How to Help the Hoarder in Your Life:
Some Suggestions for Family and Friends
Renae M. Reinardy, Psy.D., LP
Hoarding is a condition that not only affects the individuals who suffer from it, but also the people who care about them. Family members and friends are often concerned about their loved ones who exhibit this behavior, but find that their attempts to help are often met with resistance and rarely result in long term change. Family members living with the hoarder experience the hoarding more directly and can be negatively impacted in a number of ways (e.g. not being able to use areas of the house, allergies, safety threats, and psychological stress). I have worked with many families who present for treatment after a disastrous attempt to help clean up their loved one's home. A common situation is where adult children will go into to their parent’s cluttered home and clear it out without permission. The most common reactions from the parent who hoards are deep feelings of betrayal, anger, anxiety, and grief. Most family members expect some type of negative reaction, but are often shocked by the intensity of the emotions. It can take several months, or even years for hoarders to recover from a situation like this.
I can appreciate how difficult it is to see your loved one living in a way that you view to be substandard, and in may cases even dangerous. Hoarding is a complicated condition and it requires a comprehensive plan in order to produce long-term change. There are numerous factors to consider in deciding on the best approach to help your loved one. In this article I will offer tips on how family and friends can be helpful, briefly describe some components of treatment, and make some suggestions on how to decrease stress in a crisis situation.
Where to Start:
First you should educate yourself about this behavior. In the past few years there have been a handful of books written by experts who treat this condition. Go to the International OCD Foundation (IOCDF) website and look at the Book List for some excellent resources . This behavior is so much more than messiness and treatment includes much more than just cleaning the house. Hoarding involves both skills deficits that are likely biological in nature, and learning patterns that have been in place for many years, often decades. Many hoarders also have become isolated, distant, and less active. They may replace relationships with connections to their items. Hoarders often find their possessions to be sources of opportunities, reminders of events or people, pleasurable, and/or extensions of themselves.
Help your loved one find a professional in your area. In some areas this will be a difficult task, but visit the IOCDF Treatment Provider Database to look for a local therapist. There are not many therapists who specialize in this behavior. You would likely be best served by working with a cognitive behavioral therapist who is familiar with hoarding or is willing to learn. Again, the IOCDF Book List has great resources for professionals. Supervision and continuing education are also often offered by experts in hoarding.
Be patient. Understand that change is very difficult for most hoarders and therapy is not a “quick fix.” The goal of cognitive behavioral treatment (CBT) is to teach clients the skills that they need to manage problematic behavior on their own.
Reward progress. The change process starts out very slowly in treatment. It may take 1 hour to go through a 1/2 inch stack of papers. As with any skill, as the person who hoards gets more practice in making decisions regarding their items, the process gets easier and things speed up. Remember to give verbal praise to your loved one for any effort they put into changing this behavior.
Avoid common traps. Because the process is slow, most family and friends feel pressured to accelerate the process by helping the hoarder make decisions about their possessions, or by just doing it for them. Since this is a skill, like doing Algebra, if you do it for them they are not going to learn. When the hoarder does not have an active role in the decluttering process the home almost always becomes recluttered. Also, be mindful of the comments you are making to the hoarder in your life. It is often not motivating to remark on how little they are doing, or how long it will take if they keep going at their current rate. You will also have to control your excitement to move on to other areas once one area is clear. Take pause to notice what they have already accomplished. These tips make sense to most people, but they can be difficult to actually follow.
Show them kindness. Remember that hoarding is just one component of this individual. Don't forget about all of the things that you enjoy about them. I can understand that you may feel cheated by this behavior, but you should know that hoarding is rarely malicious. Most people who hoard find it very difficult to change on their own. Saving their stuff does not mean that they care more about their stuff than you. They are literally unable to do what you have asked of them, which is often to “just throw it out.” It is good to rebuild your relationship by doing enjoyable activities together, as strong relationships often make it easier for hoarders to part with their possessions.
What happens in treatment?
While therapy should be individualized to meet the client’s particular needs, there are common components that are used in successful treatment. Psychoeducation should always be a part of the treatment so that the person who hoards understands that there are millions of Americans who suffer from this condition and that there is treatment available. This often gives people hope, where often there was none.
A behavioral assessment is made to assess the level of clutter in the home, and the thoughts and behaviors that maintain the problem. Compulsive acquisition is also assessed. After the assessment, a behavioral plan is collaboratively made with the client and therapist on how best to start processing the items in the client's home. Target areas are established and the hoarder begins making decisions about their items. Exposure and response prevention strategies are also used to gradually expose clients to difficult decisions, and to resist the urge to avoid or go back on their decision. Therapists never make decisions for the client and should never touch an item without explicit permission. Clients may bring items into the office or the therapist may make a home visit at some point during treatment. Simple categorical systems are put into place to help the client develop a systematic way to process their items. Churning is strongly discouraged and items should be placed into a final category, rather than just being moved from one place to the next. Clients will save more items in the beginning than what they will toward the end of treatment.
Throughout the decluttering process, clients are asked to identify, challenge, and replace thoughts that are contributing to their acquisition, avoidance, and saving difficulties. Treatment should proceed systematically and goals are adjusted to set the client up for success. The completion of weekly homework is an essential component of successful treatment. As hoarders progress through treatment, they are able to learn the skills to change thinking and behavioral patterns, which result in long term changes that help them maintain their decluttered living environment. Relapse prevention is discussed with clients and they may need occasional booster sessions to maintain their gains long term.
There can be factors that prohibit the therapeutic process from proceeding in the way that I just briefly described. When hoarders are living in truly dangerous conditions (e.g. home structural problems, extreme fire hazard, mold, animal waste), are involved in legal issues, dealing with social service agencies (e.g. child protective services), have a deadline to move out of their home (e.g. eviction, move to assisted living, sale of home), or are physically unable, then other means may be necessary. In these situations family members, friends, hired help or even legal authorities may become involved in the disposal of items. It is important to understand how incredibly stressful this can be for the individual who hoards. It is also important to understand that the hoarder will often harbor strong negative feelings toward the individual(s) involved in the process.
One way to diminish the negative effects of this situation is to work with a therapist in a “crisis management” type of way. In most situations the hoarder should be aware of what needs to happen and how it is going to occur. They should be given the opportunity to work with someone to decide on necessities that need to be removed from the home. Of course, the individual will not be able to save as much as they wish, but there can be truly important items that they want to retrieve that others may not know about (e.g. a picture of their mother, diary, special jewelry item, hidden cash, or a favorite shirt). When they are able to retrieve a few of these items, it can make an extremely difficult situation a bit easier.
Once the home is decluttered, understand the hoarding problem is not solved. If the hoarder does not learn the skills that they need, recluttering their old environment or new one is highly likely. In treatment a therapist can help the individual process the event, mend relationships, and to learn the skills to overcome their hoarding so that they will likely never have to go through that situation again.
There is much more information now available on hoarding, but additional work needs to be done to improve the availability of treatment and its efficacy. Resources are also lacking in providing services to family members and social service organizations in dealing with hoarding. While hoarding can be a difficult condition to treat, it is often treatable. Some of my most devoted, funny, intelligent and caring clients have suffered from this condition.
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