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 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 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)...