1 { Hoarding Hoarding Maria M. Maria M. Talbott Talbott, M.S.W., Ph.D., Associate Professor , M.S.W., Ph.D., Associate Professor [email protected]; 503 [email protected]; 503-725 725-5008 5008 Marcos Marcos Bote Bote, Ph.D. , Ph.D. ANNUAL CONFERENCE MAY 17-20, 2015 REDMOND, OR The Collyer brothers, Homer and Langley, died The Collyer brothers, Homer and Langley, died in their house on 5 in their house on 5 th th Avenue in Harlem, NY, in Avenue in Harlem, NY, in 1947. Homer had become blind and paralyzed. 1947. Homer had become blind and paralyzed. Langley used to get food and bring it to him, Langley used to get food and bring it to him, but Langley had been crushed by a booby trap but Langley had been crushed by a booby trap he set for intruders into the home. Langley he set for intruders into the home. Langley died, and then Homer had starved a few days died, and then Homer had starved a few days later. This had happened before the police later. This had happened before the police entered the home. It took them 2 weeks to find entered the home. It took them 2 weeks to find Langley’s body. In their house was found 140 Langley’s body. In their house was found 140 tons of stuff, including a Model T chassis, 14 tons of stuff, including a Model T chassis, 14 pianos and more than 25,000 books pianos and more than 25,000 books The The Collyer Collyer Brothers Brothers
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HoardingHoarding
Maria M. Maria M. TalbottTalbott, M.S.W., Ph.D., Associate Professor, M.S.W., Ph.D., Associate [email protected]; [email protected]; 503--725725--50085008
Marcos Marcos BoteBote, Ph.D., Ph.D.
ANNUAL CONFERENCE
MAY 17-20, 2015
REDMOND, OR
�� The Collyer brothers, Homer and Langley, died The Collyer brothers, Homer and Langley, died in their house on 5in their house on 5thth Avenue in Harlem, NY, in Avenue in Harlem, NY, in 1947. Homer had become blind and paralyzed. 1947. Homer had become blind and paralyzed. Langley used to get food and bring it to him, Langley used to get food and bring it to him, but Langley had been crushed by a booby trap but Langley had been crushed by a booby trap he set for intruders into the home. Langley he set for intruders into the home. Langley died, and then Homer had starved a few days died, and then Homer had starved a few days later. This had happened before the police later. This had happened before the police entered the home. It took them 2 weeks to find entered the home. It took them 2 weeks to find Langley’s body. In their house was found 140 Langley’s body. In their house was found 140 tons of stuff, including a Model T chassis, 14 tons of stuff, including a Model T chassis, 14 pianos and more than 25,000 bookspianos and more than 25,000 books
The The CollyerCollyer BrothersBrothers
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�� Very severe clutter, usually getting in the way Very severe clutter, usually getting in the way of normal living and causing problems. of normal living and causing problems.
�� Having a large number of animals and Having a large number of animals and neglecting neglecting them: not them: not providing basic providing basic care care ((food, sanitation, shelter)food, sanitation, shelter)
�� People who hoard usually accumulate things People who hoard usually accumulate things (or animals) and keep getting more.(or animals) and keep getting more.
�� Implies that the person is not able to get rid of Implies that the person is not able to get rid of the things or animals, even though they have the things or animals, even though they have far too many possessions to use, or too many far too many possessions to use, or too many animals to take care of. animals to take care of.
Hoarding DefinitionsHoarding Definitions
�� Subjectivity and controversy about what Subjectivity and controversy about what is “excessive,” or “useless” and whether is “excessive,” or “useless” and whether animals are being “harmed”animals are being “harmed”
�� Unclear line between collecting, saving Unclear line between collecting, saving and hoarding, hoarding may exist on a and hoarding, hoarding may exist on a continuum.continuum.
�� Hoarding term refers to problematic Hoarding term refers to problematic behavior, but: whose problem?behavior, but: whose problem?
�� Definition may include interference with Definition may include interference with daily functioning, distressdaily functioning, distress
�� Is it a mental disorder? Or a Is it a mental disorder? Or a SSocial ocial phenomenonphenomenon, defined , defined interpersonally?interpersonally?
A heterogeneous A heterogeneous conditioncondition
“Hoarding” is not an acceptable term to “Hoarding” is not an acceptable term to many hoarders (nor is “junk”). many hoarders (nor is “junk”).
Some terms that may be acceptable:Some terms that may be acceptable:your belongingsyour belongingsyour thingsyour thingsyour papersyour papersyour petsyour petsyour collectionsyour collections
Ask the hoarder how s/he refers to his or Ask the hoarder how s/he refers to his or her clutter, things, animals: use the term her clutter, things, animals: use the term that s/he uses. that s/he uses.
AssessmentAssessment——what to call what to call itit
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Ascertain if the hoarding is:Ascertain if the hoarding is:
--just a nuisance or just a nuisance or
--embarrassing to family members or embarrassing to family members or neighbors, or neighbors, or
--if it is imminently dangerous:if it is imminently dangerous:
Is it unsafe or harmful, or just very messy?Is it unsafe or harmful, or just very messy?AssessmentAssessment
�� Any possible danger associated with the hoarding should be Any possible danger associated with the hoarding should be assessed: assessed:
�� Is the hoarder able to prepare meals and to eat and Is the hoarder able to prepare meals and to eat and drink healthy food? drink healthy food?
�� Is he or she able to sleep? Is he or she able to sleep? �� Is he or she able to excrete in a working bathroom?Is he or she able to excrete in a working bathroom?�� Does the hoarder have shelter?Does the hoarder have shelter?�� Is the hoarder able to bathe or shower?Is the hoarder able to bathe or shower?�� Does he or she breathe healthy air?Does he or she breathe healthy air?�� Are others harmed by the hoarding? How? Are others harmed by the hoarding? How? �� Are animals being harmed?Are animals being harmed?�� Is there a fire risk?Is there a fire risk?�� Is there a danger of falls? Is there a danger of falls?
AssessmentAssessment
�� The level of risk should be assessed. The level of risk should be assessed.
When there is some risk or danger, the type, When there is some risk or danger, the type, extent, and likelihood of the risks would extent, and likelihood of the risks would determine whether coercive intervention might determine whether coercive intervention might be justified. be justified.
Some small level of risk should be acceptable. Some small level of risk should be acceptable.
AssessmentAssessment
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�� If it is just a nuisance or embarrassing, the If it is just a nuisance or embarrassing, the intervention may become increasing intervention may become increasing tolerance of the situation. People can learn to tolerance of the situation. People can learn to tolerate their discomfort. tolerate their discomfort.
�� In this case, the autonomy of the person who In this case, the autonomy of the person who hoards may trump community disapproval, hoards may trump community disapproval, and family and service providers might want and family and service providers might want to support each other in withstanding the to support each other in withstanding the disapproval. Issues that may come up for disapproval. Issues that may come up for others include property values, and others include property values, and professional reputations and liability. professional reputations and liability.
AssessmentAssessment
General measures:General measures:A) Living Conditions Rating ScaleA) Living Conditions Rating ScaleB) YaleB) Yale--Brown ObsessiveBrown Obsessive--Compulsive Scale:Compulsive Scale:
-- Hoarding subscale of the ObsessiveHoarding subscale of the Obsessive--Compulsive InventoryCompulsive Inventory
�� Specific measures:Specific measures:A) Frost and Gross 1993 (22 item) and 1998 (24)A) Frost and Gross 1993 (22 item) and 1998 (24)B) Saving InventoryB) Saving Inventory--Revised (SIRevised (SI--R, Frost et al, 2007) R, Frost et al, 2007) 26 to 23 (five point scales)26 to 23 (five point scales)C) Spanish Version of the SIC) Spanish Version of the SI--R (TortellaR (Tortella--Feliu et al, Feliu et al, 2006) 2006) D) Saving Cognitions Inventory (SCI, Steketee et al, D) Saving Cognitions Inventory (SCI, Steketee et al, 2007) (24 items)2007) (24 items)
How to measure it?How to measure it?
�� Incidence: Unknown. Some estimates:Incidence: Unknown. Some estimates:�� 1/2000 (Macmillan & Shaw, 1966)1/2000 (Macmillan & Shaw, 1966)
�� 26/100.000 (Frost et al, 2000)26/100.000 (Frost et al, 2000)
�� 1.000.000 < 2.000.000 (Saxena, 2007) in US1.000.000 < 2.000.000 (Saxena, 2007) in US
�� 3,000,ooo + in US3,000,ooo + in US
�� Age/Onset:Age/Onset:
Onset in childhood or adolescence, Onset in childhood or adolescence, severity increases with ageseverity increases with age
After a traumatic episode or together with After a traumatic episode or together with a psychiatric or psychological conditiona psychiatric or psychological condition
Incidence and OnsetIncidence and Onset
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�� Family patterns:Family patterns:
Past history of relatives hoarding (although this can also Past history of relatives hoarding (although this can also lead to the child being determined to lead to the child being determined to notnot hoard)hoard)
Many, especially older adults, live aloneMany, especially older adults, live alone
Couples hoarding (few cases in the literature)Couples hoarding (few cases in the literature)
Brothers hoarding (hoarders from Harlem)Brothers hoarding (hoarders from Harlem)
Often the rest of the family doesn’t like the hoarding but Often the rest of the family doesn’t like the hoarding but can’t get the person to stopcan’t get the person to stop
“My father taught me not to
throw things away in case
some day they would be
useful”
Male, Scotland
�� Reaction to loss, deprivation, scarcityReaction to loss, deprivation, scarcity
�� Loss of memoryLoss of memory
�� Projects, busyProjects, busy--nessness
�� IndecisivenessIndecisiveness
�� Emotional attachment to objectsEmotional attachment to objects
�� Feelings of usefulness to othersFeelings of usefulness to others
�� Loneliness, emptinessLoneliness, emptiness
�� DiversionDiversion
Possible Psychological and Possible Psychological and Social Causal FactorsSocial Causal Factors
�� Difficulty sorting and categorizingDifficulty sorting and categorizing
�� Heightened ideas about the value, potential for use, and meaning of Heightened ideas about the value, potential for use, and meaning of many different objectsmany different objects
�� Might need it in the futureMight need it in the future
�� Procrastination Procrastination
�� Perfectionism (need to make a perfect organizing system)Perfectionism (need to make a perfect organizing system)
�� Wanting to be preparedWanting to be prepared
Possible Psychological and Social Possible Psychological and Social Causal FactorsCausal Factors
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�� Not wanting to wasteNot wanting to waste
�� Lifetime accumulationLifetime accumulation
�� Desire for reassurance, safety, controlDesire for reassurance, safety, control
�� Pleasure of acquiringPleasure of acquiring
�� Impulse control issueImpulse control issue——shopaholicshopaholic
�� Cultural values about shopping, acquiring, havingCultural values about shopping, acquiring, having
�� Good deal (bargain)Good deal (bargain)
�� Wanting to give things to peopleWanting to give things to people
Possible Psychological and Possible Psychological and Social Causal FactorsSocial Causal Factors
�� Preserve identityPreserve identity
�� Forgetfulness about what things are, where they belongForgetfulness about what things are, where they belong
�� Fear that valuables may be mixed up with clutterFear that valuables may be mixed up with clutter
�� BoredomBoredom
�� Some clutter and disorganization leads to more disorganization Some clutter and disorganization leads to more disorganization and more clutter; having some animals can lead to their breeding and more clutter; having some animals can lead to their breeding and making baby animals. and making baby animals.
Possible Psychological and Possible Psychological and Social Causal FactorsSocial Causal Factors
�� PowerlessnessPowerlessness
�� Child abuse and domestic violenceChild abuse and domestic violence
�� Depression & lack of energyDepression & lack of energy
�� Some hoarders are lazy, as are some nonSome hoarders are lazy, as are some non--hoarders. Many people hoarders. Many people who hoard are depressed or paralyzed by their stuff, not lazy. who hoard are depressed or paralyzed by their stuff, not lazy.
�� Isolation is an effect and a cause of hoarding. Isolation is an effect and a cause of hoarding.
Possible Psychological and Social Possible Psychological and Social Causal FactorsCausal Factors
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Biological ConditionsBiological Conditions
1. Cerebral glucose metabolism (Baxter et al, 1988, Saxena et al, 1. Cerebral glucose metabolism (Baxter et al, 1988, Saxena et al, 2004)2004)
2. Genetics2. Genetics
�� Chromosome 14 for families with OCD (Samuels et al, 2007)Chromosome 14 for families with OCD (Samuels et al, 2007)
3. Damages in the mesial frontal 3. Damages in the mesial frontal region region (Anderson et al, 2004) of the brain:(Anderson et al, 2004) of the brain:
Psychological and psychiatric conditions:Psychological and psychiatric conditions:OCD and other anxiety disordersOCD and other anxiety disordersDepressionDepressionAnorexiaAnorexiaAutism/AspergerAutism/AspergerAttention Deficit Disorder / HyperactivityAttention Deficit Disorder / HyperactivityPersonality DisordersPersonality DisordersKleptomaniaKleptomaniaSocial PhobiaSocial PhobiaBrain damageBrain damageDementia/AlzheimerDementia/AlzheimerCapgras SyndromeCapgras SyndromeOCPDOCPDBipolar DisorderBipolar DisorderTourette’s SyndromeTourette’s SyndromeParanoid DisordersParanoid DisordersSchizophreniaSchizophrenia
�� Use of drugs or hospitalization (Highly Use of drugs or hospitalization (Highly ineffective)ineffective)
�� Paroxetine/fluvoxamineParoxetine/fluvoxamine
�� RisperidoneRisperidone
�� OlanzapineOlanzapine
Types of Intervention: Types of Intervention: PsychiatricPsychiatric
Types of Intervention: Types of Intervention: Coercion Coercion
May have to call Adult Protective Services, May have to call Adult Protective Services, health department, or housing inspector, or health department, or housing inspector, or landlord may have to threaten to evict or evict if landlord may have to threaten to evict or evict if anyone in danger, or Humane Society or public anyone in danger, or Humane Society or public animal control if animals in danger. Some animal control if animals in danger. Some pressure may be helpful.pressure may be helpful.
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Someone doing the cleaning out (“mucking Someone doing the cleaning out (“mucking out”) out”)
for the hoarder, all at once:for the hoarder, all at once:--ineffective long term, ineffective long term, -- may make the hoarding worsemay make the hoarding worse--may sometimes be necessary to avoid may sometimes be necessary to avoid eviction, imminent danger, etc. eviction, imminent danger, etc.
The person who hoards needs to learn how to The person who hoards needs to learn how to organize in a way that makes sense to that organize in a way that makes sense to that person, and needs to learn how to make person, and needs to learn how to make choices and needs to gain confidence in choices and needs to gain confidence in her/his abilities. her/his abilities.
CoercionCoercion
�� Psychosocial and TherapyPsychosocial and Therapy
�� The rest of the presentation is about these kinds The rest of the presentation is about these kinds of interventions. of interventions.
�� Goals need to be agreed upon before any sorting Goals need to be agreed upon before any sorting is attempted. is attempted.
Types of InterventionTypes of Intervention
Developing and SustainingDeveloping and Sustainingthe Hoarder's Motivationthe Hoarder's Motivation
“How does the clutter fit with the things that you value in life?”“How does the clutter fit with the things that you value in life?”
“How has this affected your spouse?”“How has this affected your spouse?”
“What are the successes you've had in the past in meeting challenges “What are the successes you've had in the past in meeting challenges and achieving goals?”and achieving goals?”
“How much time are you spending looking “How much time are you spending looking
for things?”for things?”
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Developing and SustainingDeveloping and Sustainingthe Hoarder's Motivationthe Hoarder's Motivation
Take pictures of the clutter.Take pictures of the clutter.
““How does the clutter affect your life?”How does the clutter affect your life?”
“What are the best things that could “What are the best things that could
come out of change?”come out of change?”
“What would you like your life to be in the future?”“What would you like your life to be in the future?”
Envision not Envision not loss loss but home as place of but home as place of
comfortcomfort and and acceptance.acceptance.
�� Questioning thinking errors, or cognitive Questioning thinking errors, or cognitive distortionsdistortions——strongly held beliefsstrongly held beliefs——that do not that do not serve the hoarder and prevent that person from serve the hoarder and prevent that person from moving forward in their life. moving forward in their life.
�� An example of a thought distortion: “Giving An example of a thought distortion: “Giving away or getting rid of something would make away or getting rid of something would make me feel guilty, it would mean I am a bad me feel guilty, it would mean I am a bad person.” This belief is untrue, and it helps keep person.” This belief is untrue, and it helps keep the hoarder surrounded by clutter. the hoarder surrounded by clutter.
�� Another example: “I’m so busy I’ll never have Another example: “I’m so busy I’ll never have time to get organized.”time to get organized.”
�� “I can’t make decisions about anything.” “I can’t make decisions about anything.”
�� “If I don’t buy this now, I’ll always regret it.” “If I don’t buy this now, I’ll always regret it.”
�� “I should be able to throw things away.” “I should be able to throw things away.” ––compares behavior to an compares behavior to an arbitrary standard that the hoarder is not then ready to meetarbitrary standard that the hoarder is not then ready to meet
�� “I bought this today, so I’m a failure.” “I bought this today, so I’m a failure.”
�� For a hoarder who is keeping things that are For a hoarder who is keeping things that are associated with a loved one who is gone: associated with a loved one who is gone:
Are you memorializing your loved one in Are you memorializing your loved one in a meaningful way, or might there be a more a meaningful way, or might there be a more fitting way of honoring their memoryfitting way of honoring their memory——a a charitable donation made in their name, or charitable donation made in their name, or keeping one small item rather than many? The keeping one small item rather than many? The loved one would probably feel most honored if loved one would probably feel most honored if the item is treated respectfully. the item is treated respectfully.
CBT: Thinking ErrorsCBT: Thinking Errors
�� For people who are hoarding because of having For people who are hoarding because of having experienced serious scarcity earlier in their lives: experienced serious scarcity earlier in their lives:
�� Are you shopping to make up for not having all the Are you shopping to make up for not having all the things you wanted or needed earlier in your life? things you wanted or needed earlier in your life?
�� Or are you afraid that you may not have what you Or are you afraid that you may not have what you need in the future? need in the future?
�� Will this item that you want to purchase resolve Will this item that you want to purchase resolve either problem? either problem?
�� Buying things you don’t need costs you money and Buying things you don’t need costs you money and makes you less able to provide the things you do makes you less able to provide the things you do need for yourself. need for yourself.
CBT: Thinking ErrorsCBT: Thinking Errors
�� “It’s a good deal” “It’s a good deal” �� Are you going to use it (at a specific time in the Are you going to use it (at a specific time in the
near future)?near future)?
�� Do you already have another like it at home? Do you already have another like it at home?
�� Will it take up space, causing you stress? Will it take up space, causing you stress?
�� Do you have a place for it? Do you have a place for it?
�� Does it need to be repaired? Does it need to be repaired?
�� Do you love it? Do you love it?
�� Distinguish between needs and wantsDistinguish between needs and wants
�� “It’s free” “It’s free” ––not if it costs in clutter, not if it costs in clutter, disorganization, and moneydisorganization, and money
CBT: Thinking ErrorsCBT: Thinking Errors
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�� With the person who hoards, we can:With the person who hoards, we can:
�� play out the scenarios of what might happen if play out the scenarios of what might happen if they didn’t have the thing that they don’t want to they didn’t have the thing that they don’t want to throw out, throw out,
�� talk about how bad would that be, talk about how bad would that be,
�� talk about how likely it is, and talk about how likely it is, and
�� what would be the advantages of being able to what would be the advantages of being able to give it away or discard it. give it away or discard it.
�� Practice letting go of valued objects (or not Practice letting go of valued objects (or not acquiring new ones) and sitting with the stress acquiring new ones) and sitting with the stress and anxiety = Exposureand anxiety = Exposure
�� Client usually finds that his prediction of how Client usually finds that his prediction of how bad he’d feel was worse than he actually felt, so bad he’d feel was worse than he actually felt, so he learns that he can handle parting with the he learns that he can handle parting with the things he doesn’t need. things he doesn’t need.
�� With practice, it becomes easier and represents With practice, it becomes easier and represents progress. progress.
�� After the experience, ask hoarder to report how After the experience, ask hoarder to report how serious the feelings of doubt (“I don’t know what serious the feelings of doubt (“I don’t know what I missed” and fear (I’ll never get over missing that I missed” and fear (I’ll never get over missing that opportunity”) are. Usually they are not as intense opportunity”) are. Usually they are not as intense as was expected. Usually they are tolerable. as was expected. Usually they are tolerable.
�� Getting rid of an item, and then experiencing the Getting rid of an item, and then experiencing the anxiety of that. Best to start with a lowanxiety of that. Best to start with a low--impact impact item here. item here.
�� Repeatedly facing one’s fears and learning to Repeatedly facing one’s fears and learning to manage the uncomfortable feelings an thoughts manage the uncomfortable feelings an thoughts associated with them allows anxiety to gradually associated with them allows anxiety to gradually fade away. fade away.
ExposureExposure
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�� Mail and miscellaneous Mail and miscellaneous paperpaper
�� MagazinesMagazines�� PhotosPhotos�� ClothingClothing�� CoatsCoats�� BooksBooks�� Audios and videotapesAudios and videotapes�� SouvenirsSouvenirs�� Decorative itemsDecorative items�� GamesGames�� HardwareHardware
Category List Category List ––ExampleExample
• Furniture
• Empty containers
• Food
• Kitchen utensils
• Pots, pans, dishes
• Cleaning tools
• Garden and yard tools
• Recreation equipment
• Paint equipment
• Pet Food & equipment
• Handicrafts
�� A combination of pressure and support, often A combination of pressure and support, often from two different sources, may bring about from two different sources, may bring about successful change. successful change.
�� The pressure of an external authority (e.g., the The pressure of an external authority (e.g., the possibility of being evicted or of losing all of possibility of being evicted or of losing all of one’s pets) may provide the motivation to one’s pets) may provide the motivation to change. change.
�� To convert the motivation into action, support To convert the motivation into action, support as well as pressure is needed. A friend, as well as pressure is needed. A friend, relative, or other “coach” can prevent the relative, or other “coach” can prevent the hoarder from becoming overwhelmed. hoarder from becoming overwhelmed.
Balance Pressure and Balance Pressure and SupportSupport
�� If resources are present, a professional organizer If resources are present, a professional organizer may be hired.may be hired.
�� Or try a friend, neighbor, family member, or Or try a friend, neighbor, family member, or caregivercaregiver
�� If the person who may be the coach has badgered, If the person who may be the coach has badgered, belittled or shamed the hoarder in the past, they belittled or shamed the hoarder in the past, they will probably need to change their behavior and will probably need to change their behavior and some time will be needed to gain trust. some time will be needed to gain trust.
A Sorting “Coach”A Sorting “Coach”
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�� May take time before coach is allowed into May take time before coach is allowed into residence. May need to gain trust first. But residence. May need to gain trust first. But can’t wait forever. can’t wait forever.
�� In general, coach provides support, In general, coach provides support, encouragement.encouragement.
�� Coaching takes time. Coaching takes time.
CoachingCoaching
�� Meet at regularly scheduled times with hoarder at her or Meet at regularly scheduled times with hoarder at her or his home. Don’t express shock, revulsion, or dismay. No his home. Don’t express shock, revulsion, or dismay. No criticism.criticism.
�� Expect to feel frustrated. Expect to feel frustrated.
�� Some things to Some things to notnot say:say:�� You’re never going to use that.You’re never going to use that.
�� Just throw it away! It’s no big deal.Just throw it away! It’s no big deal.
�� Just get rid of it. You won’t miss it. Just get rid of it. You won’t miss it.
A Sorting “Coach”A Sorting “Coach”
�� Start in one part of one room. Start in the Start in one part of one room. Start in the easiest room. Then move to area next to that easiest room. Then move to area next to that place. One room at a time.place. One room at a time.
�� Figure out places to keep things, and label Figure out places to keep things, and label them.them.
�� Avoid “churning” Avoid “churning” ––moving things from one moving things from one undifferentiated pile into another one. undifferentiated pile into another one.
�� Promise not to touch or move things without Promise not to touch or move things without permission. No clandestine throwing out. permission. No clandestine throwing out. Hoarder makes all decisions.Hoarder makes all decisions.
CoachingCoaching
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�� Help with staying on task, paying attention, Help with staying on task, paying attention, not becoming distractednot becoming distracted
�� Say: If an item doesn’t make you feel good, it’s Say: If an item doesn’t make you feel good, it’s ok to get rid of it. ok to get rid of it.
�� Also: Even if it does make you feel good, it may Also: Even if it does make you feel good, it may still have to go if the clutter is interfering with still have to go if the clutter is interfering with your life. your life.
CoachingCoaching
�� Help the person to remain focusedHelp the person to remain focused
�� Four options: discard, recycle, give away, keepFour options: discard, recycle, give away, keep
�� “Have you used it in the past year?”“Have you used it in the past year?”
�� “Can you do without it?”“Can you do without it?”
�� “ What are the advantages and disadvantages of “ What are the advantages and disadvantages of keeping this item?”keeping this item?”
�� “How many of these do you have?”“How many of these do you have?”
A Sorting “Coach”A Sorting “Coach”
�� Assess with the hoarder the history of their Assess with the hoarder the history of their hoarding: when it started, when it got worse, any hoarding: when it started, when it got worse, any times it improved. This can help to clarify any times it improved. This can help to clarify any causes and possible solutions. Use the causes and possible solutions. Use the information about possible causes and solutions information about possible causes and solutions to deal with what the clutter is about. to deal with what the clutter is about.
�� Assess if the issue is acquiring, not discarding, or Assess if the issue is acquiring, not discarding, or bothboth
�� Help the hoarder to identify emotions that come Help the hoarder to identify emotions that come upup--e.g., guilt, shame, etc. e.g., guilt, shame, etc.
A Sorting “Coach”A Sorting “Coach”
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•• Provide emotional support for sorting. Provide emotional support for sorting.
•• Praise small improvements.Praise small improvements.
Comment on strengths: “I see that you Comment on strengths: “I see that you can easily access your bathroom sink and can easily access your bathroom sink and shower,” “What a beautiful painting!” or shower,” “What a beautiful painting!” or “I can see how much you care about your “I can see how much you care about your cat.”cat.”
A Sorting “Coach” A Sorting “Coach”
��Recognize progress, state the Recognize progress, state the remaining problem in enough remaining problem in enough detail that the client can detail that the client can understand the requirement, and understand the requirement, and ask for specific changes. ask for specific changes.
Building Inspector Building Inspector ExampleExample
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�� “I see that you have a pathway from your front door to your living room. “I see that you have a pathway from your front door to your living room. That’s great that you’ve kept things out of the way so that you don’t slip or That’s great that you’ve kept things out of the way so that you don’t slip or fall. I can see that you can walk through here pretty well by turning fall. I can see that you can walk through here pretty well by turning sideways. The thing is that somebody else that might need to come into sideways. The thing is that somebody else that might need to come into your home, like a fire fighter or an emergency responder, would have a your home, like a fire fighter or an emergency responder, would have a pretty difficult time getting through here. They have equipment they’re pretty difficult time getting through here. They have equipment they’re usually carrying and fire fighters have protective clothes that are bulky. We usually carrying and fire fighters have protective clothes that are bulky. We [note the alliance implied by the use of “we”] need a pathway here that is [note the alliance implied by the use of “we”] need a pathway here that is wide enough for them to get through to help you or anyone else who wide enough for them to get through to help you or anyone else who needed it. In fact, the safety law states that [insert wording about egresses], needed it. In fact, the safety law states that [insert wording about egresses], so this is one important change that has to be made in your home.” so this is one important change that has to be made in your home.” ((BratiotisBratiotis, et al., 2011), et al., 2011)
What a building inspector What a building inspector might say: might say:
�� Develop other activities. Make life fuller. Develop other activities. Make life fuller. �� Develop social relationships, church, Develop social relationships, church,
etc.etc.——fill social void. Arrange for others to fill social void. Arrange for others to visit hoarder in home, in their room. Use visit hoarder in home, in their room. Use the home, kitchen, etc. the home, kitchen, etc.
�� Principle of satiation (Ayllon, 1963)Principle of satiation (Ayllon, 1963)
Interventions that Don’t Require Interventions that Don’t Require Motivation (These could work with Motivation (These could work with people with cognitive impairment) people with cognitive impairment)
�� Encourage all involved to develop selfEncourage all involved to develop self--awareness about subjectivity of standardsawareness about subjectivity of standards
�� Increase the tolerance of the family, the Increase the tolerance of the family, the community, and the professionals involved community, and the professionals involved
Interventions that Don’t Require Interventions that Don’t Require Motivation (These could work with people Motivation (These could work with people with cognitive impairment) with cognitive impairment)
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�� If the home has improved, there needs to be If the home has improved, there needs to be attention to an ongoing system, schedule, etc., attention to an ongoing system, schedule, etc., to maintain the home. The situation can easily to maintain the home. The situation can easily revert to its former state. revert to its former state.
After Progress Has Been After Progress Has Been MadeMade
�� Desirable to coordinate services: Desirable to coordinate services:
��Sharing ideasSharing ideas
��Providing mutual supportProviding mutual support
��Developing shared Developing shared understanding of situationunderstanding of situation
Systems IssuesSystems Issues
�� Possible participants in task force or other Possible participants in task force or other coordination efforts:coordination efforts:�� Legal servicesLegal services�� Aging servicesAging services�� Fire and safetyFire and safety�� Housing inspectors & workersHousing inspectors & workers�� Protective ServicesProtective Services�� Mental health staffMental health staff�� Animal controlAnimal control�� Health inspectorsHealth inspectors�� Landlords, property managersLandlords, property managers�� NeighborsNeighbors�� FamiliesFamilies�� Visiting NursesVisiting Nurses�� MedicineMedicine
Systems IssuesSystems Issues
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�� Many places have hoarding task forces or Many places have hoarding task forces or multimulti--disciplinary teams that deal with disciplinary teams that deal with hoarding issues.hoarding issues.
�� Multnomah County is developing a hoarding Multnomah County is developing a hoarding task force. Contact Michelle Clifton at task force. Contact Michelle Clifton at
Bratiotis, C., Schmalish, C.S., & Steketee, G. (2011). Bratiotis, C., Schmalish, C.S., & Steketee, G. (2011). The Hoarding Handbook: A Guide for Human The Hoarding Handbook: A Guide for Human Service ProfessionalsService Professionals. NY: Oxford University . NY: Oxford University Press.Press.
Zasio, R. (2011). Zasio, R. (2011). The Hoarder in You: How to Live a The Hoarder in You: How to Live a Happier, Healthier, Uncluttered Life. Happier, Healthier, Uncluttered Life. Rodale Books. Rodale Books.
Frost, R. O., & Steketee, G. (2010.) Frost, R. O., & Steketee, G. (2010.) Stuff: Compulsive Stuff: Compulsive Hoarding and the Meaning of Things.Hoarding and the Meaning of Things. NY: NY: Houghton. Houghton.
Useful BooksUseful Books
TolinTolin, David F., Frost, Randy O., & , David F., Frost, Randy O., & SteketeeSteketee, Gail. (2007.) , Gail. (2007.) Buried in Buried in Treasures: Help for Compulsive Treasures: Help for Compulsive Acquiring, Saving, and HoardingAcquiring, Saving, and Hoarding. .
SteketeeSteketee, Gail, & Frost, Randy O. (2007.) , Gail, & Frost, Randy O. (2007.) Compulsive Hoarding and Acquiring: Compulsive Hoarding and Acquiring: Therapist GuideTherapist Guide. NY: Oxford U. Press.. NY: Oxford U. Press.
SteketeeSteketee, Gail, & Frost, Randy O. (2007.) , Gail, & Frost, Randy O. (2007.) Compulsive Hoarding and Acquiring: Compulsive Hoarding and Acquiring: WorkbookWorkbook. NY: Oxford U. Press.. NY: Oxford U. Press.
��http://www.tufts.edu/vet/cfa/hoardinghttp://www.tufts.edu/vet/cfa/hoarding(The Hoarding of Animals Research (The Hoarding of Animals Research Consortium)Consortium)
A local weekly meeting can be accessed A local weekly meeting can be accessed through this ethrough this e--mail address: mail address: [email protected]@hotmail.com
A group for OCD at OHSU:A group for OCD at OHSU:http://www.ohsu.edu/xd/education/schoolshttp://www.ohsu.edu/xd/education/schools
Useful websites with local Useful websites with local meetingsmeetings
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�� Pacific University Psychology Department has Pacific University Psychology Department has clinics to deal with hoarding: clinics to deal with hoarding: http://www.pacificu.edu/spp/faculty/rosqvist.cfhttp://www.pacificu.edu/spp/faculty/rosqvist.cfmm
Other helpOther help
We are grateful to the following people who have We are grateful to the following people who have assisted with this project: Rebecca Gray and assisted with this project: Rebecca Gray and Sandra Wood.Sandra Wood.
