In the last article, we looked at what hoarding is and what it isn’t, together with some reasons why people hoard. We then started to look at how you can really help people in that situation. As this article reveals, it has a lot to do with the helper’s attitude. This article features material adapted and expanded from a talk given by Dr. Catherine Ayers at the San Andreas Stein Institute for Research on Aging, California (link below).
MEDICATION, CBT, DISCARDING (EXPOSURE THERAPY)
There are some effective medications, particularly SSRIs, but they won’t teach anyone skills and tools to discard and make choices. They will lower the physiological level of distress, however.
Cognitive Behavioural Therapy (CBT) is a treatment based on how thoughts and behaviours can be adjusted to reduce symptoms. It works remarkably well for those who can change, but most hoarders aren’t in that position. Many hoarders are elderly. One piece of CBT that does work is exposure to discarding: exposure therapy, as it’s known. You can help with this yourself.
First, we need to lay the foundation for a hoarder to get their life back and get more organised. To help with compliance issues and not relapsing back to habits, there are some weaknesses you can help to improve – such as how to use a calendar, how to make to-do lists and get things done and how to start a filing system.
Together, you’re laying the groundwork for further work – steps to remember, appointments. Ask them what they need to do to make specific things happen. Those that don’t practice don’t do well. It has to be daily.
Home visits are incredibly important. People can ‘learn’ in outside conversations, but the problem’s actually living at home. Have them make difficult choices and discard things, based on their own choice. By sticking with it repeatedly over time, they learn they can tolerate it, they can take the stress of making decisions and that bad things don’t follow when they discard. Once they start, daily practice is key.
HOMEWORK
It’s very practical: for a set, agreed period in an agreed corner they start going through stuff, sorting and discarding. We can’t get hoarders to throw everything out, but we can ask them to get themselves to make those difficult choices.
They go through items systematically, considering each one and making choices. When there’s uncertainty, they can stop and see if it’s an item they can let go of. Then they have to put all their ‘keeps’ in their final resting place, which means putting them away – and you do have to hold them to that. Not finding a place to put something might mean they don’t need to keep it. Don’t bully them though – to be objective, imagine they’re a new friend rather than people you may have grown impatient with chronically.
Discarded items need to go in the rubbish, immediately. Some people discard easily, often surprising themselves, but still have little piles everywhere that they aren’t putting away. You can be firm without losing the trust.
FIVE MINUTES EVERY DAY
Sometimes people start with five minutes daily, due to resistance and anxiety. Meet where the person is emotionally and go from there. They need to know they are creating change because they are making choices for themselves. They need help, not shouting, advice or stress.
If you’re willing to be non-judgmental and try to be with them at home, that will make a huge difference. Use appropriate, step-by-step language such as, “What do you think we can do today? What would you like to see happen?”
To summarise: this is suffering, not somebody wilfully being lazy or messy. Help is possible if you can empathise with this person’s situation and see your role as gradually letting them take over for themselves – instead of you hoarding the problem.
The talk which inspired this article is at: https://www.youtube.com/watch?v=xeYnkkofqjU
You might also find this one useful: https://www.youtube.com/watch?v=icbNpdwizZc