Interestingly, a female patient also exhibited unwanted behavior toward Dr. Orion’s psychiatrist husband. This patient frequently parked in front of their home in the evenings. Unlike Fran, whose stalking behaviors became increasingly intrusive, frightening, and violent, this patient did not escalate her behavior. It was an unwanted intrusion, but he did not feel fearful or victimized by it. Therefore, it didn’t meet the clinical or legal definition of stalking—the unwanted behaviors must produce fear in the victim. Another psychiatrist, however, might consider the same scenario to be fearful.
Terminating the therapeutic relationship
Once you have reviewed the case with a colleague and/or a threat-assessment professional and determined that you feel uncomfortable and unsafe, it’s time to terminate the doctor-patient relationship.
Ethical and professional care dictates that you provide the patient with a reasonable written notice (e.g., 30 days) prior to termination. Three referral options with phone numbers are typically provided. This also protects you from a potential malpractice tort of abandonment while the patient still needs treatment. If you sense possibly imminent danger, however, you may need to abbreviate the 30-day notice.
Write a summary note in the patient’s chart that includes, in addition to the usual case summary components, the following:
- Your reason(s) for termination. Include discussion with colleagues and/or threat assessment or law enforcement professionals;
- Your diagnostic and treatment impressions, the treatment provided, and the patient’s response to treatment;
- Your referral choices and the rationale for those decisions, e.g., “female patient with schizophrenia and erotomanic delusions and a history of same-sex stalking referred to a male psychiatrist.” The referral should be made to an outside agency or system. (Once Dr. Orion realized that she was being stalked, she initially made the mistake of transferring her patient to a male colleague who shared her office suite, thus making it easy for Fran to continue to stalk Dr. Orion in her own office.)
- Documentation of your discussion with professionals to whom you are referring the patient, along with the patient’s release of information permitting you to do so.
- Documentation of your discussion with the patient. If applicable, include your statement that you feel it is in the patient’s best interest to continue psychiatric care.
- A copy of the termination letter.
If the stalking persists, the psychiatrist should follow guidelines for victims provided later in this article.
J.P. and his ‘ex-girlfriend’
J.P., 19, met Ms. T. when both were 16 and still in high school. Ms. T. was a “partying friend”; they smoked pot together and “hung out.” Although they never dated nor had a romantic relationship, J.P. found Ms. T. to be “pretty and fun,” and developed secret romantic feelings for her.
In their senior year, J.P. wrote Ms. T. a letter professing his love for her. She laughed at it, was dismissive of his feelings, and shared it with friends. He subsequently felt humiliated and rejected and, in retaliation, began spreading rumors that she was a “witch” and a “lesbian.”
After their graduation, they saw each other on a few occasions at parties, but rarely spoke. About a year and a half later, J.P. saw Ms T. with a man he had once fought. He regarded this man as “no good” and a poor choice on Ms. T.’s part. He obtained her phone number from one of their mutual high school acquaintances and called her. They spoke briefly; he accused her of “using drugs and dating an asshole.”
LEGAL, CLINICAL DEFINITIONS OF STALKING
In Ohio, the legal definition of menacing by stalking* includes:
- Engaging in a pattern of conduct that knowingly causes another to believe that the offender will cause physical harm to the other person or cause mental distress to the other person
- A first-degree misdemeanor or fourth-degree felony
Clinical definitions of stalking include:
- The willful, malicious, and repeated following and harassing of another person that threatens his or her safety
- Repeated and persistent unwanted communications and/or approaches that produce fear in the victim
Unwanted communications or behaviors that a stalker might engage in:
- Sending letters
- Phone calls
- E-mails
- Appearing at victim’s home or workplace
- Destroying property
- Assault
- Murder
Typical profile of a stalker:
- Male
- Unemployed or underemployed
- Single or divorced
- Criminal, psychiatric, and drug abuse history
- High school or college education
- Significantly more intelligent than other criminals
- Suffered loss of primary caretaker in childhood
- Significant loss, usually of a job or relationship, within a year of the onset of stalking
*Ohio revised code. Sec. 2903.211
2 controversies in dealing with stalkers
- Whether to change a phone line. One recommendation is to maintain the phone line with an answering machine turned down and let the stalker call it. The victim then obtains another phone line and gives the number only to select friends, colleagues, etc. This way the stalker has a venue for self-expression but the victim does not have to listen to it. Law enforcement can be given the tapes for review. By allowing the stalker continued access to the phone line, the stalker does not have to seek out other potentially more violent ways to pursue his or her victim.
- Whether to seek a restraining order. There is some disagreement on whether restraining orders are useful. In some cases, a restraining order may escalate the situation, such as with prior intimates. In other situations, it may give the victim a false sense of security and ultimately may be of little use if the stalker violates it. When the stalker violates a restraining order and experiences no significant painful consequences, this can increase his sense of power and correspondingly reduce that of the victim.
Source: www.stalkingassistance.com