How to overcome hoarding

Session 1: Engaged Rebecca in a discussion about the excessive clutter in her apartment to help her identify and self-assess symptoms of hoarding. Defined hoarding for her and asked if she feels some of her behavior could be representative of hoarding. Discussed ways she does and doesn’t exhibit hoarding behaviors. Rebecca acknowledged she does have some hoarding tendencies. Asked her to consider the emotions that drive her to save or purchase items unnecessarily – e.g., does she feel an emotional attachment to certain items or is she fearful of losing or throwing things away? Encouraged her to talk about the symptoms she deals with on a daily basis as a result of her mental illness, such as depression and anxiety, and consider whether these symptoms might be driving her to hoard.

Session 2: Continued the discussion we began last week, with the goal of helping Rebecca understand hoarding and to explore personal behaviors related to hoarding. Explained that many people who struggle with hoarding fail to realize how much it impacts their lives until the situation becomes nearly unmanageable. Described common reasons people hoard (e.g., belief that items are necessities or will increase in value, emotional attachment, sense of security, belief that items need an owner, discarding items is too much work, etc.). Asked Rebecca if she could relate to any of these reasons and if so, how they impact her life.

Session 3: Continued the conversation with Rebecca about how hoarding affects her life. She was able to describe how it made her feel but had trouble providing concrete examples, so I offered suggestions for her to consider: Unsanitary living environment, clutter that interferes with her ability to perform ADLs like cooking and bathing, large portions of her home unusable, important documents hard to find, pets that can’t be properly cared for, difficulty getting ready and getting places on time, potential legal issues (e.g., threats of eviction or loss of voucher), etc. Rebecca said she could relate to most of them. I asked her if she wanted to make changes. She said she wanted to try. Agreed that next week, we would begin developing a game plan for reducing clutter.

Session 4: Last week Rebecca acknowledged that hoarding was having a negative impact on her life and said she wanted to make changes. I pointed out to her that the actual act of reducing clutter was simple; the challenge for her will be maintaining a state of mind that allows her to consistently do it. Reminded her of the symptoms she described in our first session, which she felt might be driving her to hoard. The symptoms she identified were anxiety and depression. Agreed on specific coping skills she will begin using to prepare herself to reduce her hoarding tendencies – physical exercise to manage depression and general anxiety, and deep breathing to manage occasional spikes in anxiety (i.e., feelings of panic). Offered to help Rebecca practice these and other coping skills in upcoming lessons if necessary.

Session 5: Directed Rebecca to observe her home and belongings closely, then create 2 lists – things she knows she should get rid of, and things she is sure she wants to keep. The first list does not have to be specific – its purpose is just to prepare her for reducing clutter and to assess her readiness to get rid of certain items. General terms like “trash” and “spoiled food” are acceptable. The second list should be much shorter and describe specific items she is unwilling to get rid of. Reviewed the coping skills Rebecca should be using throughout the time she is attempting to reduce clutter and hoarding behaviors. Confirmed that she has already started using them. Praised her for sticking to the game plan and for trying to make positive changes in her life.

Session 6: Asked Rebecca to think about how reducing clutter could improve the quality of her life and write down her ideas on a list as they came to her. Directed her to keep this list in a prominent place in her home, such as on her bathroom mirror or refrigerator door, where she will see it every day. To further strengthen her commitment to reducing clutter, I reframed the process as gaining rather than losing. Pointed out that apartments in Orange County rent for an average of $2.50 per sq. ft., which means every stack of old magazines or clothes that occupies that amount of space in Rebecca’s home is costing her $30 a year to store. Throwing those items away will make the space available to her again so she can use it and enjoy it. Asked her to review the list of "must keep" items on a regular basis to see whether her feelings about any of the items has changed.

Session 7: In prior sessions I helped Rebecca prepare for the task of reducing clutter by identifying coping skills she will use to manage symptoms that encourage hoarding, having her create a list of ways reducing clutter will improve her life, and by reframing the process of decluttering as one of gain rather than loss. Today I proposed 2 other activities that could help her stay committed: putting extra effort into maintaining personal hygiene, as this will help support a frame of mind that is conducive to making positive changes, and reducing isolation by spending more time outside her apartment, in the company of others. Suggested she prioritize her goals by starting with her bedroom, kitchen, and bathroom, and reducing clutter in those areas first to ensure she is able to sleep comfortably and perform her ADLs. Advised her to take things slow and focus on small areas of her home at a time, and to devote an equal amount of effort to maintaining overall lifestyle changes.