Stalking of the mental health professional: Reducing risk and managing stalking behavior by patients.

Abstract

Stalking is a prevalent issue that is often underreported and underdiscussed both in the general population and in clinical settings. Among mental health professionals, 6%-11% of providers will be stalked by a patient during their career. Stalking has a considerable negative impact on both the personal and professional lives of these individuals that is compounded by systemic and individual factors. Many health care organizations lack well-defined procedures on how to manage stalking, and mental health professionals have been found to have minimal training in how to address stalking behavior. Ethical guidelines across multiple health care disciplines emphasize avoiding harm and maintaining patient confidentiality. Although state licensing boards allow exceptions to confidentiality as mandated or permitted by law, these state laws may offer little protection to the mental health professional being stalked by his or her patient. Failing to address stalking behaviors could be detrimental to both current and future providers as well as preventing the stalker from receiving modification of problematic behavior. General models of stalking management have been offered in the past, but few address the specific challenges associated with the stalking of mental health professionals by their patients. The authors present 2 vignettes to demonstrate the common management challenges of these cases. The authors propose a dual pathway, 3-tiered model of stalking management that adopts a public health approach to guide interventions both on the individual provider and systemic level. Limitations and suggestions for future research are discussed.

The COVID-19 era: How therapists can diminish burnout symptoms through self-care

“…Client aggression has also been observed to result in clinicians' long-lasting psychological damage such as intense anxiety, depression, PTSD, anger and a fear of returning to work (Burns, 2018;Chen, Hwu, Kung, Chiu, & Wang, 2008;Figley, 2015;MacDonald, Colotla, Flamer, & Karlinsky, 2003). Client aggression could, indeed, be physical but could also include unwanted phone calls, verbal threats not only towards the therapist but their family members as well, or threats of destroying one's office or home (Carr, Goranson, & Drummond, 2014;Guy et al, 1992). Such vicarious traumatization, expressed by feeling compassion fatigue may help explain why as many as half of the psychotherapists who routinely treat traumatic clients have symptoms of secondary or acquired trauma (Reuben, 2015).…”

Stalking

“…Another component of understanding violent crime is the victim–offender interaction or dynamic (Balemba & Beauregard, 2012; Block, 1981; Echeburua et al, 2009; Guerette & Santana, 2010; Sacco & Kennedy, 2002) and stalking (De Smet, Loeys, & Buysse, 2013; Geistman, Smith, Lambert, & Cluse-Tolar, 2013; Malsch et al, 2011; Reyns, 2010). Several studies suggest that victims’ behavioral responses can potentially influence the progression, escalation, or de-escalation of the stalking (Carr, Goranson, & Drummond, 2014; De Smet et al, 2013; Geistman et al, 2013; Sato Mumm & Cupach, 2010). For example, research that has examined stalking victim responses suggests that actions that make targets less accessible can contribute to eroding the stalkers’ interest (Cupach & Spitzberg, 2004; Dutton & Winstead, 2011).…”

“…Some of the strategies used by victims are more subtle in terms of conveying unwantedness, and others are more direct. Advice from various researchers and threat assessment experts suggests direct, succinct, and unambiguous notification that the behavior is unwanted is an important step to safety in stalking situations (Carr et al, 2014; de Becker, 1997; Meloy, 1998; Mullen et al, 2006; Pathé, 2002; Sinwelsky & Vinton, 2001; Spitzberg & Cupach, 2008; 2014). Further, when an offender is notified that the behavior is unwanted but persists anyway this is an important red flag and in that the deliberate and intentional component of the course of conduct is even clearer (Fein & Vossekuil, 1999; Fein et al, 1995; Miller, 2001a).…”

Stalking victimization among police officers.

“…Another group of professionals in danger of stalking victimization are those in the mental health field (for more details, see Carr, Goranson, & Drummond, 2014). Patients suffer from mental disorders, some of which seem to be associated with stalking behavior such as delusional or personality disorders (McEwan & Strand, 2013).…”