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[Please
refer to Part I of this article in the April Focus1 for helpful ways to diagnose and treat your
client, and to better understand the Hoarding Spectrum. I also provide some
clinical methods and resources for individual and group work.]
"Out of clutter, find simplicity.
From discord, find harmony.
In the middle of difficulty lies opportunity."
-
Albert Einstein
(1879-1955)
The
Outer Journey
Hoarding
behavior in humans spans a continuum from normal collecting to pathological
self-neglect and can be associated with a variety of psychiatric disorders.2
In
Part I of this article, looking at "The Inner Journey," I reviewed
some aspects of unexpressed grief, fears of intimacy, and codependent
tendencies in people affected by cluttering and hoarding behavior.3 Here we take up "The Outer
Journey," which is more functionally-oriented.
Most
clients on the Hoarding Spectrum who are referred to you will want to focus
on their homes. By the time they see you, things at home most likely will
have reached a crisis level. (Some people who hoard are able to maintain
fairly neat desks at work, but their homes are far more dysfunctional.)
On the task level, first we identify some
‘hot spots,’ the areas that are most annoying (kitchen counters, dining room
tables) or even dangerous (blocked egress).
These hot spots must be cleared first -- clearing spaces that create the most visual
impact first helps build momentum into the process. According to the
philosophy of Feng Shui,
it is most dangerous (to your psyche or soul) to have clutter near doorways.
Besides being a practical safety issue -- especially for the elderly -- Feng Shui teaches that blocked
egress of the home or office also blocks your life energy quite markedly.4
There
is often a strong urge on the part of family members or other lay helpers to
perform some sort of “intervention” involving a fast and dramatic "Big
Clean Out" that happens over just a few days. While the whirlwind
approach may make for good television
or magazine copy, clinically this addresses others’ needs much more than the
client’s – and leaves no room for emotional processing and the necessary
grief work; so it should be avoided for everyone’s benefit (unless there is a
pending eviction, nursing home placement or other urgent matter).
Complex
psychodynamic, behavioral and neurological issues have affected each client
on the Hoarding Spectrum, while The Big Clean Out is a prime example of the
hazards of instant innovation -- the quick turnaround -- effected by external
helpers, who are unaware of the depth and risk in what is occurring.
For
gently exploring and contracting decluttering tasks
from week to week, I apply several proven methodologies.
The
Kaizen Method
Kaizen is
a Japanese word that literally means "good change." After World War II, when Japan starting
experimenting with ways to humanize their factories, kaizen took on the meaning of
‘small steps for continual improvement.’ This philosophy has become
widely used in corporations, and now therapists are applying kaizen to help clients with long term,
chronic resistance to change.
In
his excellent book, One Small Step Can Change Your Life,
psychologist Robert Maurer, PhD, explores how small steps become giant leaps.5
First,
Maurer reviews this process neurologically, to show how to bypass the
fight-or-flight response and prevent what Daniel Goldman originally called an
"Amygdala Hijack."6
Maurer
then demonstrates from his research how to reduce task processes to tiny
increments. These tiny actions may seem quite insignificant to the casual
observer, but over time, they are immensely effective in creating new neural
connections that assist the client in making the desired changes.7
For
clients on the Hoarding Spectrum, that might translate to setting a timer and
spending five minutes per day (when alone) to declutter
one small area. Over time, this could
be increased to 15 minutes, and then longer segments; that increase might
happen over weeks, or months.
To
facilitate this process, Maurer also uses Kaizen Mind Sculpture, a focused
visualization technique, and Kaizen-esque ‘small
questions’ to generate creative ideas and motivation for the Mind Sculpture
exercises. Something such as "What is a tiny step I could make to
achieve my goal?" can trigger wonderful ideas and subliminal motivation
in the client's mind which will assist him/her in taking action.8
Intensive Support Between Sessions
Clients
also need access to support , process and debrief their toxic feelings while
tackling their clutter. I have two
strong suggestions for this:
First,
following Maurer's methods, I allow clients to call my voicemail and leave a
brief message sharing their feelings, resistance, or success for the day.
Yes, this is a daily call. They
understand that I will not be returning their call, unless there is an
emergency.
Second,
to help the client build successful momentum in between sessions or group
meetings, I have found no better way than implementing a Clutter Buddy Duo
program. This is an option after strong rapport is established, and only when
there is no pending eviction or other urgent matter on the clinical agenda.
I
encourage my clients to find a Clutter Buddy ("CB") and be part of
a weekly Clutter Buddy Duo to help chip away at their mountain of stuff. Here’s how it works: two people pair up,
and take turns meeting at their respective homes or offices once a week for a
maximum of two hours per week. They
then report back to me, or the group, what happened, their progress,
resistance, whatever transpired. There's always an abundance of rich clinical
content for clients to share concerning CB Duos' work together.
The
CB Duos will inevitably have transference experiences, projections, some PTSD
and other triggering emotions as they work together. I do screen for any
self-harming or suicidal ideation, and some clients may not be well enough to
work with a CB Duo format. (This would be determined before allowing them to
participate in a group.)
This
is an important part of the recovery process. It does not seem to be possible
for people centrally affected by hoarding behavior to make a consistent
effort to release clutter alone and by themselves. [See the December 2009 Focus CPT column on “Too Much Stuff” for a discussion of the “second
monkey” neurology of this. – Ed.]
People often immediately ask me to recommend a professional organizer,
but I request that they first spend some time learning how to do the
releasing work as part of a CB Duo.
As
part of their psycho-education, I
provide CB Duos with training in reflective listening, and encourage the CB
Duo to practice reflective listening with one another. There is to be no advice,
no fixing, and no rescuing; just passive reflective listening, and kindness.
As you already know, it's not hard to learn, but it is challenging to
practice, especially in the beginning.
CB
Duos are encouraged to use the Four Questions for Hoarders and Clutterers9
to discuss each object at hand, applying the questions to see if the item
Stays, or goes to Goodwill, Consignment or Trash.
Choosing
a CB is a sensitive and important decision.
During my groups, we do role-playing and practice working with faux
CBs in order to feel comfortable and be clear about this new role. I have a
list of do's and don'ts in this process which helps clients follow through on
their own.10
This
is an empowerment journey for clients. I do not want to inappropriately
reinforce a dependency on myself or a professional organizer, although our
services will certainly have a temporary place in the CB Duo's life.
Success
begets more success. I look for my clients to be able to stand in their power
more each week and succeed beyond their expectations by “hastening slowly” to
make continuous progress. Learning to practice kaizen with self-care, daily forgiveness exercises, and spending
a minimum of 15 minutes per day working on a clutter hot spot has lead to
many truly remarkable (and permanent) transformations.
Edited by Bet MacArthur MSW LICSW Member, SWTRS.
___________________________
Notes:
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1. Wessan, L. (2014). Deconstructing the
Hoarding Spectrum: A Holistic Approach. National Association of Social Workers.
FOCUS. Vol. 41, No. 4.
2. Steketee, G.et al.(2014). Group Treatment for Hoarding Disorder:
Therapist Guide. New York:
Oxford University Press.
3. Op. cit. Wessan, L. (2014)
4. Kingston, K. (2013). Clear Your Clutter With Feng
Shui. London: Little, Brown Book Group.
5. Maurer, R. (2004). One Small Step Can Change Your Life.: The Kaizen
Way. New York: Workman Publishing.
6. Goleman, D. (1998). Working with
Emotional Intelligence. New York: Bantam Books. p. 87.
7. Maurer, R. (2004). pp. 21-34.
8. Ibid. pp. 79-84.
9. Wessan, L. (2014). How to find a Clutter Buddy and be a Victorious
Clutter Buddy Duo.
http://mirthmaven.wordpress.com/2014/03/11/how-to-find-and-work-with-a-clutter-buddy/
10. Ibid.
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