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Excerpt from Clinical Practice Today (May 2014)
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Deconstructing the Hoarding Spectrum: A Holistic Approach
Part II

Lisa Wessan, LICSW, CLYL, RM

Please refer to Part I of this article in the April FOCUS1 for helpful ways to diagnose and treat your client, and to better understand the Hoarding Spectrum. I also provide some clinical methods and resources for individual and group work.

“Out of clutter, find simplicity.
From discord, find harmony.
In the middle of difficulty lies opportunity.”

—Albert Einstein

The Outer Journey

Hoarding behavior in humans spans a continuum from normal collecting to pathological self-neglect and can be associated with a variety of psychiatric disorders.2

In Part I of this article, looking at “The Inner Journey,” I reviewed some aspects of unexpressed grief, fears of intimacy, and codependent tendencies in people affected by cluttering and hoarding behavior.3 Here we take up “The Outer Journey,” which is more functionally-oriented.

Most clients on the Hoarding Spectrum who are referred to you will want to focus on their homes. By the time they see you, things at home most likely will have reached a crisis level. (Some people who hoard are able to maintain fairly neat desks at work, but their homes are far more dysfunctional.)

On the task level, first we identify some ‘hot spots,’ the areas that are most annoying (kitchen counters, dining room tables) or even dangerous (blocked egress). These hot spots must be cleared first — clearing spaces that create the most visual impact first helps build momentum into the process. According to the philosophy of Feng Shui, it is most dangerous (to your psyche or soul) to have clutter near doorways. Besides being a practical safety issue — especially for the elderly — Feng Shui teaches that blocked egress of the home or office also blocks your life energy quite markedly.4

There is often a strong urge on the part of family members or other lay helpers to perform some sort of “intervention” involving a fast and dramatic “Big Clean Out” that happens over just a few days. While the whirlwind approach may make for good television or magazine copy, clinically this addresses others’ needs much more than the client’s – and leaves no room for emotional processing and the necessary grief work; so it should be avoided for everyone’s benefit (unless there is a pending eviction, nursing home placement or other urgent matter).

Complex psychodynamic, behavioral and neurological issues have affected each client on the Hoarding Spectrum, while The Big Clean Out is a prime example of the hazards of instant innovation — the quick turnaround — effected by external helpers, who are unaware of the depth and risk in what is occurring.

For gently exploring and contracting decluttering tasks from week to week, I apply several proven methodologies...


Full article includes...

  • The Kaizen Method
  • Intensive Support Between Sessions
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