Help for Helping Professionals: Risk Management Strategies for Stalking

by Dr. Jocelyn Markowicz, PhD, Psychologist

Help for the Helping Professional: Risk Management Strategies

The success of psychotherapy is correlated with the attachment between client and therapist in the therapeutic relationship (Farber, 2015). According to Dr. Farber, empathy and building the bond of attachment is our stock-in-trade as mental health practitioners. When empathy builds the bond of attachment with someone starved for connection, a therapist may inadvertently set themself up to become a victim of a stalker (Farber, 2015).

Safety Risks Often Discounted

When a therapist embarks on training, they are imbued with ethical principles to guide the delivery of services. One crucial ethical principle is to take reasonable steps to avoid harming their clients and minimize harm where it is foreseeable and unavoidable. However, training programs do not adequately equip mental health providers to take reasonable steps to mitigate the safety risks inherent in working within the mental health field. Unfortunately, therapists often lack support when they talk about the dangers faced in their profession. Therapist safety concerns are often met with the sentiment that “it comes with the territory.” Therefore, they must deal with and manage risks or even active threats alone. People often have the same view when nurses, physicians, firefighters, law enforcement officers, and service members talk about the risk they are managing. The dismissal of the severity of risk that mental health providers take on reduces their access to resources and tools to reduce that risk successfully. An industry designed to help individuals who struggle with the perpetration of harm against others does not negate the provider’s right to be free from harm. Stalking, in particular, has become a major concern for therapists in this technological boom.

Stalking and Therapists

Stalking is a prevalent phenomenon with significant negative psychological, physical, social, and financial consequences (Sheridan, Adrian, & Scott, 2019). According to the U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics (2015), a greater percentage of females experience stalking than males. Additionally, 2.2% of females compared to 0.8% of males experienced at least one stalking victimization within a 12-month period. Storey and Hart (2017) correctly documented that prevalence estimates are considerably higher for individuals holding certain professions. Mental health professionals (psychologists, psychiatrists, counselors) have higher rates of stalking than other professionals (Galeazzie & DeFazio, 2006; Store, 2012). Nearly 19.5% of psychologists report being stalked in the context of their professional lives (Lion & Herschler, 1998; Smoyak, 2003; Whyte et al., 2011). Additionally, 32% to 64% of counselors have been victims of some form of harassing behavior from a client (Romans, Hays, & White, 1996; Store, 2016). 

Health care workers and mental health care workers have been stalked by their clients, as documented in several studies from the United States (Romans, Hays, White, 1996; Gentile et al., 2002) and abroad (Galeazzi, Elkins, & Curci, 2005; Abrams & Robinson, 2011). In fact, research has demonstrated that co-workers also stalk service providers, but the percentage of stalking from service users is higher (Ashmore et al., 2006). This means that, although anyone can potentially be stalked within their professional environment, mental health professionals are at a higher risk of being stalked by their clients than others in other work environments.

Reducing the Risk

Specific risk reduction and threat management interventions are needed to ensure that therapists have effective risk management tools and risk reduction policies at their disposal. Why is risk reduction necessary for professionals in mental health? According to Galeazzi, Elkins, & Curci (2005), mental health professionals who have been stalked by their clients have left the field, reported lost time from work, and moved to a different state to escape their stalker. They have also carried weapons to work in response (Pope, & Vasquez, 2011). The impact of stalking on providers is substantial. There is limited training currently available about how to manage stalking in one’s mental health career. The call is to have adequate systems in place to reduce the likelihood of stalking and appropriately respond when it does occur. In the age of technology, stalking risks are increased due to clients having multiple ways to contact their practitioners and access their personal information online. Mental health providers may face online stalking or be stalked by phone or email in addition to unwanted physical presence in the professional or personal environment. Here are six risk management strategies: 

#1 Implement Client Consultations

Harm reduction involves the initial assessment of risk in your professional environment. Therapists are trained to assess risk for client harm to self and others but often do not view harm to themselves as a potential area to consider. Professionals working in a private practice setting, group forensic setting, or within a hospital setting will have different risk factors to consider. For example, a provider working in an independent private practice may wisely implement more stringent policies to reduce risk than a provider who works within a health system and has access to on-site security guards and other professionals that may serve as a risk management team.

When possible, all new clients should participate in an initial consult to determine if this treatment setting will offer the most effective treatment and evaluate any potential risk factors that the provider or system may have to manage. Clinicians are encouraged to refer individuals to a higher level of care and to agencies that can responsibly manage harm potential more effectively as needed. For example, a client with a history of stalking may need to work with a provider in a larger treatment agency versus a solo provider in private practice in order to minimize the risk of intimate attachment that may lead to stalking behavior. The risk assessment process can inform the policies a provider creates for the safety of everyone involved. 

#2 Provider-Client Technological Access

Therapists should use business phones and office email systems versus their personal cell numbers and email addresses to communicate with clients. At the beginning of treatment, therapists should outline communication policies, specifically what content is to be communicated electronically (i.e., scheduling new appointments of cancellations versus crisis intervention) and time parameters for communication with clients (e.g., during business hours only). One’s communication policy should, of course, contain a limits of confidentiality policy and discussion of how the professional will handle violations of the communication policy. A communication policy that outlines limits to professional responsiveness and limitations to the depth of electronic communication can minimize safety risk by establishing clear, professional boundaries.

#3 Maintain Communication Boundaries

Therapists should adhere to the communication policies they set forth for their clients. If a provider establishes that they will not communicate with clients after business hours via email, they must not violate their own policy. If a professional indicates that they will not address clinical issues via email, they must follow through on that commitment. Psychotherapists violating their own communication policy may condition their clients to violate the policy as well. Boundary violations from either party increase safety risks.

#4 Seek Support from Colleagues

Mental health providers have the privilege of helping individuals who struggle with a variety of emotional and behavioral concerns. Given the nature of this work, risk cannot be prevented, but it can be reduced and managed more effectively with support. Not unlike individuals seeking services for distress due to being threatened, clinicians also need support as they implement protocols to reduce their risk or manage active threats. The inherent risk of the mental health profession does not negate the need for support in the face of risk management or active threat reduction. I encourage therapy for therapists to help them manage the distress of working within risky situations or addressing active threats.

#5 Individualized Action

When therapists are managing an active stalking threat, they must take care of themselves the same way they take care of others. They must seek support from other mental health professionals to determine ways to work within the boundaries of ethical mandates while preventing harm to themselves. They may also need to seek the assistance of law enforcement to manage risk and prevent harm. The individual goals and efforts of mental health providers to manage the risk inherent in their position can make a significant difference in the outcomes they experience.

#6 Systemic Action

Training therapists to implement protocols to minimize their safety risks is vitally important to bringing about widespread change in risk management for mental health providers. Psychiatrists and psychologists are the professionals most likely to be stalked, possibly because aspects of the psychotherapeutic relationship can produce misunderstandings about the nature of the intimacy generated and appropriate boundaries in this type of relationship (Galeazzi, Elkins, & Curci, 2005). Mandating risk management continuing education for mental health providers to learn how to minimize their own safety risk should be encouraged. Consultation services for psychologists who are navigating managing active stalking threats should be more accessible. The impact of reduced safety for therapists comes at too great a cost to themselves and their communities. Mental health providers need systemic protection plans so that they can continue working hard to minimize distress and improve life functioning for their clients.

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References

Abrams, K. M., & Robinson, G. E. (2011). Stalking by patients: Doctors’ experiences in a Canadian urban area. Journal of Nervous and Mental Disease, 199, 738-743. 

Ashmore, R. Jones, J., Jackson, A., & Smoyak, S. (2006). A survey of mental health nurses’ experiences of stalking. Journal of Psychiatric and Mental Health Nursing, 13, 562-569. 

Farber, S. (2015 ) My Patient, My Stalker Empathy as a Dual-Edged Sword: A Cautionary Tale. American Journal of Psychotherapy | Vol 69, No. 3, 331-355. 

Galeazzi, G.M., Elkins, K., & Curci, P. (2005). The stalking of mental health professionals by patients. Psychiatric Services, 56, 37-138. 

Gentile, S. R. , Asamen, J. K., Harmell, P.H.,, & Weathers, R. (2002). The stalking of psychologist by their clients. Professional Psychology, Research and Practice, 33, 490-494. 

Lion, J.R., & Herschler, J.A. (1998). The stalking of clinicians by their patients. In J.R. Meloy (Ed.), The psychology of stalking: Clinical and forensic perspectives (pp. 163-173). San Diego, CA: Academic Press.

Mark M. A. Bureau of Justice Statistics, January 22, 2015, NCJ 248470.

Pope, K. S., & Vasquez, M. J. T. (2011). Ethics in psychotherapy and counseling: A practical guide (4th ed.). John Wiley & Sons Inc.

Romans, J.S. C., Hays, J.R., & White. T. K. (1996). Stalking and related behaviors experienced by counseling center staff members from current or former clients. Professional Psychology: Research and Practice, 27, 595-599. 

Sheridan, L. North, A. C. & Scott, A. J. (2019). Stalking in the Workplace. Journal of Threat Assessment and Management. Vol. 6, No. 2, 61-75.

Smoyak, S. (2003). Perspectives in mental health clinicians on stalking continue to evolve. Psychiatric Annals, 33, 641-648. 

Storey, J.E., Hart, S.D., & Lim. Y.L. (2017). Journal of Threat Assessment and Management. Vol. 4, No. 3 122-143. 

U.S. Department of Justice Office of Justice Programs. Bureau of Justice Statistics, January 2015. https://www.bjs.gov/index.cfm?ty=pbdetail&iid=5217

Whyte, S., Penny, C., Christopherson, S., Reiss, D., & Petch, E. (2011). The stalking of psychiatrists. International Journal of Forensic Mental Health, 10, 254-26.

Lower view of professional woman walking on a rainy cobblestone roadEvery January since 2004, National Stalking Awareness Month has taken place to raise awareness of the impact stalking can have on its victims. Below are some stalking statistics and facts that highlight just how detrimental stalking can be to a person’s safety, mental health, and emotional well-being.

If you are being stalked, stay alert and reach out for help. Making sure trusted friends or family members know about the situation is a good idea, as is documenting any evidence of the stalking and reporting the incident to your local law enforcement.

Stalking Statistics: The Big Picture

Statistical Risk Factors for Being Stalked

How Stalking Impacts Victims

Stalking on College Campuses

Stalking and the Justice System

Facts About Stalkers

It’s normal for stalking to cause strong feelings of fear, anxiety, and even anger in those who are targeted. Working with a compassionate therapist can help you overcome trauma and other mental health impacts of stalking.

References:

  1. Ngo, F. (2018). Same-sex and opposite-sex stalking in the United States: An exploration of the correlates of informal and formal coping strategies of the victims. International Journal of Criminal Justice Sciences, 1(13), 230-246. doi: 10.5281/zenodo.1403433
  2. Stalking fact sheet. (n.d.). Stalking Prevention, Awareness, and Resource Center. Retrieved from https://www.stalkingawareness.org/wp-content/uploads/2019/01/SPARC_StalkngFactSheet_2018_FINAL.pdf
  3. Stalking. (2017, July 24). Bureau of Justice Statistics. Retrieved from https://www.bjs.gov/index.cfm?ty=tp&tid=973
  4. Stalking. (2016). The National Center for Victims of Crime. Retrieved from https://ovc.ncjrs.gov/ncvrw2016/content/section-6/PDF/2016NCVRW_6_Stalking-508.pdf
  5. Stalking statistics. (n.d.). Retrieved from http://sites.jcu.edu/vpac/pages/educate-yourself/stalking/stalking-statistics
  6. Tjaden, P., & Thoennes, N. (2000). The role of stalking in domestic violence crime reports generated by the Colorado Springs Police Department. Violence and Victims, 15(4), 427-441. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11288939
  7. Quick guide to stalking: 16 important statistics, and what you can do about it. (2017, January 30). National Coalition Against Domestic Violence (NCADV). Retrieved from https://ncadv.org/blog/posts/quick-guide-to-stalking-16-important-statistics-and-what-you-can-do-about-it
  8. West, S. G., & Hatters-Friedman, S. (2008, August 10). These boots are made for stalking: Characteristics of female stalkers. Psychiatry (Edgemont), 5(8), 37-42. Retrieved from http://innovationscns.com/these-boots-are-made-for-stalking-characteristics-of-female-stalkers

Dear GoodTherapy.org,

I have been with my boyfriend for going on three years. A couple of months ago, he said he thought it would be “healthy” for us to be able to have access to each other’s phones. He wants to be able to read my text messages whenever he wants and says he’s okay with me reading his too.

I thought this request was odd, to say the least. I told a couple of friends about it and they also said it was weird. Neither one has an “open phone” policy with their partners. They think it speaks to trust issues on his part.

[fat_widget_relationships_right]

We don’t have a history of infidelity, so that can’t be it. I’ve never betrayed him in any real sense. The only thing I can even think of that created any sort of weirdness in our relationship was when I got hit on at a friend’s wedding. That was about six months ago, and while I did accept a friend request from the guy on Facebook, we have only exchanged a couple of comments on public posts. Friendly, but nothing racy. My boyfriend mentioned our interactions once but not in a way that would suggest he felt threatened or insecure. Anyway, I asked him if that had anything to do with his request and he said no.

So I’m not sure what’s going on, but I don’t like knowing my boyfriend insists on seeing my messages. To avoid giving him cause for alarm, I told him I’m fine sharing. We keep our phones unlocked now and he is free to look at mine whenever he wants. Though I’ve never witnessed him doing it, I know he does. I have never looked at his. I just don’t feel a need.

What do you think is happening here? Am I going about this the right way? Should I insist on a boundary? —Open-Ended

Submit Your Own Question to a Therapist

Dear Open-Ended,

Thanks for writing in. I, too, have some concerns about this “open phone” policy and understand your reluctance, which I encourage you to pay more attention to. Before expounding, however, I’m going to briefly discuss what, exactly, a “boundary” is, in my clinical experience, since the term gets thrown around a lot while meanings differ.

Since I like to work from a point of view I call “emotional mindfulness”—and what are love and intimacy if not emotion-based experiences?—I think of a boundary as an inflection point beyond which one will suffer in an unacceptable way. This point of departure most often concerns a specific behavior which causes a person a level of distress or suffering they are not able or willing to tolerate.

It is, in other words, a way of warding off a negative emotional experience, which is why it’s so important such things be discussed in a relationship with as open a mind and heart as possible—even or especially when they don’t “make sense” or conflict with our own way of viewing things. Concrete statements can be debated, while feelings remain indisputably personal: “here is how someone ought to behave in a situation” versus “this is what upsets or hurts or feels positive about this.”

My sense is you and your boyfriend are somehow missing each other in this regard. On the one hand, you say, “To avoid giving him cause for alarm, I told him I’m fine sharing [phones].” Thus, after some internal deliberation and perhaps anxiety, you agreed with his request—except you are writing to me about it, indicating there remains some anxiety or reservation.

The concern I have here is that the focus has become centered on the mechanics rather than the emotional meaning of this sharing. By “meaning,” I refer to how you both think and feel about what’s happening and how it impacts the relationship. In a way, the background dilemma has been tabled, not solved.

The fact a guy hit on you at a wedding became understandably concerning for your boyfriend; this guy then “friended” you on Facebook, which you accepted. While your trusting of others isn’t a bad thing unto itself, I would hope you can see how that might have been anxious-making for your partner, perhaps due to some of his own history (just as some of yours may have impacted your decision to friend the guy and/or agree to share phones).

In all fairness, your boyfriend did not come out and discuss his concerns explicitly, which is part of the “missing each other” I mention above. He took a literal or physical approach rather than risking vulnerability in discussing it. You may have taken a similar route in agreeing to share your phone when you were hesitant, both of you bypassing the emotional risk or vulnerability so crucial to building closeness or intimacy.

I find generally that all behavior, especially when it concerns a close relationship, is a kind of communication, sometimes revealing intention that may or may not be conscious. On some level, your boyfriend’s impulse to check your phone—which will require checking and rechecking because it doesn’t address the underlying emotional problem, another reason it’s only a Band-Aid solution—is a way of saying, “I don’t trust you.”

Your decision to friend this fellow—and here I’m reaching a bit—could mean you do not like to feel constrained, for example in who you do or don’t befriend or interact with. You might believe, “I told him I’m taken, he gets it, and I’m fine with it.” Of course, your boyfriend could harbor similar sentiment about checking your phone: “I’m not suspicious of anything in particular, it’s just a way of shoring up trust and makes me feel better.” It sounds like both of you are facing common human anxieties that might, if mutually shared and understood, lead to deeper understanding and a strengthened emotional bond.

The “I’m” and “me” parts are key. It’s hard to put the “we” above “me” in any relationship, especially when we don’t get the other person’s point of view (more on that in a second), or if that POV conflicts with or appears to get in the way of our autonomy, freedom, and so forth.

I find generally that all behavior, especially when it concerns a close relationship, is a kind of communication, sometimes revealing intention that may or may not be conscious. On some level, your boyfriend’s impulse to check your phone—which will require checking and rechecking because it doesn’t address the underlying emotional problem, another reason it’s only a Band-Aid solution—is a way of saying, “I don’t trust you.”

It could also be saying, “I do trust you, but I get so anxious about this that I must have validation or confirmation. It’s hard to say no to this need to know.”

Your deciding to friend the guy at the wedding is a way of saying, “Hey, you can trust me, I’m loyal to you.” It could also be a matter of “I have a hard time saying ‘no’ as it might hurt the other person’s feelings, so it’s safer to just agree.”

Both of you overlap in saying, “Please understand this, don’t be hurt”—agreeing with the other’s behavior in a way that misses the underlying, more vulnerable anxieties or hopes for understanding. Thus, the relationship remains anxiety-laden, which is probably why you decided to write in.

In either case, you and your boyfriend have real (and understandably human) vulnerabilities around trust and betrayal. It’s worth sitting down with each other for an open conversation in which you try to hear the other person out in terms of their hopes and fears. If this feels uncomfortable, reach out to a therapist who can help facilitate things in an impartial way.

Perhaps your boyfriend was once betrayed by a partner, leading to anxiety around a repetition of this; perhaps you once said no to someone and it backfired or hurt you. In either event, I would think the solution has to come from within each of you in a shared way, rather than a physical or concrete way of controlling anxiety and postponing some stepping-outside-the-comfort-zone. We cannot avoid the need to emotionally stretch—sometimes awkwardly, uncomfortably—in the growth required for long-term intimacy.

I see this in couples counseling all the time, where one person needs to turn up the volume on their wants or needs (yourself, in this case), while the other needs to dial it down a bit in terms of intrusiveness or demand (your boyfriend)—while both partners attempt to center on the emotional vulnerabilities driving the conflict, rather than resting in an external solution. Putting the cart before the horse is something we all do, though the “horse” (i.e., the relationship) only ends up feeling blocked, restless, or cagey.

I hope this helps. Thanks again for writing!

Darren Haber, MFT, PsyD

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