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“Anything that you cannot relinquish when it has outlived
its usefulness possesses you, and in this materialistic age a great many of
us are possessed by our possessions. We are not free.”
~Mildred Norman
Ryder1
(aka the Peace
Pilgrim, 1908-1981)
Is it possible that we are all living on the Hoarding Spectrum? According to a recent study paid for by
Rubbermaid storage products, 91 per cent of people are overwhelmed by their
clutter some of the time. Of that group, half of them feel they can’t allow
visitors at home because of it.2
For
this article, let’s refer to clutterers and
hoarders on the same hoarding spectrum. Both clutterers
and hoarders suffer from Clutter Blindness, a perceptual-distortion
phenomenon. Picking a behavioral label is often just a matter of degree,3 since many symptoms and behaviors are
identical in the two groups. To help you make your initial diagnosis, I would
like to distinguish hoarders from the more common clutterers
in three ways.
(1) Hoarders suffer from CHAOS (Can't
Have Anybody Over Syndrome). When a hoarder reaches this point, regardless of
how much stuff is actually in the home, we understand that social isolation,
depression, anxiety and other imbalances are crippling the client's
life.
Usually,
a hoarder will not ask for help until the situation becomes critical, e.g. an
eviction notice is received, nursing home placement is required, there is a
pending relocation, or when the sale of a home is infeasible due to hoarding
complications. To reach this crisis point, the client situation has gone
beyond CHAOS to another level.
For
example, some of my elderly clients have suffered from upper respiratory
illnesses and rashes, due to black mold and other contaminants in the home.
Elderly hoarders are especially at risk for injurious falls, and being
crushed or immobilized by the hoarding pile is another common risk. In the
end stages, vermin and dead animals are often found in the hoard. It may be
very difficult for the hoarder or for family members to recognize that such
physical conditions are actually life-threatening.
The
new DSM V has recognized this by making hoarding a stand-alone behavioral
diagnosis, where in the past it was lumped broadly into obsessive and
compulsive behaviors.4
It
is very common for the hoarding client to be eligible for a dual diagnosis,
as well as possessing a strong codependent streak. Hoarders often have very good intentions,
"saving this for someone who might need it." This exaggerated tendency to rescue and
save is complex, and has psychodynamic and attachment issues that should be
uncovered in treatment.
(2) To meet criteria for a hoarding diagnosis,
the client must achieve a rating of two or more on the
National Study Group on Disorganization’s Clutter Hoarding Scale,5 an
excellent diagnostic tool. The NSGCD scale has five levels -- clutterers are diagnosed at Level I. Hoarders are
diagnosed at Levels II through V.
(3) Clutterers
Anonymous, a 12 Step spiritual fellowship based on the principles of
Alcoholics Anonymous, has a useful set of screening questions which can help
your client identify and self-select treatment for this diagnosis.6 (Hoarders are typically unwilling to get
help, and are often resistant to change even when they enroll themselves in therapy or programs.7)
Once
you have established that you are indeed working with a hoarder, you should
assume the client has a very complex set
of disorders to work through.
You will encounter one or more of the following complications:
addictions, chemical imbalances, eating disorders or malnutrition, ADD, ADHD,
OCD, and severe social isolation, at the least. Most hoarders also have an Axis III
(medical) diagnosis and will often need medication and psychiatric
supervision.
Clutterers do
not necessarily present with dual or multiple disorders, nor do they always
need medication. Their home or office may be visitable
and physically non-toxic. Some amount
of clutter or sub-par organization and storage is common: even hoarding
expert Dr. Robin Zasio,
admits to having a make-up drawer that is "out of control."8
Now
let’s begin to explore the treatment of clutterers
and hoarders from a clinical perspective. This work will always call for a
holistic approach – uni-dimensional treatment or
help for cluttering and hoarding is not effective. For example, forcibly restraining, removing, or
deceiving the subject while his or her place is rapidly cleaned out,
"the big clean out" is a common lay approach -- it is the opposite
of a safe approach to these diagnoses.
The Inner Journey:
Face It, Trace It and Erase It
I have come to view my clients on the Hoarding Spectrum as having two
sets of treatment paths, the Inner Journey and the Outer Journey. Both are necessary, for if you work on just
one, there is likely to be relapse and/or an incomplete release of the
clutter.
For
this article, I will share some useful insights on the Inner Journey. In a second article (Part II), I will
elaborate further on the Outer Journey, which is task oriented.
The
Inner Journey has two components: One part takes clients through a series of
exercises that bring them back to the source of their clutter, and usually
involves grief work. The second part
is a series of forgiveness exercises and assignments.
Some
participants can trace the onset of their clutter, e.g. due to a relocation,
death, divorce or illness. These traumatic events can block the
healthy flow of filing, storing and discarding. When left untreated and unsupported, over
time the Level I Clutterer can move along the NSGCD
spectrum to become a Level V Hoarder, due to this original unprocessed
catastrophic event and the isolation it can trigger.
Group
work is especially helpful for people on the Hoarding Spectrum. While individual treatment is not
contra-indicated, I have found that groups have a special healing dynamic and
help to diffuse toxic shame much quicker.9
To
get to the core issues, I use an array of tools for the Inner Journey
segment, including forgiveness meditations, writing, sharing in dyads,
homework and journaling between sessions. It can take a few weeks in group
for participants to feel safe enough to open up, but then these structures
are very productive.
Dr.
Bradley Nelson's energy medicine methods are very effective for processing
trauma in groups. His work has set new standards for methods to process
trauma and PTSD.10
To
foster cohesiveness in the group, I encourage members to snap their fingers when
they identify with something someone is sharing. This creates an accepting,
convivial atmosphere that makes it safer to share "crazy stuff"
about clutter. When a room full of nice people are snapping away as you share
about your mess, it quickly becomes less painful and daunting.
Working
this way, there is a lot of laughter with the tears, and this helps diffuse
toxic shame so members can feel more connected in the group.
Shame
is a huge component of the forgiveness journey. How many times I have heard
people say, "I should know better. I'm so embarrassed that I just can't
do this. Why is it so hard for me to throw things away?"
To
that I respond, "What is Shame? Should Have Already Mastered Everything? Nay, nay, I say. You do not have to be an expert at
anything yet. You are perfectly fine
just where you are NOW! Learning to forgive oneself and let go of things not
done is part of your advanced psycho-spiritual training. Banish the word
SHOULD from your thoughts and words. Let's end this suffering now!"
When
I say these words, there is a palpable sigh in the room, sometimes tears.
People on the Hoarding Spectrum need to feel forgiven, and unconditionally
accepted.
Another
part of the Inner Journey is seeking to find out "What is the payoff of
having your clutter?" Clients are
often startled by this question. But after we talk about the
"benefits" and how it's working for them, they begin to uncover
their deeper reasons for maintaining their clutter, e.g. fear of intimacy; or
loneliness and unresolved grief.
After
one closed-eye exercise -- part hypnotherapy and part visualization -- a
client realized that the reason she could not throw out her stuff is that she
would also want to throw out her husband! There was a strong connection
between her clutter and her junky husband.
"They all need to be put out!" she said to the group, as she
laughed and cried out her tears from this realization.
(Continued
in Part II, The Outer Journey, in the May issue of FOCUS.)
Edited by Bet MacArthur
MSW LICSW Member, SWTRS.
[Wessan, L. (2014).
Deconstructing the Hoarding Spectrum: A Holistic Approach. National
Association of Social Workers. FOCUS. Vol. 41, No. 4.]
__________________________
Notes:
1Pilgrim, Peace (1982). Peace Pilgrim: Her
Life and Work in Her Own Words. Ocean Tree Books: Sante Fe, NM.
2 Zasio, Robyn (2011). The Hoarder in You. Rodale Press: NY. p.18.
3 Frost, R.O., Steketee, G. (2013). Treatment
for Hoarding Disorder: Workbook. Oxford University Press: New York, NY.
4 Obsessive,
compulsive and related disorders. (2013). American Psychiatric Association.
http://www.dsm5.org/Documents/Obsessive%20Compulsive%20Disorders%20Fact%20Sheet.pdf
5 NSGCD
Clutter Hoarding Scale (2003).
http://www.childrenofhoarders.com/pdf/nsgcd_clutterhoardingscale.pdf
6 Clutterers Anonymous Screening Tool. https://sites.google.com/site/clutterersanonymous/Home/am-i-a-clutterer
7 Zasio, Robyn (2011).
8 Ibid. Page x.
9 Bradshaw, J. (1988). Healing the Shame that Binds
You. Health Communications: Deerfield Beach, FL.
10 Nelson, B. (2007).The Emotion Code: How to Release Your
Trapped Emotions for Abundant Health, Love and Happiness. Wellness Unmasked Publishing: Mesquite, NE.
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