiClemente, 2003) and

domestic violence (Begun, Shelley, Strodthoff & Short, 2001). The model was

originally developed for addictive or habitual behaviors that usually have a high

observable frequency that enables close monitoring of progress. Given that many

offense behaviors such as violence have a relatively low base rate, the suitability of using

the model for such offending has been questioned, particularly in the custodial setting

where abeyance is enforced and participation in treatment inﬂuences parole decisions

(Casey, Day & Howells, 2005). The issue of determining the efﬁcacy of treatment in the

custodial setting is an important point in terms of stalking treatment overall, and

reinforces the centrality of a community focus for treatment, including supervision and

ongoing treatment post-release for offenders who have been imprisoned and patients

who have been hospitalized.

Whilst adopting elements from various psychological therapies in the treatment of

stalkers, it is useful to utilize the labels of the stages of change from the transtheoretical

model to describe the stalkers’ cognitive readiness to change. The following

demonstrates how we apply this concept. In the ﬁrst stage, pre-contemplation, the

stalker has no intention of changing their behavior, as they do not regard it as

problematic. Increasing the stalker’s awareness of why their action is a problem can

sometimes be achieved through discussing the effect on the victim. Victim impact

statements may assist in imparting this message. Education regarding what constitutes

stalking can be reinforced by working through the relevant legislation with the stalker.

Having the stalker articulate what they hoped to achieve with regard to the victim when

they ﬁrst commenced stalking and then compare this to the actual outcome, in relation

to both their own situation and to the impact on the victim, can be used as a means of

showing stalkers the futility of their endeavor.

The goal of the contemplation stage is to bring stalkers to accept that their behavior is

a problem and to come to the decision that they want to change. Reinforcement of the

personal advantages of ceasing the harassment can be undertaken through cost–beneﬁt

analyses, both for continuing and for stopping the behavior. Prompting may be required

for the stalker fully to appreciate the full costs of persistence, including the

consequences from legal, ﬁnancial, emotional, and time perspectives. Stalkers should

be helped to accept the failure of their pursuit through cognitive reframing, in a manner

which fosters change in the beliefs that maintain the behavior, whilst enabling them to

preserve their dignity. For stalkers who claim success in their goals (particularly when

the intent is creating fear and distress), identifying and emphasizing the personal costs

of continuing in the same manner may be the only means of establishing meaningful

dialogue.

The next stage, preparation, involves the development of plans to change the

behavior. This requires the clinician to describe the issues to be addressed, derived from

the dynamic risk factors identiﬁed in assessment. The clinician must endeavor to frame

these in a positive manner, so that the stalker can see the beneﬁts of each change.

Involving the stalker in the selection of therapeutic targets gives them a sense of

ownership which increases the likelihood of their committing to treatment. The new

behaviors are then put into practice in the action stage. It can often prove difﬁcult for

stalkers to abandon entrenched behaviors and implement change. Encouragement

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through the positive reinforcement of pro-social behavior and the identiﬁcation of

alternative activities to replace the maladaptive behavior can assist the stalker through

this difﬁcult phase. Lapses should be analyzed in an objective and constructive manner

which enables the recognition of trigger factors and facilitates the development of

strategies for avoiding potential high-risk situations.

Success in the maintenance stage requires the identiﬁcation of any current factors

which might impede therapeutic progress and increase the risk of recurrence. The risk

of relapse may be reduced through the joint development of contingency plans to deal

with potentially perilous situations, including the environmental and the social, as well

as with speciﬁc emotional states. Emphasis is placed on the beneﬁts of maintaining

commitment to abstention, with gentle reiteration of the detrimental consequences of

relapse.

The treatment targets are those factors identiﬁed as problems for the individual and

usually require a mixture of therapeutic approaches. After treatment targets are

identiﬁed, they need to be prioritized so that the most pressing issues are addressed. The

methods we advocate are those that have been shown to have empirical validity

including interpersonal, cognitive behavioral, and behavioral therapy techniques, as

well as social cognition theory (the processing of information through the development

of schemas, attributions or stereotypes) and the relapse prevention paradigm. This is

combined with education regarding the methods to overcome their particular deﬁcits,

such as conﬂict resolution, emotional regulation, and social and communication skills.

SERVICE INNOVATIONS

Effective assessment and development of management plans for stalkers requires the

availability of individuals who are trained in determining risk in stalking situations. The

importance of mental illness, psychological problems, and vulnerable personality

factors in initiating and driving stalking behaviors, necessitates the involvement of

mental health professionals, if comprehensive and meaningful assessment is to be

achieved. The difﬁculty with this is that, in the absence of serious mental illness, stalkers

rarely fall within the remit of mental health services. The question then arises as to

possible frameworks in which specialist assessment and treatment can be achieved.

Examples of two very different service models designed to overcome such deﬁcits in

service provision are described below: the Fixated Threat Assessment Centre (FTAC)

in the U.K. and the Problem Behavior Program in Australia.

FTAC was established in 2006 to assess and manage the risk to politicians and to

members of the British royal family from individuals who stalk, harass, threaten, or

inappropriately pursue them. The service won an award for policing excellence from

the U.K. Association of Chief Police Ofﬁcers in 2009. Whilst its focus is on the

prominent as a victim group, the principles on which it operates have been recognized as

having potential wider applicability in responses to stalking (James et al., 2010).

FTAC’s essential characteristic is that, whilst being a police unit, it is jointly staffed by

police ofﬁcers and by psychiatric nurses, psychiatrists and psychologists from the

National Health Service, whose posts are funded by the Department of Health. These

health personnel are trained in the use of the Stalking Risk Proﬁle (MacKenzie et al.,

2009). The joint approach brings a psychological and psychiatric perspective to the

handling of stalking cases, as well as facilitating psychiatric interventions and treatment

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in cases where this is appropriate. By collating information from both policing and

medical sources, FTAC is able to provide comprehensive reports on cases and specialist

assessment of different types of risk, as well as guidance on management and treatment.

Whilst this may entail police action, it usually involves referral to psychiatric services in

the area in which the individual resides. It is their responsibility to provide treatment,

which in cases of those with psychotic illness is usually in the context of involuntary

commitment. However, FTAC is also able to advise police and psychiatric services in

the management of difﬁcult cases by sending personnel around the country to meet with

members of different agencies handling cases. Advice can be provided to police, to

family doctors, social services, families and to any other relevant community agency.

This is probably of most value to local clinicians in terms of people who do not ﬁt into

the group that psychiatric services would normally consider for compulsory detention,

such as some cases with delusional disorder or paranoid personalities. FTAC staff are

able to advise on an area which is unfamiliar to many clinicians, and also help develop

inter-agency management plans for dealing with more problematic cases. FTAC acts

both as a catalyst for intervention by extant services, and also as a specialist resource

which can advise other agencies on how to evaluate and manage people who stalk the

prominent. The model is now being advocated as suitable for adoption in the general

population in the management of problematic stalking cases. Whilst FTAC does not

detain or treat, one of its main functions is to assist psychiatric services around the

country so to do.

In contrast to FTAC, the Problem Behavior Program (PBP) at the Victorian

Institute of Forensic Mental Health (Forensicare) in Melbourne, Australia, was

developed not only to provide expert assessments for those that engage in problem

behaviors such as stalking, but also to offer an avenue of treatment for those where

existing services failed to treat or lacked the requisite skills. The mandate for

Forensicare, as with most forensic and general mental health services, was to assess and

treat individuals with serious mental illness. In addition to managing a secure forensic

hospital, Forensicare was given the responsibility throughout Victoria of overseeing the

reintegration of forensic clients into the community, as well as providing community

services for offenders with serious mental illnesses. Although the focus of Forensicare’s

community operations was in working with those whose offenses were committed in the

context of psychiatric disorder, it also ran a community assessment and treatment

service for sexual offenders and research clinics for stalkers and threateners, few of

whom were mentally ill. From the ﬂood of referrals requesting assessment and

treatment of such cases, it soon became apparent that there was a substantial gap in

service provision for high-risk offender groups whose needs were not being met by either

the public or private health sectors. In 2003, the PBP was formally established through the

amalgamation of the existing clinics to cater for those who engaged in problem behaviors,

with or without the presence of mental illness (Warren, MacKenzie, & Mullen, 2005).

The criteria for referral to the PBP is that the individual is considered as, or suspected

of being, at signiﬁcant risk of engaging in behaviors that lead to serious physical or

psychological harm. These behaviors include violence, sexual offences against adults

or children, ﬁre-setting, threatening, and stalking-related acts. Most referrals come

from the courts, correctional services, area mental health services, and private clinicians

primarily within Victoria, but also from other states. In addition, there have been

increasing numbers of individuals who self-refer or attend voluntarily in order to

address their problems in the absence of criminal charges. As the proﬁle of the program

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has grown, referrals have increased markedly and the PBP has now become a major

component of Forensicare’s community operations.

The PBP is staffed by consultant psychiatrists and clinical and forensic psychologists

who work in conjunction to provide comprehensive assessments and treatment

options. The bulk of the work entails conducting assessments and offering treatment

recommendations for the referrer to implement in their own service, with outside

support, if necessary. However, with high-risk cases whose treatment needs are failing

to be met by other services, treatment is provided by the PBP. A collaborative team

approach is used, in which individual clinicians have the advantage of working in an

environment in which they receive the clinical support of colleagues and share the

responsibility of potential risk. An important plank in this arrangement is the holding of

regular review meetings, which serve as an important learning environment in which the

experience and expertise of senior clinicians is shared with their colleagues and with

those training to become the next generation of clinicians.

Since its inception, the PBP has conducted thousands of assessments. By providing a

concentration of expertise, it has become a fertile resource and an example of good

practice in dealing with problem behaviors. In addition, a substantial body of research

has been produced, particularly in the area of stalking. Through this, the PBP has

gained recognition nationally and internationally as a center of excellence for its work

with a wide range of offender groups. The clinicians in the program provide education

to external organizations in both the public and private sectors, including the courts.

They present their research at international conferences and in specialist journals. The

PBP has also become a much sought-after clinical placement for those seeking to

expand their knowledge of assessing and treating problem behaviors.

The PBP is undertaking a joint research project with Monash University which

involves a trial of a standardized intervention for treating stalking behaviors. This

research, supported by a large grant from the Australian Research Council’s Discovery

Project scheme, includes a randomized controlled trial of a 6-month psychological

stalking treatment program conducted at the PBP. The treatment protocol incorporates

the principles from the risk, needs, and responsivity literature (Andrews & Bonta, 2006)

and the other treatment methods discussed earlier. The experimental intervention takes

a cognitive behavioral and skills enhancement approach, combined with elements of the

transtheoretical model and informed by the tenets of social cognition theory. The risks

and needs identiﬁed through a comprehensive assessment form the foundation of

treatment targets that are addressed through a selection of prescribed therapeutic

modules. The treatment is then delivered in weekly individual sessions.

Stalkers receiving the experimental treatment will be compared with a ‘treatment as

usual’ group, and with stalkers who do not attend for recommended treatment. The

efﬁcacy of the intervention will be investigated using a minimum 12-month follow-up of

police and public mental health databases to establish reoffending, with permission also

obtained from participants for a prospective ten-year follow-up.

PROTECTING THOSE WORKING WITH STALKERS

Clinicians in psychiatric services may come into contact with those who have engaged

in stalking behaviors, or with stalking victims, through community health or prison

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services or the judicial process. Although many mental health workers are apprehensive

about treating stalkers out of concern that they will become a target, transference of

abnormal feelings and abnormal attention to the therapist by stalker patients is an

infrequent occurrence (Mullen et al., 2009). Of far greater risk are patients who have

not been identiﬁed as stalkers. In working with individuals who have psychiatric or

psychological problems, there is often a sense of being divorced from the stalking

phenomenon, with a perception that the professional role offers protection when care is

delivered objectively. The fact is frequently overlooked that, in working with such a

disturbed and dysfunctional population, the professional is vulnerable to becoming a

target themselves. There is a growing body of literature that highlights the risk posed to

clinicians of becoming victims of stalking, particularly those who work with mentally ill

patients (Galeazzi, Elkins, & Curci, 2005; McIvor & Petch, 2006: Mullen, Pathe &

Purcell, 2009; Pathe, Mullen, & Purcell, 2002; Purcell, Powell, & Mullen, 2005;

Sandberg, McNiel, & Binder, 2002). Whether the harassment occurs because the

clinician has attracted the amorous or the malicious attention of a patient, the

consequences, both personally and professionally, can be disruptive and potentially

devastating.

The extent of the damage that can be wreaked is illustrated by the case of Jan

Falkowski, a consultant psychiatrist in Britain, who was stalked for three years by Maria

Marchese, the partner of a patient. At the outset, Marchese embarked on an anonymous

campaign to sabotage the wedding of Dr Falkowski and his then ﬁancee Deborah. The

couple were subjected to a barrage of terrifying telephone calls, e-mails and text

messages threatening to kill Deborah and the wedding guests. It was made clear they

were being watched and their houseboat was broken into and ﬂooded with gas. Despite

Marchese’s eventual apprehension, she went uncharged and recommenced her

harassment. Under the strain of the ordeal, the couple separated and Dr Falkowski

commenced a new relationship. Marchese then accused him of drugging and raping

her, supporting her allegations with underwear that proved to contain traces of his

DNA. Dr Falkowski was charged and subsequently suspended from his job. After 18

months, the rape case collapsed when it was proven that the underwear contained the

DNA of three people. It transpired that Marchese had obtained Dr Falkowski’s DNA

from a condom she had found in his dustbin. The stalking case was reopened and

Marchese eventually received a nine-year prison sentence. Dr Falkowski’s harrowing

ordeal has recently become the topic of the docudrama,

U Be Dead

(Hughes & Payne,

2009).

Clinicians are not the only ones susceptible to victimization by stalkers. In our

experience, the police and even the judiciary can attract a stalker’s unwanted attention,

be it romantic or resentful. In one of our cases, a stalker attempted to burn down the

house of a judge who had upheld a ruling against her. In another, a police ofﬁcer was

bombarded by telephone calls from a woman who had become besotted with him after

he arrested her for stalking. Understanding the intrinsic risks should be a crucial

component in the training provided to those likely to encounter stalkers in a professional

capacity (Mullen, Pathe, & Purcell, 2009). Care should be exercised about allowing

information into the public domain that might help a stalker contact or locate

individuals outside the workplace. Public listings of home addresses in telephone

directories or voters’ registers should be avoided, and participation in social networking,

such as Facebook or Twitter, is to be discouraged. For lone practitioners who are not

afforded the protection of working within a large organization, careful consideration

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should be given to the wisdom of working with this population in isolation, and

attention paid to ensuring ofﬁce security.

Within health and social care organizations, there should be a policy of zero tolerance

of threats and a protocol for immediate response measures when clients engage in any

behavior that is not acceptable. Traditionally, there has been a culture of tolerance in

the helping professions to inappropriate behavior by patients or clients. However, such

tolerance not only places the clinician, their family and co-workers at greater risk of

escalating intrusions, it seldom proves to be in the client’s best interests in the longer

term (Pathe, Mullen, & Purcell, 2002). It is essential that patients are informed at the

outset that, if they behave in unacceptable manner, they risk disengagement from the

service and potential legal consequences. If the individual does not desist from

unreasonable behavior, employees across the service, including receptionists, need to be

alerted to concerns and the need for documentation and reporting. The service has to be

prepared to follow through on warnings given to an individual, as failing to do so risks

greater boundary violations.

All organizations and businesses have an ethical and, in many jurisdictions, a legal

obligation to protect their employees. Employers, especially in larger organizations and

services, need to be aware that stalking can both originate in or intrude upon the

workplace. It can involve the targeting of individuals in their personal capacity or as

representatives of an organization that has attracted a stalker’s ire. The onus is on

organizations to ensure workplace safety through the development and enforcement of

policies and procedures that address all forms of harassment.

The importance of education about early warning signs of aberrant attention, about

the types of unacceptable behaviors concerned, and about the need to report them,

cannot be over-emphasized. Employees are often reluctant to report what may appear

to be minor events, either through embarrassment or fear of appearing an alarmist,

overly sensitive or somehow at fault. Managers need to be sensitive to these issues and

encourage reporting in order to remain abreast of all events. What may appear to be an

isolated incident to one witness might reveal a pattern of behavior when combined with

what others have experienced or seen. Employees at all levels must be brought to

appreciate the importance of protecting not only their own personal information, but

also that of their colleagues and clients.

CONCLUSIONS

Our contention in this article is that the adoption of specialist programs, such as

the PBP, should be considered in other jurisdictions as a means to overcome the

deﬁciencies that currently exist in most areas in the services provided in stalking cases.

This would beneﬁt all agencies involved, including stalkers, their victims, the police,

and the courts. The provision of specialist assessment and management services,

whatever the model, requires resources. However, there is a need to set this, in a cost–

beneﬁt analysis, against other ﬁnancial considerations: policing costs of responding

to stalking incidents; the costs of taking individuals to court; the cost of imprisonment;

the cost in lost production for those victims who, because of the stalking itself or its

psychological sequelae, are obliged to take time off work; and the costs of treating

psychological and, on occasion physical damage to the victims and also to the stalkers

themselves. To be added to this are elements which are of a social value which is not

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readily ﬁnancially quantiﬁable; diminishing the psycho-social impact of stalking; and

preserving public conﬁdence in the police and the criminal justice system.

All those involved with either stalkers or their victims should be trained in assessment

of the risks involved, including those of mismanagement (Kamphuis, Galeazzi, et al.,

2005: Mullen, Pathe, & Purcell, 2009). This is particularly pertinent for mental health

professionals who have an essential role, not only in the assessment and treatment

of stalkers and their victims, but also in conducting research and ensuring the

dissemination of information that can instruct clinicians, law enforcement agencies, the

judiciary, policy-makers, and members of the general public alike.

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