Deconstructing the Hoarding
A Holistic Approach
by Lisa Wessan MSW, LICSW
Co-chair of the NASW Northeast Private Practice Shared Interest Group
[This article was
published in the FOCUS, National Association
of Social Workers, May 2014, Vol. 41 No. 5]
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."
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.
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
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.