Treating stalking a practical guide for clinicians troy mcewan

Treating Stalking : A Practical Guide for Clinicians Troy Mcewan

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Treating Stalking

A Practical Guide for Clinicians

TROY M c EWAN

Centre for Forensic Behavioural Science

Swinburne University of Technology and Forensicare Australia

MICHELE GALIETTA

John Jay College and City University of New York USA and

ALAN UNDERWOOD

Stalking Threat Assessment Centre, North London Forensic Services

Queen Mary University of London United Kingdom

This edition first published 2024

© 2024 John Wiley & Sons Ltd

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Set in 10/12pt STIX Two Text by Straive, Pondicherry, India

For Cleo, and the only good relationship that was ever started by stalking. Thanks for sharing your considerable knowledge about stalking, for being able to see the funny side of all of this, and for putting up with this book getting written.

For my grandfather Ron who gave me the opportunity for postgraduate study by covering my course fees. Without his constant encouragement and stubborn refusal to accept any attempts to repay him, I would not have been here to write this.

For my mother, Dr Maryann Galietta, who proved that women can indeed “have it all.” Through her actions and choices, she modelled love of family, love of the pursuit of knowledge, and how to do the tightrope act that comes with balancing these – always with compassion, strength, and a good measure of common sense.

Thank you Mom!

Acknowledgements

Our sincere thanks to our colleagues Prof. Barry Rosenfeld, Dr Frank Farnham, Dr David James, Prof. Jim Ogloff, Prof. Michele Pathé, Prof. Paul Mullen, Dr Rachel MacKenzie, Prof. Rosemary Purcell, Dr Sara Henley, and Prof. Stephen Hart for sharing their expertise and knowledge with us over many years. We also acknowledge colleagues we have worked with and learned from at Forensicare’s Problem Behaviour Program, the Stalking Threat Assessment Centre and National Stalking Clinic, and the SHARP Research Team. Without the opportunity to work with and learn from them, this book would not have been possible.

Alan’s heartful thanks to Ellie, who has endured the proxy process of writing (and the hearing about it) for the last two years with grace, good humour, infinite patience, and the copious provision of tea. Without your steadfast support, I would not have managed it.

Finally, we would like to thank the clients who have taught us so much over many years of practice and who have been willing to share their information and time by participating in research, knowing that it was for our scientific endeavours and not necessarily their own benefit.

About the Companion Website

This book is accompanied by the companion website: www.wiley.com/go/McEwan/APracticalGuideforClinicians

The website includes: Printable handouts and colour version of treatment worksheets

Introduction

Since emerging as a concept about 35 years ago, stalking has been considered a harmful behaviour that warrants a societal response. This has brought stalking into the realm of mental health professionals and behavioural scientists, particularly those working within criminal justice agencies and mental health services that are tasked with intervening to reduce risks and prevent harm. Yet, despite three decades of stalking research, there remain few studies examining effective treatment and management of people who stalk. This leaves efforts to treat stalking poorly evidence-based and wholly reliant on the knowledge and ability of individual clinicians.

As clinicians with specific interest in stalking, we find the lack of research on treatment and management of people who stalk troubling. Stalking victimisation affects approximately 15% of adults during their lifetime, and in half of cases persists for six months or more. The majority of victims are threatened, a substantial minority are physically assaulted, and stalking victimisation is known to lead to significant psychological and social harm. Fifty percent of people whose stalking attracts criminal justice attention continue to stalk, even after conviction. Treatment of people who stalk may be one of the few ways to provide long-term relief for stalking victims, yet it has attracted little research attention compared to similar harmful behaviours such as violence or sexual offending.

Between us, we have over 50 years of combined experience working with people who stalk across three different continents. We also have the benefit of the collective wisdom of our colleagues, who have a wealth of knowledge in this area. We wrote this book in an effort to distil some of this knowledge and experience into a detailed and comprehensive how-to guide for therapists working with people who stalk. Our goal is to present a structured and practical approach to treating stalking behaviour based on principles and strategies that we have found to be effective in our practice.

We begin the book with a case study. Reflecting on our bias as practicing clinicians, we find that case vignettes are often the most effective way of communicating complex clinical ideas, and we make use of them throughout the book. In this introductory chapter, we have chosen a case study that demonstrates the kinds of problems that often arise when trying to treat stalking behaviour and why a specialist approach is needed. The chapter goes on to argue why treatment of people who stalk is warranted, and why it requires specific knowledge to do well. We then describe the nature and scope of the

Treating Stalking: A Practical Guide for Clinicians, First Edition. Troy McEwan, Michele Galietta and Alan Underwood.

© 2024 John Wiley & Sons Ltd. Published 2024 by John Wiley & Sons Ltd.

Companion website: www.wiley.com/go/McEwan/APracticalGuideforClinicians

problem of stalking, and how criminal justice systems have tried (and often failed) to respond to it adequately. We emphasise the importance of being able to recognise stalking in clinical practice and provide advice about how to do so, so it is clear when treatment for this pernicious behaviour is needed. Finally, this introductory chapter concludes by considering the biases inherent in our approach to stalking, before providing an overview of the remainder of the book.

Our primary goal in writing this book, the first specifically devoted to treating stalking, is to help clinicians grappling with understanding their clients’ behaviour and trying to manage the risk that they pose to others. However, we also hope that the book prompts new research interest in this under-studied area. We would very much like our book to be a starting point that can both guide practice and inspire further therapeutic and research developments in this field.

CASE EXAMPLE

I wish there was a logical explanation for my obsession with you, which has been there for so long … Maybe I just want you to think of me, every day and preferably every hour. That is the best I can achieve … I don’t care how you think of me, only that you think of me. That I exist, that you know me and don’t forget me … I can only repeat myself and tell you about all the great things [about you] that have touched me so deeply. That make me want to be a part of your life, even if it is the blackest page in your life, as your stalker.

This letter was sent from prison by a man who had been stalking the woman he was writing to for over three years. Although he had known the woman when they were children, three decades later the two were strangers and the stalking began when she accepted his request to link up on a social media site. He proceeded to bombard her with messages, gradually escalating to locating her home and workplace, knocking on her door, and entering her home when she was not there to leave her gifts of flowers, money, and underwear. He followed her in the street, loitered outside her workplace, and all the while continued to try to communicate with her via phone, social media, and occasional letters. The intensity of the behaviour waxed and waned over three years, but there was rarely a week without at least one unwanted contact. Eventually, he was arrested, convicted, and imprisoned. The stalking was his first serious offence and after a brief period of incarceration the man was placed in a residential mental health service in the community to receive court-ordered assessment and treatment. He had been receiving psychological and psychiatric treatment for nearly a year when the treating clinician contacted one of us for peer supervision. The man’s

CASE EXAMPLE (continued)

court order was coming to an end in a few months, and he would be discharged, but the treating team was worried about the stalking victim’s safety.

The clinician reported that the man insisted that the victim wanted his contact and had only participated in the prosecution against him due to the influence of police and the judge. He said that he “just wanted to speak to her” so she could tell him herself that she did not want to see him. He told the therapist that he would continue to try to contact the woman until he was allowed to speak to her in private, and reported violent fantasies in which he would kidnap the woman to force her to speak to him. He was unperturbed by the thought of returning to prison. The man was entirely socially isolated, and his favourite activity was to go for drives in his car by himself, though the treating team was not aware of where he was going when he left the facility’s grounds. The treating team knew that he maintained awareness of the victim via the internet and that he felt happy when he saw the victim’s activities online. He voiced the intention of joining a sports club of which she was a member so he could meet her there.

There was considerable concern about what the most appropriate diagnosis might be, with thoughts about the relevance of both personality and pervasive developmental disorder (a psychotic disorder had been excluded and he had previously been treated with antipsychotic medication with no effect). Psychological treatment to that point had taken a schema therapy approach to hypothesised personality disorder, but the clinician was worried that the man continued to appear “obsessed” with the stalking victim, spent most of his time ruminating about her, and did not seem to consider his behaviour to be problematic at all. The clinician had discussed the man’s feelings and thoughts about the stalking victim and advised that he should write down his thoughts about her, given they were highly preoccupying. When supervision was sought, the clinician knew little about the function of the stalking for the client and what specifically might reinforce it, only that the client perceived that he had a right to contact the victim due to his feelings for her.

The clinician was clearly invested in helping this man avoid further offending and in preventing harm to the victim. They realised that their efforts to date had had little effect. However, in discussion with them, it was also clear that they did not have a thorough understanding of why their client was stalking, and the focus of therapy was on clarifying and treating the effects of his mental disorder rather than changing his behaviour. While there were concerns about the potential risk to the victim, there were no direct risk management strategies in place. The man was essentially continuing to stalk from hospital – monitoring the victim online and potentially in person during his long drives to unknown destinations. While he was engaging in therapy, the treatment provided was not addressing the functional drivers of the stalking, and the hospital environment was doing little to actively manage his behaviour or provide incentives that could motivate him to change.

We begin with this case example not to criticise the clinician or the treating team. They were clearly doing their best and were frustrated and concerned that their best wasn’t having the desired effect. But this case encapsulates several issues that we have observed to commonly undermine effective treatment of stalking behaviour. First, the team had insufficient knowledge of what stalking is and did not recognise ongoing stalking behaviour when it was present. Supervision was sought primarily because the client had disclosed violent fantasies about the stalking victim, leading to concern for her safety given his ongoing “obsession.” The fact that he continued to monitor her behaviour online while hospitalised had not raised any alarm bells. Lack of stalking awareness meant that there was insufficient monitoring of behaviours of concern and not enough attention to actually preventing him from stalking. Second, the primary focus of formulation and intervention was mental disorder rather than understanding how (or whether) mental disorder contributed to stalking and what other treatment needs might be relevant. It was the stalking that led to the client’s involuntary hospitalisation and which was associated with the potential for future harm, meaning the stalking should have been a direct focus of intervention. Despite this, the treating team had no structured understanding of the meaning of the stalking to the client, its function and what drove and maintained it, or what might be associated with it continuing or escalating to physical violence. The lack of a psychologically informed explanation of the stalking behaviour in turn meant that the treatment approach was not sufficiently focused on key drivers and reinforcing factors. While personality dysfunction clearly played an important contributing role, schema therapy was unlikely to be effective in addressing one of the primary treatment needs: the fact that the client did not see his behaviour as a problem and had no desire to change.

You may read this case study and identify with the clinician and treating team, recalling current or past clients whose treatment and management have presented similar challenges and missed opportunities. Alternatively, you might have never worked with someone who has stalked, and you are reading this book in preparation for a future client. In either case, we would like you to take away four things from this case study that will help you understand our approach throughout the rest of this book. First, remember that stalking is a behaviour, not a mental disorder. Treatment should be guided by a comprehensive understanding of the individual and situational factors that create and maintain the stalking, which can then be used to identify ways to change it. Treating mental disorder is sometimes important to treating stalking, but often it is not the main focus. Second, to treat someone who stalks, you need to understand what stalking is and how it presents. Only when stalking is recognised can effective treatment and risk management be implemented. Third, make sure you have enough knowledge about stalking to provide competent treatment. This introductory chapter provides some fundamental information about stalking that will help prepare you to treat people who stalk but always

seek out up-to-date reviews and data. Fourth, and finally, be like this clinician and reach out for expert help if your treatment is stalled or you are unsure what to do. Treating people who stalk is not straightforward, and an informed second opinion is often useful. We hope that this book can provide some initial insights that make working with this tricky population a little easier.

What Is Stalking?

Given the breadth of behaviour involved in stalking, it is helpful to start with a clear definition that can be used to identify when treatment might be required. Stalking is a pattern of behaviour in which one person imposes themselves into the life of another by making repeated unwanted intrusions that cause distress or fear. Most stalking behaviour is the stuff of everyday human interaction – telephone calls, text messages, visiting someone’s house. It is the pattern of conduct, the actor’s intent, and the effect on the target that make otherwise routine actions problematic. A defining feature of stalking is a mismatch in the level of contact desired by the two people involved, with one insisting on more contact than is wanted by the other (Cupach et al., 2000; White et al., 2000). Stalking is one end of a continuum of unwanted behaviour involving such mismatched desires. At the least concerning end of the continuum are overly intrusive one-off exchanges – an unwanted but relatively common part of everyday life. In a minority of cases, such events may develop into short-lived and self-limiting periods of harassment (sometimes termed unwanted pursuit behaviour) that cause discomfort but are not harmful. In some cases, such harassment crosses the line into a targeted and protracted stalking campaign, causing distress or fear and potentially causing considerable harm to the victim and those around them (Purcell et al., 2004; Thomas et al., 2008). What demarcates normal – albeit unwanted – behaviour from stalking differs from case to case depending on the nature of the behaviour, its persistence and the vulnerabilities of the target(s).

A stalking episode (the time between the first and last unwanted intrusion) can involve a multitude of different behaviours over days, weeks, months, or even years. The types of behaviour used by the person are limited only by their imagination and what they believe will achieve their goals, whether that is to frighten the victim, to begin or resume a relationship with them, or to obtain justice or some other outcome. There is no “prototypical” pattern of stalking. Most people will use multiple methods of communication (telephone calls, emails, social media, letters, graffiti, etc.) and contact (following, loitering, accosting, or other means of putting themselves in close physical proximity to the victim) to make their presence felt. Many will also use other behaviours such as sending unsolicited materials (intended as gifts or to frighten), getting proxies to contact the victim for them, using the internet or electronic

means to spread damaging misinformation or track the victim, using formal complaints or legal mechanisms to target the victim, or engaging in property damage, threats, or physical violence (Dreßing et al., 2020; Purcell et al., 2000; Spitzberg & Cupach, 2014). The frequency and severity of unwanted intrusions will fluctuate over the course of a stalking episode. There will be times when the victim faces a barrage of unwanted contacts, and then weeks or even months when there is no contact at all and they think the stalking might have stopped, only for contact to resume. Regardless of the duration, frequency, or severity of unwanted intrusions, once they form a pattern of behaviour that causes the target significant distress or fear, stalking should be considered present.

Why Is Treatment for Stalking Needed?

Persistent stalking can be highly damaging, both to those targeted and to those who stalk. It is a crime in much of the industrialised world, and people who stalk are held to account and punished through the mechanisms of criminal justice. Yet we know that police and court intervention doesn’t stop stalking –studies from Australia, Europe, and North America show that around half of people who have been reported to police, prosecuted, and convicted continue to stalk their victim, and up to a quarter go on to stalk someone else (Hehemann et al., 2017; McEwan et al., 2019, 2020; Mohandie et al., 2006; Rosenfeld, 2003). In these cases, punishment and the hope of deterrence are simply not effective if the goal is to stop stalking. Responding to stalking with only criminal justice sanctions will not protect many victims from ongoing psychological and physical harm, or reduce the impact of stalking more broadly.

That a purely criminal justice approach fails to stop stalking is unsurprising if you consider what we know about why people stalk. Stalking arises from an array of psychological, social, and cultural influences. The psychology that supports stalking is grounded in the individual’s interpretations of the people and world around them, their expectations of themselves and others, and the meanings that they ascribe to events. Stalking behaviour is sustained by longstanding patterns of emotional experience and expression, psychological skills deficits, and environmental cues (Mullen et al., 2009; Mullen, James et al., 2009; Parkhill et al., 2022; Purcell & McEwan, 2019; Rosenfeld et al., 2009). These are things that do not often change easily, even when someone wants to stop stalking. For a substantial sub-group of people who stalk, symptoms of severe mental illness and their impact on thinking and emotions are also a direct cause of their stalking behaviour. Without appropriate treatment of these symptoms, affected individuals are unlikely to be able to desist from stalking. But even where psychopathology isn’t directly implicated in stalking behaviour, the

kinds of psychological factors that contribute to it may not be changed simply through the imposition of a sentence in court.

If we accept that stalking is a problematic behaviour that emerges from and is sustained by an array of individual and situational influences, it suggests that interventions designed to change behaviour by changing such influences might reduce or even stop stalking. This is not a revolutionary concept. Psychological and social interventions are commonplace for other problematic behaviours, such as violence, harmful sexual behaviour, and offending more generally (Craig et al., 2013). A library of articles and books on these topics has been published over the past four decades, collectively known as the “what works” or “principles of effective interventions” literature. Beginning with the work of psychologists in the Canadian correctional system in the 1980s, this literature provides a fairly clear picture of how to design and deliver effective psychological interventions to reduce offending behaviour. Such approaches have a common set of ingredients:

•  they are provided to individuals assessed as being at relatively higher risk of reoffending,

•  they target areas of need that are related to the behaviour of concern,

•  they are tailored to the individual’s personal characteristics and ability to engage with treatment,

•  they are based on valid psychological theory, and

•  they treat people with respect and acknowledge their humanity and ability to change (Bonta & Andrews, 2016; Polaschek, 2010).

Treatment based on this approach and delivered by appropriately skilled and knowledgeable practitioners has been repeatedly shown to positively effect offending behaviour, including specific types of offending such as sexual offending (Gannon et al., 2019). Although such psychological interventions are not the only ingredient in helping people to desist from offending (Polaschek, 2019), they can clearly be an important part of this process.

It is our belief that people who stalk should have the same access to effective specialist assessment and treatment as those who engage in other problematic behaviour, whether that is within or external to the criminal justice system. Unfortunately, this is not currently the case. There are very few agencies providing specialist stalking assessment or treatment internationally (see Chan & Sheridan, 2020, and Meloy & Hoffmann, 2021, for examples). Those that do tend to be isolated and their work has rarely been subject to outcome evaluation (with the notable exception of Rosenfeld et al., 2009, 2019). There are no validated psychological treatments specifically designed to address stalking-related needs, and, to our knowledge, no major correctional or probation service offers treatment programmes designed for stalking. This is somewhat astonishing given stalking is common, with approximately one in six adults being victimised during their lifetime (McEwan & Pathé, 2014),

and over 100,000 stalking cases being recorded by police each year in the United Kingdom alone (Home Office, 2022). Data from the Australian Bureau of Statistics (ABS) suggest that only about one third of stalking victims report their experiences to police, which gives some sense of the scope of the problem (ABS, 2016). There is undoubtedly significant unmet treatment need within the criminal justice system and outside it. Failing to provide appropriate treatment and risk management options for stalking places an entirely unfair burden on victims who have to try to manage this destructive behaviour and whose lives can be laid waste as a result (Korkodeilou, 2017, 2020a; Logan & Walker, 2021; Pathé & Mullen, 1997). It also condemns those who persistently stalk to endless pointless interactions with the criminal justice system, simultaneously destroying their lives and costing the community considerable sums.

It might seem reasonable to assume that existing interventions for general offending, intimate partner abuse, or even general violence might be appropriate for people who stalk, meaning specific treatment approaches are not required. Indeed, physical or sexual violence is relatively common in stalking episodes (present in 20–50% of cases; McEwan, 2021). While it is possible that these individuals would benefit from programmes designed to reduce these behaviours, this does not take into account the remaining majority of people who stalk but do not engage in physical or sexual violence and may be at risk of further stalking. Such programmes also fail to address the targeted and persistent nature of stalking behaviour, which can be severely damaging regardless of the presence of physical violence (Kamphuis et al., 2003). Similarly, general offending programmes would likely have some relevance for the substantial proportion for whom stalking is part of a wider pattern of offending and antisocial behaviour (Eke et al., 2011; McEwan et al., 2017, 2020). However, such programmes do not address the targeted nature of stalking or the fixated mindsets that seem to contribute to its persistence. Additionally, such programmes would not be suitable for those without a wider pattern of offending behaviour. Finally, though just under half of stalking emerges out of the breakdown of an intimate relationship (Logan, 2020; Cupach & Spitzberg, 2004), most existing programmes for intimate partner abuse have been shown to have minimal effect in reducing the behaviour (Eckhardt et al., 2013; Gondolf, 2004; Travers et al., 2021). Moreover, while stalking and intimate partner abuse are clearly related in some cases, whether the two patterns of behaviour share similar treatment needs more generally is unclear. What little research that exists suggests that most people who abuse intimate partners do not go on to stalk post-relationship, while a subset of ex-intimate stalking cases emerge from relationships that are not characterised by abuse (Edwards & Gidycz, 2014; Ferreira & Matos, 2013; Senkans et al., 2020). Lack of attention to the unique aspects of stalking in existing treatment approaches means that there have been calls for stalking-specific interventions for over 20 years (Kamphuis & Emmelkamp, 2000; Mullen et al., 2001a).

Unfortunately, they have not led to a body of research that can easily inform psychological treatment. The stalking research literature has largely focused on epidemiology and risk assessment, with far less attention to the psychological mechanisms and contextual cues that contribute to stalking (Parkhill et al., 2022). The treatment literature at present consists of opinion pieces by clinicians (including the authors of this book) who provide general guidance and principles for treatment based on their experience with people who stalk (e.g., Kropp et al., 2002; MacKenzie & James, 2011; Mullen et al., 2001a, 2001b; Purcell & McEwan, 2019; Rosenfeld, 2000; Rosenfeld et al., 2009; Siepelmeyer & Ortiz-Müller, 2020). There remains only one peer-reviewed evaluation of a stalking treatment approach, in which dialectical behaviour therapy was trialled with some limited effect (Rosenfeld et al., 2009, 2019). This means that practitioners who provide treatment to people who stalk are largely working without an integrated evidence base, drawing on their knowledge of the stalking literature where possible, but frequently generalising from work with other problematic behaviour and having to reinvent the wheel when treating stalking.

In this context, our intention in writing this book is twofold. First, we want to provide detailed guidance to practitioners so they can more easily work with clients in ways that help stop stalking. Between us we have over 50 years of experience directly assessing and treating stalking behaviour and conducting research with this population. We thought it would be useful to distil this knowledge, and that gleaned from our colleagues, into consensusbased, detailed, and practical guidance for assessing and treating stalking. Second, and equally importantly, we hope that the publication of this book might trigger renewed research interest in the psychological treatment of people who stalk. We particularly want to highlight where further research is needed to build an evidence base that can inform the development of future treatment approaches.

Key Facts About Stalking

While stalking behaviour has existed for centuries, the construction of stalking as a social problem and a crime is relatively new (Mullen et al., 2000, 2001b).

The modern concept of stalking emerged in social discourse in the Englishspeaking world in the late 1980s, gradually attracting community, media, and eventually political attention that led to its criminalisation (Mullen et al., 2001a, 2001b; 2009; Mullen, James et al., 2009). As anti-stalking laws were introduced across industrialised, liberal democracies, stalking began to attract attention from epidemiologists charged with quantifying this new type of crime, and mental health practitioners and support services who were suddenly confronted with victims and stalkers in clinical and forensic

settings. Legal, sociological, and criminal justice research followed and there is now a sizeable research literature encompassing different philosophical and scientific perspectives on stalking. The majority of that research comes from North America, Western Europe, and Australia, though that is gradually changing (Chan & Sheridan, 2020). This body of research means that we are now able to describe with some certainty the characteristics of those who stalk, their victims, and common features of stalking behaviour.

Stalking victimisation is common, with 15–20% of women and 5–10% of men in Western industrialised nations reporting victimisation during their adult lives (ABS, 2016; McEwan & Pathé, 2014). The majority (60–80%) of victims are women, and 70–80% of perpetrators are men (Cupach & Spitzberg, 2004), with same-gender stalking accounting for 15–20% of reported cases and more commonly involving all-male dyads (Strand & McEwan, 2011). In forensic settings, these figures are skewed, with approximately 90% of people who stalk being male and 90% of victims female (McEwan et al., 2017; Nijdam-Jones et al., 2018). Most women who are stalked will be stalked by men, whereas men are equally likely to be stalked by a man or a woman (Sheridan, North et al., 2014).

Both people who stalk and those who are targeted have an average age in the mid-30s, though stalking victimisation and perpetration occurs across the lifespan (Sheridan, North et al., 2014; Sheridan, Scott et al., 2014). The handful of studies on stalking among adolescents suggests a similar phenomenon, though adolescents appear to be somewhat less persistent, but potentially more overtly aggressive, than their adult counterparts (Borges & Dell’Aglio, 2019; Cloonan-Thomas et al., 2022; Fisher et al., 2014; Purcell et al., 2009; Sheridan et al., 2014a, 2014b).

Approximately one-third of adult stalking victims are physically assaulted during the stalking episode, with rates being higher among former intimates and lower among stranger and acquaintance victims (Logan, 2020). In a very small proportion of stalking cases such violence is seriously harmful or even lethal (James & Farnham, 2003; McEwan, 2021; Sheridan & Roberts, 2011). Yet stalking is harmful even in the absence of physical violence. Some stalking victims have described the experience as “psychological terrorism” and “psychological rape” (Mullen & Pathé, 2002). Victimisation is associated with post-traumatic stress symptomatology, depression, substance misuse, and reduced employment and education performance (Hall, 1998; Johnson & Kercher, 2009; Kamphuis et al., 2003; Logan, 2020; Pathé & Mullen, 1997; Thomas et al., 2008). More prolonged stalking has been associated with greater psychological impact on victims, regardless of the presence of overt aggression (Blaauw et al., 2002; Diette et al., 2014; Dreßing et al., 2020; Purcell et al., 2005). Spitzberg & Cupach’s (2014) meta-analysis of 41 studies suggests an average stalking duration of approximately 15 months, though with substantial variation between studies. However, as Spitzberg and Cupach point out, it is not the duration per se that causes the most harm from stalking but

the “cumulativeness” of the behaviour – it is the combination of frequent and unpredictable intrusions over a sustained period that appears to be traumatising for many victims.

Former intimate partners are responsible for just under half of all stalking episodes; approximately, one-third are perpetrated by people who are prior acquaintances of the victim (e.g., work colleagues, neighbours), and roughly one in five people who stalk are complete strangers to the victim (Spitzberg & Cupach, 2014). A wide range of motivations are reported by people who stalk, including the desire for reconciliation or revenge following the breakdown of a relationship, the desire to establish or enact a relationship with the object of their affection, the desire to express grievance following perceived mistreatment, or to obtain sexual gratification and potentially prepare for a sexual attack (Mullen et al., 2000, 2009; Mullen, James et al., 2009). While most people who stalk persistently target a single victim in a particular context, potentially as many as 20% of people go on to target multiple different victims in different stalking episodes over time (sometimes referred to as “serial stalking”; Coupland & Storey, in press; Hehemann et al., 2017; McEwan et al., 2018).

A large number of those who stalk have mental disorders, with prevalence rates in clinical/forensic samples of at least 50% and possibly as high as 70% (McEwan & Strand, 2013; Nijdam-Jones et al., 2018), though this may be similar to rates in other offender groups (Wheatley et al., 2020). Personality, mood, substance use, and psychotic disorders are most common, with autism spectrum disorders and intellectual disability also reported in smaller numbers. As Albrecht et al. (2022) describe, there are several hypothesised pathways linking mental disorder and stalking. The most direct concerns the role of delusional beliefs about the stalking victim, which clearly drive stalking behaviour in a sub-group of cases. More common is an indirect link, with the symptoms of mood, personality, substance use, or other disorders contributing to stalking through their impact on thinking and emotions, but not directly causing stalking behaviour.

Explaining Stalking

The heterogeneity of stalking behaviour and people who stalk has led multiple authors to develop descriptive typologies attempting to reduce complexity, facilitate communication, and guide responses (see McEwan & Davis, 2020 and Spitzberg & Cupach, 2007 for review). The main stalking typologies that are used in practice have several similarities, most obviously distinguishing between those who stalk former intimate partners and those with other prior relationships with the victim. More complex typologies also incorporate some evaluation of the person’s apparent motivation and the presence and nature of psychopathology associated with the stalking (McEwan & Davis, 2020).

Stalking typologies are useful when they are used as a heuristic to help inform hypotheses about what might be contributing to the stalking and when they can help guide immediate management actions. However, they are only a way of organising information to guide initial thoughts. In a treatment context, the application of a typology is not a substitute for a full assessment and formulation of the individual’s behaviour (see Chapter 2 for further discussion of the use of typologies when assessing stalking).

Unfortunately, there is no simple answer to the question of what leads some people to stalk while most others do not. Stalkers’ pursuit can cost them their friends and family, their job, their health, and in some cases, their freedom. Yet they persist, persevering for months or years, intentionally or inadvertently destroying the lives of their victims, and often their own. There have been attempts to adapt existing theories of relationships and behaviour to stalking, including applications of attachment theory, behavioural theory, social learning theory, and social information processing theory. All of these approaches have explanatory strength and some empirical support, but some significant explanatory gaps remain (see Parkhill et al., 2022 for review). There is only one truly novel theory of stalking, Spitzberg and Cupach’s Relational Goal Pursuit Theory (Cupach et al., 2000; Cupach & Spitzberg, 2004, 2014). This theory has considerable explanatory potential and has been tested in several studies, but at present remains limited to explaining stalking in the context of relationship pursuit. Developing a comprehensive theory of stalking is difficult because of the heterogeneity of those who stalk, and the fact that a wide variety of situational and individual factors contribute to it. However, the lack of a compelling and comprehensive psychological explanation for stalking may be one reason that the research literature is yet to thoroughly investigate psychological factors that could be the focus of treatment (Birch et al., 2018; Parkhill et al., 2022).

Laws Prohibiting Stalking

Given the importance of anti-stalking laws to the contexts in which specialist assessment and treatment services are provided, this section introduces how such laws are typically structured and gives an overview of research about how they are (and are not) used. The first modern stalking law was introduced in California in 1990, and laws around most of the Anglophone world, much of Europe, and parts of Africa and Asia followed throughout the 1990s and 2000s (though not without controversy; Dennison & Thomson, 2005; Van der Aa, 2018; Wells, 1997). The rapid proliferation of anti-stalking laws in the absence of a single accepted social definition of stalking means that there is considerable variation between jurisdictions in how stalking is legally defined (McAnaney et al., 1993). Some laws have since been subject to legal challenge,

while others have been amended after criticisms that they did not in fact prevent stalking (Harris, 2000; Mullen et al., 2009; Mullen, James et al., 2009).

Stalking is difficult to legislate against because it usually involves behaviours that would be, in other circumstances, completely innocuous. Although some stalkers are overtly threatening or violent, many of the acts that constitute stalking are part of everyday interactions: telephone calls, emails, social media contacts, sending gifts, waiting for someone at their home or work, etc. It is their unwanted imposition and repetition over time that creates a sense of menace. As noted by McEwan et al. (2007), stalking is qualitatively different from, for example, the legitimate pursuit of a complaint or acceptable attempts to reconcile a failed relationship, but it has proven difficult for legislators to specify where such legitimate pursuit ends and when criminal sanctions are warranted (see also Ogilvie, 2000).

While different jurisdictions have taken different approaches to defining stalking there are some commonalities across anti-stalking laws. They typically involve at least two, potentially three, elements: (a) defining the pattern and nature of the unwanted behaviour (the conduct element), (b) defining the intent of the perpetrator (the mental element), and often, though not always, (c) some requirement for a negative impact on the target of the stalking (the impact element; Fox et al., 2011; McEwan et al., 2007). Different jurisdictions have defined these three elements in different ways and with different levels of specificity, which can have real impacts on how laws are used and who can access them. Some jurisdictions also limit definitions of stalking to behaviour that occurs between intimate or former intimate partners, or simply outlaw “stalking” as a form of domestic violence without any further definition. We encourage readers to find their local anti-stalking statute, consider how the three elements are operationalised, and how this might impact the use of the law in their jurisdiction.

The Use of Anti-stalking Laws

A growing body of research has shown that where stalking laws exist, they are not necessarily used to their greatest effect (Brady & Nobles, 2017; Hehemann et al., 2017; Van der Aa & Groenen, 2011). Epidemiological samples of stalking victims suggest that between one-third and half report the experience to police (ABS, 2016; Baum et al., 2009; Purcell et al., 2001; Tjaden & Thoennes, 1998). When asked why they did not report to police, many victims either think that it did not warrant police attention or believe that the police will not take their complaints seriously (Fremouw et al., 1997; Laurinaitytė et al., 2022; Tjaden & Thoennes, 1998). Other research suggests that these doubts about police responses may be justified, with multiple studies observing that police are slow to respond to stalking and often

ineffectual in stopping it (Brewster, 2001; Korkodeilou, 2016; Pathé & Mullen, 1997; Taylor-Dunn et al., 2021). The relative lack of police response to stalking may also be reflected in findings that the number of stalking reports recorded by police is far smaller than might be expected, given the prevalence of the behaviour (Bouffard et al., 2021; Brady & Nobles, 2017).

Several authors have suggested reasons for inadequate police responses to stalking. First, many stalking victims do not identify their experience as stalking when reporting it to police. Most experience dozens of unwanted intrusions before seeking help and often report only the most recent behaviours that have caused them to become more concerned (Korkodeilou, 2020b; Roberts & Dziegielewski, 1996; Taylor-Dunn et al., 2021). They may report troubling telephone calls or an assault but do not recognise or think to label the broader pattern behaviour as stalking (McEwan, 2021). This means that recognising stalking relies on police awareness and willingness to proactively ask questions to identify it. This in turn does not occur because many police do not have any specialist knowledge about stalking, and if there is no immediate crime reported, they do not think to ask additional questions that could allow them to identify stalking (Brandt & Voerman, 2020). Even when they do ask, most stalking statutes are very broad, leaving much room for police discretion about what constitutes a “pattern” of behaviour or “reasonable fear” (Brandt & Voerman, 2020; Spitzberg, 2002). Studies have demonstrated that police with less experience in stalking view it as less serious and warranting less response (Lynch & Logan, 2015; Scott et al., 2013), potentially affecting discretionary decisions about whether it has occurred. This is consistent with observations from qualitative research with stalking victims by Taylor-Dunn et al. (2021) and Korkodeilou (2020b), whose participants reported being told that there was nothing the police could do until a “real” crime (i.e., a threat or physical violence) occurred. It is also consistent with studies of police actions in response to stalking reports, which show that police are more likely to respond to stalking if there is physical violence present (Ngo, 2019). Both Brandt and Voerman (2020) and Spitzberg (2002) suggest that a key factor in inadequate police responses to stalking is the failure to recognise the behaviour at the earliest opportunity. While it has not attracted the same kind of research attention or critique, failure to recognise stalking is also a key problem when considering whether and when stalking treatment might be required.

Recognising Stalking

The first step in offering treatment for stalking is knowing who might require it. Stalking does not always present clearly, and assessors need to be alert to its presence where it is not labelled. It is typical for people who stalk to be prosecuted using a collection of discrete offences (e.g., a threat, an assault, breach

of a restraining order) rather than a stalking charge (Brandt & Voerman, 2020; Lynch & Logan, 2015; Sentencing Advisory Council, 2022; Spitzberg, 2002). This renders stalking invisible in correctional or forensic systems that frequently rely on the nature of the charge to identify potential assessment and treatment needs (e.g., those with sexual offences are assessed for sex offender programmes). An example of this from our own practice is a client who was serving a probation order for a threat conviction and was referred for risk assessment and management recommendations. On reviewing the collateral information and speaking to the probation officer, it was clear that the threat took place in the context of an ongoing pattern of unwanted intrusions that included following the ex-partner, turning up at her home, and making dozens of non-threatening telephone calls. At no point in the police or court process was the pattern of the behaviour described as stalking. Thankfully, the probation officer was alert to the potential and had identified stalking from the description in the police summary of charges.

It is essential to be aware that stalking may be present whenever these kinds of behaviours or offences are present. Always ask questions about the context in which discrete acts of offending or concerning conduct took place so patterns of stalking are identified. The questions in Box 1 are a useful starting point when trying to identify whether stalking is present and whether the approach outlined in this book is likely to be helpful.

BOX 1 Key Questions That Can Be Used to Identify the Presence of Stalking

1. Are intrusive behaviours targeting a particular person or group of people? For stalking to be present, there must be repeated unwanted intrusions involving the same target(s). If the behaviour is accidentally targeting the same person but that is not the offender’s intent, it is probably not helpful to conceptualise the behaviour as stalking.

2. Does the target of the behaviour want to have contact with the person? Stalking involves unwanted intrusions. If there is evidence that the target(s) wants to have contact with the person, then consider other ways of conceptualising any concerning behaviour.

3. Are there legitimate reasons for the person to have contact with the target(s)? Stalking involves unwanted intrusions that have no legitimate justification. Either there are no legitimate reasons for contact with the target(s) or the person’s behaviour goes beyond the boundaries of what is legitimate in the circumstances. For example, one of our clients repeatedly contacted his expartner demanding to see his children, in violation of a restraining order.

BOX 1

Key Questions That Can Be Used to Identify the Presence of Stalking (continued)

The restraining order meant that these contacts were not legitimate even though the desire to see his children was understandable. Legitimate contact in this case would involve a lawyer or use of the court or a mediation service to negotiate access to the children while observing the requirements of the restraining order.

4. Does the pattern of intrusive behaviour cause fear or distress? Stalking is present when the cumulative nature of the pattern of behaviour has a significant negative psychological impact on the target(s). If the victim is completely unaware of the unwanted intrusions but all other criteria are satisfied, it may be appropriate to consider whether a reasonable person would be fearful if they became aware of the unwanted intrusions. For example, a sexually motivated client stalked a woman who was a stranger to him over a period of five weeks by loitering near her home, watching her through the window, breaking into her home, and moving and stealing her belongings. The woman was not aware until police told her of the pattern of behaviour after the man’s arrest. The stalking was considered present throughout the five weeks, even though the target did not become fearful until after she was made aware of the behaviour.

While the failure to name stalking when it is present is the most common challenge to recognition, the opposite problem can also arise – when stalking charges are used but the behaviour is not consistent with common social or research definitions of stalking. In these kinds of cases, proceeding based on the assumption that the problem behaviour is stalking may result in inadequate assessment and failure to identify necessary treatment targets. For example, a client presents with a stalking charge, but the behaviour involved a single incident in which he followed a woman down a street for some distance, and she was sufficiently fearful that she reported it to police. While potentially consistent with some legal definitions of stalking, this behaviour does not have the necessary repetition to be considered stalking for the purposes of assessment or treatment (it may of course be concerning for other reasons, depending on the context). Similarly, we have seen stalking charges used to prosecute voyeurs or exhibitionists who return to the same location (e.g., a train station or a school) and so inadvertently offend repeatedly against the same individual. While a pattern of intentionally targeted behaviour must be ruled out, in our experience it is more commonly coincidence that the same victim was in the same location each time in these cases. This behaviour would be better conceptualised as harmful sexual behaviour and assessed using approaches appropriate to that.

A similar issue might arise if a stalking charge is used to prosecute someone for behaviour that occurs during a continuing intimate relationship. For example, the offender and victim continue to live together, but the offender is engaging in surveillance and monitoring of their partner’s behaviour, along with other psychologically or physically abusive behaviour. In this context, our approach to stalking assessment and treatment would be inappropriate as we define stalking as an unwanted imposition, implying the absence of a consensual relationship between the two people involved. If there is an ongoing relationship, then it may be more useful to conceptualise the pattern of behaviour as intimate partner abuse (or even coercive control; Robinson & Myhill, 2021) and proceed with the assessment and risk management plan on that basis. Similarly, if there is an intimate relationship that is “on and off,” with stalking during periods of relationship breakdown and abuse during periods in which the relationship has reformed, then it is usually most helpful to conceptualise the behaviour as a pattern of intimate partner abuse but to consider risks potentially associated with periods of stalking (e.g., the risk of physical violence may be heightened post-separation) (see McEwan & Underwood, in press for further discussion of these issues).

A final area where questions may arise about whether a pattern of behaviour constitutes stalking is when the unwanted intrusions occur entirely online. In the past 15 years, it has become relatively common for people who stalk to use the internet to monitor, harass, or obtain information about their victims (Cavezza & McEwan, 2014). This is sometimes called “cyberstalking,” though, as Wilson et al. (2022) point out, the term cyberstalking is so poorly defined that the research literature on this construct is difficult to integrate and generalise. Regardless of what it is called, it is clear that those who stalk offline routinely also use online methods of intrusion. Dreßing and colleagues’ (2020) comprehensive epidemiological survey of stalking in Mannheim, Germany, identified that a quarter of stalking victims were contacted via the internet, while nearly 20% had false information about them placed online. Over 15% received emails from the person stalking them, triple the proportion reporting emails in the same survey 15 years prior (Dressing et al., 2005). Of course, this self-report survey could not identify how often the internet may have been used by the stalker to monitor or gain information without the victim being aware, so these are likely underestimates of the true use of online behaviour by people who stalk. Given how pervasive technology and the internet are in modern life, it should be assumed that people who stalk offline will also use the internet to target their victims until there is evidence otherwise.

Conceptualising online behaviour as stalking is relatively straightforward when there are also unwanted intrusions occurring offline. However, if the stalking takes place purely online, additional questions might arise. In our experience, purely online stalking episodes are usually motivated by desire to start a relationship or have sexual contact with the target, or desire to

remonstrate with or punish the target(s) for a perceived wrong (an exception is if the victim is a public figure, where other motivations are also common, see James et al., 2009). Our approach is to start with the definition of stalking that was provided at the beginning of this chapter. If there is evidence of a pattern of repeated, unwanted intrusions upon another person that has the effect of causing distress or fear, then it is potentially useful to think about this behaviour as stalking. However, other forms of online harassment such as trolling and cyberbullying often involve very similar behaviours to online stalking motivated by a personal grievance. Trolling captures a wide range of online behaviours that are variously antagonistic, deceptive, or involve vigilantism (Demsar et al., 2021). The common underlying mechanism of trolling is that it is intended to provoke a response from those targeted (Demsar et al., 2021). Cyberbullying is a targeted, repeated behaviour that is intended to cause harm and in which a power imbalance between the perpetrator and target means the target is unable to defend themselves (Slonje et al., 2013). Both behaviours may look very similar to grievance-based or resentful stalking. The key difference is that this kind of stalking is triggered by perceived mistreatment or a personal wrong – the behaviour is motivated by personal grievance rather than some other cause. Trolling and cyberbullying do not seem to involve this sense of personal grievance.

Occasionally, someone who has engaged in egregious forms of trolling or cyberbullying may be charged with stalking. Therefore, if stalking has occurred purely online it will be necessary to determine whether there is a personalised grievance against the target that is driving the persistent and unwanted intrusions. If there is, the behaviour can likely be usefully conceptualised as resentful, or grievance-based, stalking and the approach in this book may be useful. However, if there is no personalised grievance, then assessment and treatment should proceed more cautiously and with reference to wider literature on online harassing behaviour. The approaches described in this book may be useful, but there may be other motivations, goals, and skills that need to be identified in assessment and addressed in treatment.

Biases Influencing This Book

We should make clear at the outset of the book that all three authors were born, educated, and work in countries that share considerable cultural similarities and have been described as WEIRD in psychological literature (Western, Educated, Industrialised, Rich and Democratic; Muthukrishna et al., 2020). The cultural context of our lives in Australia, the United States, and the United Kingdom, respectively, informs both our thinking about stalking and the responses that we describe in this book. Stalking is a culturally bound construct that emerged in WEIRD countries in the 1990s and has spread to

some other countries and cultures in the years since, though it is by no means universally accepted (Mullen et al., 2001b). Indeed what “stalking” means in different cultures may be quite different (Sheridan et al., 2017). This is not to say that stalking does not occur outside of WEIRD cultures; multiple studies have demonstrated that stalking behaviour is reported in a wide variety of cultures, from the Caribbean to Asia, and parts of Africa and the Middle East (Sheridan et al., 2019). Nonetheless, the way that we talk about stalking in this book is culturally bound, both by our personal perspectives and by our practical knowledge of how service systems function. We strongly hope that the information in this book is helpful to thinking and practice for those who work in dissimilar cultures to our own, or who routinely work with clients from cultural minorities within WEIRD societies. However, we expect that our approaches and assumptions may need to be challenged and adapted when working with clients and service systems in different cultural settings.

In addition to our cultural biases, all three authors are psychologists, and our book presents a psychological approach to understanding stalking and treating stalking behaviour. Our emphasis is on helping clients to become aware of patterns of thinking and emotional experience that contribute to stalking and helping them to change those patterns in ways that help change their behaviour. Our goal is to equip our clients with both the skills and motivation to build a life that does not involve stalking and supporting any changes to identity and self-appraisal that may be required to achieve that.

That said, we strongly believe that psychological treatment is only one part of effective intervention for stalking. Equally important (and in some cases more important) are mental health treatment, supporting practical needs with housing and employment, and building social networks. In many cases, supervision and legal constraints on the person’s behaviour are also an essential element of intervention (MacKenzie & James, 2011). So, while this book is heavily focused on the detail of psychological treatment, we urge readers to think broadly about the needs of their clients, and what other areas of treatment need and support are required to help them (re)build a meaningful life without stalking.

Overview of This Book

The book is divided into four parts. Part 1 provides a rationale for our approach to psychological treatment of people who stalk, describes the overall approach, and lays out 10 key principles that underpin the detail provided in the following sections. Part 2 focuses on the initial assessment and formulation with a client who has engaged in stalking behaviour. Within Part 2, Chapter 2 provides detailed guidance about essential information to gather during a stalking assessment and suggestions for interview approaches to obtain it. Chapter 3

focuses on risk assessment, discussing the nature of risk in stalking cases and providing an overview of available structured approaches, their supporting evidence, and advice about using the most appropriate risk assessment instrument. Chapter 4 then focuses on developing a meaningful cognitive-behavioural formulation of the stalking that can be used to guide treatment. This chapter makes suggestions about how to discuss the formulation with the client, linking it to their own goals and understanding of the behaviour.

Part 3 addresses the core tasks of psychological treatment with people who stalk. Chapter 5 outlines steps for selecting and prioritising treatment targets and discusses common areas of treatment need and strategies to address them, based on our work with clients. Each area is described in depth and practical strategies for helping clients to change their thinking, respond effectively to their emotions, and change their behaviour are provided. Chapter 6 discusses the structure of treatment, from clarifying expectations, engaging clients, and gaining commitment to work towards collaborative treatment goals in the early stages, to session structure and planning for termination. Where Chapters 5 and 6 focus on the therapeutic tasks of treatment, Chapter 7 covers how an awareness of risk must be integrated throughout different stages of treatment, and how to respond to increases in risk of violence or further stalking that will occur during most treatment relationships. Chapter 8 is the final practice-focused chapter and moves beyond the immediate relationship with the treatment client to consider the importance of multi-agency collaboration when working with people who stalk. A framework for effective multi-agency work with stalking is presented, along with discussion of how to deal with common challenges of multi-agency work in different contexts.

The fourth and final Part of the book is contained in Chapter 9. In addition to drawing together the key themes, Chapter 9 discusses shortcomings in the existing evidence base that cause this book to be “consensus-based” rather than “evidence-based” in its approach. Drawing on the ideas that underpin our approach to assessment and treatment of people who stalk, Chapter 9 presents recommendations for future research to develop an evidence base that can inform the development of future stalking treatments.

Conclusion

Stalking is a common and problematic behaviour that can cause severe harm to those who are targeted and lay waste to the life of the person who stalks. While stalking is increasingly coming to the attention of criminal justice agencies, evidence indicates that criminal justice responses alone fail to stop stalking in up to half of cases, while approximately one in five go on to stalk someone else. This suggests that there is a need for more complex and nuanced responses to stalking behaviour, including treatment designed to change the

psychological factors that are thought to sustain it. Unfortunately, there is very limited research to inform the design of treatment approaches for stalking, and only one treatment trial has been conducted to date, with limited effect. This book is our response to the dearth of information about how to treat stalking. It is an attempt to distil knowledge gleaned from colleagues and from our years of psychological practice and research with people who stalk, into a principled and detailed approach to treatment. Throughout this book, we use case examples to communicate key ideas and points. These cases are based on our combined clinical experience, and information has been altered to protect the identities of those involved. We hope that the advice and examples that we provide in these pages can not only give practitioners accessible and useful guidance but also create impetus for more research into stalking to inform the development and evaluation of future evidence-based psychological treatments.

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