Collaborative Therapy for Hoarding Disorder
Information taken from: Employing Motivational Techniques with Psychotherapists and Professional Organizers: A Collaborative Approach with Compulsive Hoarders by Stephen Geller Katz, LCSW-R; Sondra Schiff, RN, A to ZEN Organizing, Inc.
Why is a Team Approach Essential?
Hoarding behavior is in and of itself a symptom of more deep-seated problems, of both a psychological and characterological nature. For example, a hoarder may have experienced early deprivations as a child, and in response, obsessive-compulsive traits emerge as a coping mechanism in order to withstand conflicting parental messages of a stressful childhood. As OCD spawns full-blown hoarding behavior in adulthood, the client embraces a prehistoric mal-adaptive coping mechanism aimed at control and self protection. If unchecked, hoarding clients who suffer from OCD quickly find themselves psychologically and physically boxed into a corner. This is also why the novice psychotherapist or professional organizer working alone and not well grounded may easily find themselves pulled into the quicksand and swallowed up together with the client.
The team approach is also essential for working with clients whose hoarding behavior stems from adult ADHD in a more severe form. Add to the mix depression, rage, and major control issues, and you have the makings of a disaster if the person chooses not to seek help. We have seen others in our practices that have the double-whammy combination of Obsessive-Compulsive Disorder and adult ADHD.
When engaging compulsive hoarders with long-term, chronic disorganization and collecting behaviors, a collaborative or team approach permits the client, psychotherapist, and organizer to work side-by-side to facilitate and maintain change within the home, as well as to build lasting internal cognitive-emotional change within the client. Depending on the severity of the case, the team may include others, such as an attorney, family members, friends, landlord, and social service advocates.
One of the first challenges for organizers and psychotherapists working collaboratively with a compulsive hoarder is to have them be fully on board with the idea that: a) they cannot do the job alone, and b) in all likelihood, they are going to require the intervention of at least two professionals at the same time.
The second challenge is delineating the tasks of the psychotherapist and the professional organizer. Although there are many areas that may clearly overlap, it is important to devise a written plan of clear task delineation in order to avoid role confusion and awkwardness down the road.
Role of the Psychotherapist for the Hoarding Client
In contrast, the role of the psychotherapist differs from that of the professional organizer in that the therapeutic work takes place away from the client’s cluttered physical environment. The therapist helps the client to clear out the internal mental clutter, which includes a thorough examination of the client’s pattern of cognitive distortions that keep the hoarding behavior in orbit…The therapist, in a written agreement with the client, is permitted to have regular phone contact with the professional organizer around issues pertaining to the client’s de-cluttering goals. Caution must be taken on the part of the psychotherapist to maintain the trust relationship of the client by not divulging highly personal information. Furthermore, it is recommended that a specific contract or release of information be drafted to stipulate the nature of the information to be disclosed to the professional organizer to avoid possible misunderstandings.
Role of Professional Organizer for the Hoarding Client
The role of the professional organizer for the hoarding client is to sensitively provide on-site guidance, focus, assistance and reinforcement, being aware of the client’s particular style of learning in order to optimize strengths, effort and time in achieving de-cluttering and organizing goals. When working in collaboration, the organizer will need to share with the psychotherapist observations, challenges, and progress toward the pre-established goals and objectives so that the therapist can follow up in the subsequent psychotherapy sessions.
The organizer also enforces boundaries between the therapist and the organizer by introducing the client to the concept of the “Emotional Box.” Also introduced by Schulz and Rotz, the Emotional Box serves as a metaphorical construct to contain emotionally laden issues involving strong attachment conflict around letting go of their items. Ideally, the organizer can expedite the de-cluttering process and maintain appropriate boundaries by helping the client to bring the contents of the Emotional Box to the psychotherapy sessions.
Contract for Collaborative Work
Beyond the above-mentioned releases, it is advisable that a collaborative contract for work be drafted and signed by client, psychotherapist and professional organizer. The collaborative contract will spell out specific attainable goals and objectives with reasonable time frames and will contain a client activity portion. This is our road map, and learning to stay on course and navigate it will be our key to success.
Clear goals and objectives should be established by client, psychotherapist, and professional organizer from the outset of treatment. The activity part of the contract delineates specific client tasks and should also be collaboratively designed with S.M.A.R.T. goals in mind.
The Hoarding Project offers resources for therapy services for people who hoard and their family members in both individual, couples, and family settings.
One of the services The Hoarding Project offers is a support group for family members and friends of people who hoard.