Group Treatment For Compulsive Hoarding

Ancy E. Cherian, MA, Todd J. Farchione, Ph.D.,
and Shawnee L. Basden, BA

The Center for Anxiety and Related Disorders
at Boston University, Boston, MA

Efforts are currently underway to develop effective treatments for compulsive hoarding, including both individual and group treatments. Although the relative effectiveness of group treatment for hoarding is not well established, results from recent studies are promising. The current paper will briefly highlight the key components and patient response to a group treatment for compulsive hoarding.It was developed by Drs. Gail Steketee and Randy Frost currently implemented at The Center for Anxiety and Related Disorders at Boston University.

Cognitive behavioral group treatments for hoarding consist of psycho education about hoarding, hands on exercises targeting hoarding behaviors, and homework in which new skills are practiced. The main goals of the treatment are to help patients correct cognitive errors regarding the value of possessions, facilitate the discarding of unwanted items, enhance categorization and organization of kept items, and prevent excessive acquisition and buying.

In our group treatment, we have found the hands on learning exercises, such as sorting and discarding items during treatment sessions, are particularly helpful in enhancing a patient's understanding of treatment concepts and in generalizing learned skills. Home visits are sometimes included to help clients apply techniques and skills learned in session to their everyday lives.

The duration of group treatment is typically 15 to 30 sessions spaced over a 6-month period.

Treatment sessions are usually scheduled weekly, but can be more or less frequent depending on the group's needs. Groups are usually made up of five to six patients and may be led by one or two therapists. We have found that groups of this size allow members to reap the benefits of a larger supportive context while also receiving individual attention to specific needs. In order to afford patients an opportunity for even more individualized consideration within the group setting, we sometimes find it helpful for patients to branch off into smaller groups, each led by a therapist, during in-session treatment exercises.

In our experience, most patients enjoy this format of treatment (assuming good cohesion among group members). They feel that their individual needs are adequately addressed. However, there are some instances when issues may surface that cannot be sufficiently covered within the group format. When this occurs, supplementary case management and more individualized attention may be needed. For instance, when there are more severe hoarding problems and greater functional impairment, additional measures may need to be taken. These are organizing family meetings and helping clients deal with the legal ramifications of their problem (i.e., eviction).

As in most therapies for mental health difficulties, a group setting inherently offers a supportive framework that can facilitate growth and learning. Many patients with compulsive hoarding report feeling misunderstood and socially isolated because of their problem. As such, we have found that the group treatment setting provides patients with an excellent opportunity to openly discuss their feelings and address their hoarding problem within a supportive social context. In addition to providing support, group members often learn from one another's failures and offer each other suggestions on how to tailor treatment techniques to suit individual needs.

Overall, it seems that individuals with patterns of compulsive hoarding appreciate and may even prefer a group treatment format. Not only does the group setting provide sources of social contact, but it also enables members to be in the presence of others with similar difficulties, which can ultimately normalize a condition that outsiders typically do not understand.