Helping Hoarders
A Guide for Families,
Counselors, and First Responders
by Mark A. Chidley, LMHC, Certified Rapid Resolution Therapist
Copyright © 2011 by Mark A. Chidley
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Table of Contents
I. Get Your Own Mind Right First
II. Get to Know What Hoarding Is
III. Get Ready for Hoarder Thinking and Feeling
IV. Talking to Hoarders: Connection, Uplift and Developing Discrepancy
As I completed the first draft of an article about hoarding that would later be published in Counseling Today, I desired to have my daughter Margaret, whose editorial skills far outmatch mine, read over the article and give me her feedback. In the course of doing that she shared my project with a colleague in her advertising agency. This young, up and coming creative writer in the agency immediately asked permission to contact me and get a consult about a hoarding situation in his own family that was reaching its critical point. He was at his wits end, as were his siblings, dealing with a mother whose hoarding had gone on for decades. A year later, while attending a Rapid Resolution Therapy training (an innovative trauma therapy created by Dr. Jon Connelly), I was astonished that several other therapists, who were as engrossed as I in the learning, insisted on taking me aside during lunch and hearing what I had to say about treating hoarders. Several of them had either a current client or an affected friend or family member whose hoarding difficulties had touched their lives, and they were hungry for information on what worked with this often perplexing population.
So it began to dawn on me that even with the notoriety and nationwide attention given the subject by the popular television series on A&E and the appearance of some good literature that many people were still in need of a concise way of understanding the disorder and a grasp of the steps of a helpful approach. Hoarding has come out of the closet. People who had been trying on their own to put the pieces together are joining others who have an increased interest in the disorder and, whether lay or professional, want to be part of the conversation and bring up their skills to effectively address it. They want to be better equipped in dealing with a problem that, truly, is often found right in our own backyard.
In writing this book I am not trying for a lengthy treatise, but rather a pocket guide. I’ve assembled my own experience along with some of the best material that has come out over the last few years, as a digest, written in plain language that can be read through and assimilated relatively quickly. I’m thinking of the social worker out there, who has been called into a hoarder’s situation with little previous background, or the worried family member who wants to approach it knowledgeably in order to do their best. My hope is that this little book will make the subject more accessible to a wider audience and serve as a springboard for future learning and experience. I especially hope, as with that young man mentioned above, that any whose heart has been troubled or patience stretched by the prolonged crisis that hoarding is, may herein find a light as they proceed forward.
–– Mark Chidley, August, 2011
Author’s Note
Cases described in this book are either shared with clients’ permission or are representative of typical client stories. Some stories have been combined and names or other identifying details have been changed to protect privacy.
Although this book offers tools to help you deal with a hoarder, it is
not a substitute for professional help. Please contact your local Task Force on Hoarding, Animal Control, or Public Health Department. They may suggest a qualified mental health professional in your area if you need additional support.
When Jesus came by, he looked up at Zacchaeus and called him by name. “Zacchaeus!” he said. “Quick, come down! I must be a guest at your home today.” Zacchaeus quickly climbed down and took Jesus to his house in great excitement and joy. But the people were displeased. “He has gone to be the guest of a notorious sinner, “they grumbled.
–– Luke 19: 5
I. Get Your Own Mind Right First
Not too long ago I was sitting in the production studio at WGCU, our local public radio station, with two recovering hoarders, as we three were interviewed for a noontime show. I was listening to their answers as our host, Valerie Edwards, asked them what it had been like to be “discovered” as a hoarder and what led them to accept help and begin to get well. Both gave their own versions of essentially the same answer: it was in the non-judgmental attitude of the first person through the door combined with a legitimate offer to help. A hoarder has usually been living in secret, going to lengths to avoid scrutiny, burdened with shame, fear, and possibly resentment of family, neighbors, or the authorities. To approach with respect and sensitivity to their being already overwhelmed by the problem is like a breath of fresh air for a hoarder. It is what makes all the difference of whether you can proceed or not. Adam Leath, a friend of mine who heads daily operations for Animal Control, has this attitude down pat. It can be as simple as the offer of extra kitty litter or a bag of pet food passed to a person through a tentatively cracked door. Adam usually gets himself invited in first visit because he quickly demonstrates he is there to help and not judge. The attitude Adam embodies actually has three components, which I will break down in the following paragraphs: Compassion, Curiosity, and Patience.
Compassion
Compassion comes from really getting inside various hoarder stories either through reading or experience. The uninformed public’s view is extreme and skewed. Hoarders are thought to be just lazy, dirty, crazy or all three. Hoarders are people who have become overwhelmed by a disorder of thought, emotion, and behavior they don’t understand. Except for those in extreme denial in the later stages, most are just as confused and confounded by their predicament as anyone. And most of them, approached in the right way, will be responsive to the offer of help. One lady especially comes to mind. She came by way of referral from a mental health court diversion program. She had amassed an unusual amount of cheap items, mostly through compulsive shoplifting. These items were spread throughout most of her home and into the garage. At the end of my first visit, as we walked to the door, she confessed she was feeling a huge sense of relief. “Why?” I asked. “Because you treated me with respect. I spent all afternoon worrying about you showing up, thinking that you would take a look at all this and think I was a terrible person.” For years hoarders have been told (or told themselves) they are slobs, losers, and out of control misfits not fit to live among others. Please keep this social injury in the back of your mind along with their loss of a sense of common humanity. I recommend preparing for the visit in the following way: take a moment and look back on one of your own failures or a time you blew it. Now think of the response of one person who made all the difference for you, who took the trouble to understand. If you do this before you go, you will automatically respond in the best possible way and be miles ahead of others in forming a connection.
Curiosity
Shame plays such a huge role in a hoarder’s outlook. It’s the reason most of them keep the blinds drawn or talk through a cracked door, rather than run the risk of the outside world looking in and judging them. The second element, curiosity, the right kind of curiosity, comes in as an attitude that can counter and start to diffuse the intense shame that rules a hoarder’s life. I remember the first hoarding scene in which I participated and how I was called to handle the wrong kind of curiosity.
Animal Control called and requested my assistance at a home in a nearby community in which they found 77 cats. The call had originated with a neighbor complaining about the odor coming from the home. When I arrived there were three police squad cars, four Animal Control vans, and other cars belonging to city and county code enforcement. Several neighbors were all standing out in their driveways and the one who had placed the complaint had her home movie camera set up on a tripod. It had all the makings of a spectacle, which the minute the hoarder stepped out of her doorway, would likely doom our chances of gaining her cooperation on that day. I immediately veered toward the lady with the camera. I explained the delicate nature of what we were about to attempt and our earnest need for her full cooperation in not drawing undue attention or filming. I explained Animal Control’s Public Information Officer would keep her posted. She readily complied, and both she and her neighbors went inside.
The right kind of curiosity could be characterized as what’s referred to in Zen as Beginner’s Mind. Whoever shows up first has to be willing to be taught, to get to know the hoarder as a person. Letting them reveal at their own pace, I can usually pick up a thread or theme or bit of information that might break the ice or later be helpful. The essential phrase taught to me in my Rapid Resolution training was, “I don’t want to understand by knowing how I would feel, but to really understand how it’s been for you.” This phrase, along with some Motivational Interviewing tools which will be discussed later, can open the hoarder up to the possibility of trusting in a relationship with an actual person, as opposed to the relatively safe animals and objects they’ve substituted. In their book Digging Out, by Tompkins and Hartl, the authors note there is all the difference in the world between the question, “Why do you have this?” and “Why do you have this, here.” The first puts the hoarder on the defensive. The second shows curiosity about placement and avoids justification for having the object in the first place. As the hoarder answers, the helper gains all sorts of valuable information about how they think about their habitat and how they assign importance to various locations throughout the house. The word here is just one little word, one small emphasis, but the attitude of curiosity and joining the hoarder in his or her world comes through loud and clear.
Patience
As you read your way into the published literature and surely as you gain experience, the value of patience becomes abundantly clear. This is something the TV shows, in their limited time frame to tell a compelling story quickly, sometimes omit. Most hoarding situations don’t clear up in 48 minutes or even 48 hours. It’s not uncommon to have friends, relatives, and agency visitors preparing the ground for whatever change can be made for a year or more before it actually occurs. You have to hold in mind a target that the hoarder can realistically attain and hold to it despite day to day steps forward or backward. Of course, the exception to this is any kind of forced intervention --by public health, coding, animal control, or police-- and then the rules change. These will be discussed briefly in a bit. But by and large, a huge dose of patience will never hurt you. Hoarders can sense when others are pushing their own agendas and are acutely sensitive to interpersonal pressure. If you are the kind of helper whose self-esteem rests on quickly getting someone else to do the right thing (called the righting reflex), then I will tell you ahead of time, you’ve met your match. Hoarders are notoriously resistant to outside pressure, and strongly reinforced by their own avoidance to defer emotional discomfort by doing more of what they’ve been doing, sometimes despite severe consequences.
What appears as stubbornness is born of an inflexibility of mind and fear of change that work together to their disadvantage. When hoarders get a thought in their head and sense others would like to change it, they are likely to stand their ground and cling to it all the more. There are two traps to avoid here, called The Expert Trap and the Premature Focus Trap. If you come across as having all the answers to questions the hoarder is not yet asking or even ready to face, or if you predetermine the agenda, pushing for things on which the hoarder is not yet ready to focus, you can fall into these traps. I know; I’ve had to climb out of them a time or two myself.
Better to offer your idea on a take it or leave it basis, first asking their permission to share a thought, and timing your delivery carefully. What makes for good timing? Wait for when the context makes the idea all the more relevant or the hoarder is in a good space, relatively more relaxed and open to hear it. This minimizes the odds of tripping a hoarder into an emotional defense of his or her position, a mistake family members often make. Unfortunately, once this happens, the level of resistance will increase exponentially and might stay there for awhile, lengthening the process. Hoarders are known for just shutting down and either retreating to their rooms or ordering everyone out when they get frustrated.
It is all an exaggerated version of what occurs with most of us. We all like our freedom to choose and determine how we will live. We all react when we feel someone is trying to control us. Hoarders are the same, but with a much shorter fuse and much higher level of distortion. Sometimes they believe they are fighting for the last shreds of their dignity against a world they imagine would like to strip it away from them. You can see, then, how patience, and reminding yourself that the hoarder is still ultimately the one responsible to be causative in his or her own life, are key assets to take along.
II. Get to Know What Hoarding Is
Though it’s a centuries-old phenomenon, hoarding has only been studied by researchers and mental health experts in the last twenty years or so. We are very late in coming to the party. Stereotypes, stigma, and misunderstanding have been the rule, not the exception.
The currently accepted definition of object hoarding is just now being crafted by a study group within the American Psychiatric Association. It will likely be published in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders, due to come out in 2013. It reads as follows:
Hoarding is characterized by
A. Persistent difficulty discarding or parting with possessions, regardless of their value
B. This difficulty is due to strong urges to save items and/or distress associated with discarding
C. The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible. If all living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities)
D. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others)
E. The hoarding symptoms are not due to a general medical condition (e.g. brain injury, cerebrovascular disease)
F. The hoarding symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder, decreased energy in Major Depression, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder, food storing in Prader-Willi Syndrome).
The person evaluating the hoarding is to specify if the behavior appears with Excessive Acquisition, and with what Level of Insight the hoarder appears to be functioning on a continuum of Good, Fair, Poor, or Absent. Excessive Acquisition is defined as excessive collecting, buying, or stealing of items that are not needed or for which there is no available space.
There is a lot in this to digest. I often get asked by people trying to understand the disorder if their cherished collection of sports memorabilia or their mom’s penchant for certain lipsticks or the closet full of clothes they’ve held onto, or the fact that they’ve kept all their report cards and awards since first grade makes them a hoarder. The answer is no, unless you qualify under criteria B, C, and D. Many people collect things, go through fads, hang onto keepsakes, or create inventories in order to sell or trade items. These are not hoarding. We all have a junk drawer at home or an area that could use a little tidying up from time to time. Only when use of one’s living spaces is rendered impossible (a junk drawer turns into a junk room) and there develops the significant distress parting with objects and the impairment of other life activities do you have hoarding.
The APA criteria may seem a little complex and hard to grasp at first, but reading between the lines you pick up on the massive breakdown of good judgment that develops with hoarding, which you will experience the minute you set foot in a hoarder’s home. Their distress is relative to level of insight. Hoarders with less insight tend to show less distress. Distress manifests as life becomes unlivable or a crisis occurs or there is pressure to change from others. Also, a person can hoard without excessively acquiring, by simply refusing to discard or let anything leave the home. All these unique features set it apart from other disorders.
And we’re reminded in this new definition to rule out the other medical or psychological conditions that have some (but not all) features of hoarding behavior which by their presence would better account for it. For instance, several years ago while working for Hospice, I went into homes of single, adult patients who were dealing with a stroke or a progressive dementia or were just too weak from a terminal illness to attend to housekeeping. Things had piled up, with almost as much chaos as in hoarding cases, but this clearly was not a hoarder nor due to a lifelong pattern of hoarding.
Hoarders experience impairment in what are called their ADL’s, Activities of Daily Living. They may not attend to their hygiene, cook a meal, or invite friends over because the spaces are now filled with stuff that blocks the use of the rooms for their associated purposes. They might not be able to find their checkbook or other important papers in the mounting piles of clutter, and so get behind on their bills or lose track of other important commitments or deadlines.
As an illustration, I remember being a home health aide, working my way through school. I got assigned to a retired orthodox priest who in his later years had been a part-time university professor and a full-time information junkie. His little apartment was packed out, turned into part museum, part library. Books, journals, and academic memorabilia were everywhere, including stacked in the refrigerator as well as over, under, and all around the toilet. Getting a nutritious meal into him posed a major challenge because he would bring home sliced meat, oranges, cheese, and other things he liked, but leave them out on top of on the counter, there being no room left in the refrigerator. By the time of my weekly visit, the food had usually spoiled and had to be tossed. Having possession over every bit of information ever published on his pet academic interest was literally more important to him than eating or being able to go to the toilet. Often, I had to firmly urge him to undress and let me run a load of laundry while I was there, because all his clothes, including those on his back, had been soiled and reused over and over without washing. You guessed it, because his washer and dryer were filled with papers and books.
Homes deteriorate if appliances, utilities, wiring, and plumbing are not repaired regularly. Walls and floors can deteriorate from within if piles of stuff mix with moisture and set up mold. The hoarder’s quality of life may therefore start to nosedive and health risks increase sharply. The hoard may even pose an imminent danger of fire, injury (if the piles are high and in danger of falling), disease, respiratory problems, or infection. These latter risks come from the infestations of rats, mice, roaches, and other vermin which can transmit diseases through their droppings or saliva, as they take up residence and multiply quickly in a severe hoarding situation.