Neziroglu Hoarding Presentation – Part 5

  1. Applying the Intervention Technique
  • The proposed Intervention differs from interventions aimed at addressing addictive behaviors:
  • This is more of an opportunity for family members to assertively communicate their feelings and urge the hoarder to participate in treatment
  • The hoarder is not necessarily kept ignorant of the meeting before arriving at it.
  • While boundaries are discussed in this meeting, family members are not necessarily expected to cut the hoarder out of their lives should the hoarder refuse to participate.
  1. Goal of Intervention Strategy
  • The primary objective is to get the Hoarder on board with the idea of treatment
  • Family members bring hoarder into a session
  • One by one, each member talks about how the hoarding has affected them
  • Issues are brought out in loving and supportive tones with validation
  • Ideally, hoarder agrees to give treatment a chance for a specific time period.
  1. Setting Boundaries
  • Autonomy Development: Family members of hoarders (particularly those who live in the hoard) must (re)develop a sense of autonomy, as the family’s behavior in the home is often dominated by the restrictions imposed by the hoard.
  • When family members do not live with the hoarder (e.g.):
  • Non hoarding family member may determine where to meet for social visits (i.e. outside of the hoard?)
  • What kind of contact the family member is willing to allow his/her children to have with the hoarding family member.
  • What kinds of accommodations the family member will make for the hoarder.
  • When family members share living space (e.g.):
  • making communal areas functional again
  • Rectifying health/safety code violations
  • What kinds of accommodations the family member will make for the hoarder.
  1. Behavioral Contracting
  • Behavioral Contracting involves compromise and negotiation, as well as an agreed upon way of approaching re-occurring conflicts within the home/family.
  • While family members obviously have complaints, the hoarders may also have concerns about their family members’ approaches to the hoarding situation. Therefore, an open dialogue about these “gripes,” as well as a specific agreement to pursue a more productive path often helps to reduce conflict and keep communication fruitful.

39.Typical Hierarchy of Intervention 

  • Health/safety concerns (fire safety issues addressed, unsanitary conditions addressed, etc.)
  • 2.) areas of the home that are essential to a hygienic lifestyle (functioning toilet/shower)
  • 3.) Carving out individual/private areas for each member of the household (bedrooms, etc.)
  • 4.) Targeting communal areas/areas associated with functional/comfortable living (access to a working refrigerator, stove, or countertop; access to a communal/social area, etc.)
  1. Reclaiming Functional Living Space
  • Every member of the house has a right to
  • Have access to a functioning bathroom
  • Have health/safety needs met
  • Environmental factors that allow members of the household to maintain adequate hygiene.
  • Live free of hoard-related pests
  1. Carving Out a Space in the Hoard
  • Every family member in the house should be entitled to a private, independent space within the home, to be maintained as the individual sees fit.
  • Assertive communication of the rationale behind this should be carried out.
  • If the hoard is dominating family members’ individual space, the hoarded items must be moved out.
  • Establishing a realistic timeframe for changes to be made, as well as benchmarks for expected milestones.
  • Assertive discussion of the expectations if/when this timeline is breached.
  1. To Have Contact or Not to Have Contact
  • This is a personal and value-driven decision for each family member of a hoarder.
  • Every family member has the right to decide what kind of contact is healthy for him/her to maintain with the hoarding family member
  • Recommendation: family members must choose what kind of relationship they are willing to maintain with the hoarder, and attempt to adhere to the boundaries set in place.
  1. Acceptance and Change
  • The purpose of the intervention, and other “change oriented” maneuvers is to bring about some sort of behavioral change in the hoarder.
  • What if the hoarder refuses to participate or requires a very slow treatment pace?
  • Family members of hoarders must learn how to accept the situation for what it is.
  • Accept (do not condone) the environmental/logistical problems of the hoard and make individual choices.
  1. Acceptance Strategies: Acceptance and Commitment Therapy
  • Learning to dissociate thoughts from reality (practicing observation of thoughts as thoughts, rather than indisputable reflections of reality).
  • Acting in accordance with one’s values despite the unpleasant feelings that emerge as a result
  • Fostering of the “transcendent self” (that you are not defined by your thoughts/feelings and/or your experiences).
  1. Harm Reduction
  • Harm reduction strategies are typically applied to the problem of chronic drug abuse, as a means of minimizing life-threatening consequences of addiction (e.g. the needle exchange program).
  • Tompkins (2011) introduced the use of a harm reduction model to treat hoarding.
  • Assessing areas of potential danger
  • Assembling a harm reduction team
  • Establishing realistic, concrete goals
  • Establishing harm reduction contract
  • Agree on a way of carrying out harm reduction plan
  • Agree on a manner for monitoring progress
  1. Insight Related Concerns
  • Anosognosia: The individual is unaware of his/her illness and/or the consequences
  • Defensiveness: The individual may use denial and engage in arguments to resist others influences.
  • Overvalued Ideation: The individual has a system of dysfunctional beliefs that are held strongly and have a strong affective component when contradicted.
  1. What Happens to the Hoarders?
  • Half of the patients come for treatment to talk about a variety of issues (i.e., interpersonal difficulties with family members) but refuse to treat their hoarding behavior.
  • Almost a quarter enter treatment and a quarter drop out after the initial consult.
  1. Conclusions
  • Hoarding is now a part of the OCRDs
  • Hoarding treatment is very different than OCD treatment
  • Hoarders are difficult to engage in treatment
  • Children of hoarders feel like abuse victims
  • How to negotiate the hoard is an individual familial choice