Monday, March 29, 2010

Hoarding Intervention Interview

In this hoarding intervention interview, you will read expert advice about hoarding disorder, when it's time to step in to help a loved one and how to perform a successful intervention. Dr. Simon Rego is a licensed clinical psychologist, and board-certified in Cognitive Behavioral Psychology, which is evidence-based treatment of choice for hoarding. As Director of Clinical Training at the American Institute for Cognitive Therapy, he has treated many hoarders.

Hoarding Intervention Interview with Dr. Simon Rego

LTK: How does a loved one know when hoarding has become a problem and an intervention needs to take place?

Dr. Simon Rego (SR): While we all have the tendency to acquire and save things at times, hoarding is typically only considered to be a clinical problem after it becomes “compulsive”. By compulsive, we mean that the acquiring and then failing to discard possessions turns into a repetitive behavior that the person feels driven to perform, despite the fact that the items may be of limited value. The compulsive behavior also causes extremely negative consequences (e.g., rooms so cluttered that they cannot be used as intended), and/or significant distress or impairment in the person’s ability to function. A quick way to determine whether the hoarding has reached clinical levels is to check to see if rooms/objects cannot be used as intended. If the person can no longer function at home, work, school or socially due to his/her hoarding, or if any interference in their compulsion to hoard (e.g., family members throwing out items) causes him/her to get very upset.

LTK: What is the first step when trying to help someone with a hoarding disorder?

SR: If you are a concerned friend or family member and can find a treatment provider trained to treat compulsive hoarding, you may actually have some success in getting the person in the door to get some help. Compulsive hoarders may lose motivation quickly once they realize the treatment will focus on having them “debulk” or eliminate a large percentage of the items that they have acquired. They may also be initially hesitant if they previously have had unsuccessful treatment or if family members have tried to eliminate their items without consent in the past. They may also defend their behavior as not that much different as anyone else’s collecting of things or come up with reasons why they find it important to keep their materials.

LTK: How does an intervention for hoarding work?

SR: The treatment of choice for compulsive hoarding is something called Cognitive Behavioral Therapy (CBT). CBT is an evidence-based treatment that has patients examine and challenge their problematic beliefs and also identify and change any problematic behavioral patterns. In the case of compulsive hoarding, the treatment targets the thoughts that lead to the excessive acquisition of materials of limited value (e.g., “This soap is on sale! It is such a good deal that I should buy a crate!”), the saving of these materials (e.g., “I bet Aunt Joan will be able to use this!”), and the way the person tries to organize these materials (e.g., “I’m not sure where it should go.”). The treatment then targets the avoidance behaviors that compulsive hoarders usually engage in, usually in response to the distress caused by their dysfunctional beliefs. For example, compulsive hoarders may avoid storing an object out of sight because they believe they will lose the memory the item generates.

Treatment has patients gradually and intentionally confront these beliefs using something called exposure and response prevention. For example, this may involve sorting items into categories and ranking them in terms of how anxiety provoking it would be to discard them, and then selecting an item that provokes less anxiety (at first) and then discarding it. In the process, negative thoughts become challenged and corrected, and a tolerance to anxiety can be built. Over time, if this is done in a structured, prolonged, and repetitive manner, it gets increasingly easier for compulsive hoarders to debulk materials from their home (i.e., momentum builds).

LTK: Do you always need a professional, such as a counselor, involved in an intervention?

SR: Some people on the less severe end of the spectrum may be quite successful doing the work on their own. Other people may do well using a good self-help book. Still others correct the issue with the help of family members or friends, or by hiring a de-cluttering service. It is when the hoarding has reached clinical levels (e.g., rooms cannot be used as intended or the person cannot function in other areas of his or her life or becomes very distressed when unable to/prevented from hoarding) that professional assistance becomes essential. One other thing to consider, however, is how long the issue has been a problem, and if it seems to be growing worse (i.e., rooms can still be used, but are getting very cluttered). In this case, it may be wise to act in advance of the problem getting bigger and reach out for professional assistance from someone with expertise in treating this problem.

LTK: What are some common mistakes loved ones make when trying to help a loved one with hoarding disorder?

SR: The first mistake that loved ones make with compulsive hoarders is to assume that it is not a psychological disorder. It can be easy to fall into the trap of thinking that the person with the problem simply has to “push” him or herself in order to change. As with any other psychological condition, this attitude is very unhelpful and can often make the compulsive hoarder feel alienated and more resistant to change!

Another common mistake loved ones make is trying to “help” by throwing out materials themselves – either with or without the consent of the compulsive hoarder. They may even hire a cleaning service to remove all of the materials if their patience runs thin! This is unhelpful, as it often causes the compulsive hoarder to experience great distress (which can impact relationships), and ultimately, unless the person is successfully treated, he or she will likely start to acquire and save again over time.

And yet another mistake loved ones make is to not address the problem at all! Either by ignoring it, limiting it to certain areas that they are willing to “live” with, or writing it off as part of the person’s “quirkiness” – in order to not upset him/her. Although this may “help” the person in the short-term, it only allows the problematic behaviors and thoughts to grow over time..." More