Compulsive Hoarding and Acquiring
by Gail Steketee, Ph.D. and Randy Frost, Ph.D.

Review by Jerome Bubrick, Ph.D.

Private Practice, Montclair, NJ

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I am honored to review Compulsive Hoarding and Acquiring in the “Treatments That Work” series by Gail Steketee, Ph.D., and Randy O. Frost, Ph.D. The truth is when two prominent researchers and clinicians get together and write a book, the review process is quite easy. Compulsive Hoarding and Acquiring is a welcomed empirically-based treatment manual for compulsive hoarding and should help many people with the often debilitating condition. Compulsive Hoarding and Acquiring comes in the form of a therapist guide and a client workbook. They work hand-in-hand and direct the clinician- client team through the different stages of psycho-education, treatment and relapse prevention. Both are written with a very friendly, but directive tone; and the reader instantly recognizes the authors’ knowledge of compulsive hoarding. The Client Workbook is clear in making the point that it is to supplement the treatment by a clinician. It contains interactive worksheets that allow the client to record thoughts and beliefs as they occur naturally, complete rating assessments, formulate treatment goals and do cognitive and behavioral experiments. Additionally, there are “personal session forms” that allow the client to take meaningful notes during sessions under clear subheadings including: agenda, main points, homework to discuss next time and intervention strategies used. If needed, the client can download more worksheets from the “Treatments That Work” website.

From the first pages of the book, the Therapist Guide educates its readers about compulsive hoarding, including prevalence, insight, co-morbidity, and the scientific evidence that supports their approach. They emphasize the need for a therapist-client collaboration and give the clinician methods to incorporate the Client Workbook into the treatment. The authors recommend that clinicians read through the entire book first to become familiar with the model and treatment approach prior to working with clients. This I find an especially good point, because there is often a great deal of variability between clients, so having a thorough understanding of the treatment and its components is essential to providing effective treatment. Furthermore, they structure and explain the cognitive and behavioral model of compulsive hoarding so soundly that both the seasoned CBT therapist and newcomers alike can understand the condition well.

The intervention program is divided into several distinct phases including: Assessment, Case formulation, Skills training, Exposure and Cognitive therapy, Motivational interviewing, and Relapse prevention. The treatment is designed to occur over a six month period, but it can be longer or shorter depending on the severity of the hoarding. What I really like about the book is the development and use of new and creative exercises. For example, within the Assessment phase, the authors provide several assessment measures including rating scales on saving and discarding, activities of daily living, and beliefs about saving. They have included a great new scale called the “Clutter Image Rating Scale” that gives the client pictures of varying degrees of clutter in sample rooms, including a bedroom, kitchen and living room. The client is then asked to match his/her level of clutter in his/her own corresponding rooms. I think this is a wonderful addition to the existing resources, as it is likely to prompt the clients to provide more accurate and valid ratings of their clutter.

The clutter and unclutter visualization is another innovative exercise to help assess a client’s motivational status. Essentially, clients are asked to visualize cluttered spaces and then visualize those same spaces without clutter and give feedback on their thoughts and emotions. If it appears to the clinician that motivational or insight issues may impede the treatment process, wonderful suggestions and techniques are offered in the motivational interviewing chapter.

When reading the chapters on problem-solving and learning a personalized organizational system, the reader truly sees how much experience the authors have in clearing clutter and maintaining a clutter-free situation. They give a wide variety of organizational skills and suggestions, such as how to categorize and organize papers, how to set up a filing system with commonly used filing categories, and guidelines are given on how long to keep certain items, like tax returns and credit card receipts. Again, the use of the Client Workbook reinforces what is learned in sessions, and the clients are able to use their own worksheets to develop their own system.

The chapters that address exposure with response prevention and cognitive therapy truly reflect the authors’ knowledge of and experience with treating hoarding. The case vignettes provide superb direction in how to facilitate change without being forceful or antagonistic. I really liked the section that challenges the clients’ wants versus needs with respect to acquiring. This is a huge distinction to be made in order to reduce the acquisition of new items.

Gail Steketee and Randy Frost have created a grounded, well-organized and soundly written treatment manual for an extraordinarily difficult condition. I highly recommend this book for everyone who suffers from compulsive hoarding and for those who want to successfully treat it. The only problem I have with this book is that one copy won’t be enough, you’ll probably need to purchase three!!!

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