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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.
Source:
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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