Lisa loves to entertain, but she’s married to Mike, who is a hoarder. Newspapers and magazines cover every room in their house so they can barely get to the kitchen and can never reach the couch. Lisa hasn’t invited company in eight years because she is too embarrassed by the clutter. Their 8-year-old daughter begs to visit her friends because she isn’t allowed to have anyone over—and even if she were, they wouldn’t have enough room to play. Lisa tries to clean up when Mike isn’t home, but her efforts are fruitless. When he discovers what she has done, he becomes very upset and angry. He grows even more possessive and his hoarding gets worse. Despite Lisa’s desperate pleas and threats, Mike refuses to get help.
Barbara has been living alone in her big house since her husband passed away three years ago. She has three grown daughters who love her very much, but she doesn’t let them inside. Although she has always had a tendency to hold onto things, her behavior became extreme after she lost her husband. Her hoarding got so bad that the entire floor is covered, only one chair can be used, and she has hardly any space to cook in the kitchen. Her daughters are very worried about her, but she shrugs them off when they try to convince her to get help. They would invite her to live with one of them, but they know that the clutter will follow. They are exasperated and at a complete loss about what to do.
After her mother passed away, Annie moved in with her elderly father when his health began to decline. She always called her father a pack rat because he kept lots of pencils, rubber bands, bags, and papers. But his hoarding grew worse after his wife’s death. Although Annie wants to help out her father, she feels agitated and frustrated at the mess. Having lived alone for a long time, she has difficulty adjusting to the lack of space in the house, and she’s worried about her father’s safety. Although he admits he has a problem, her father refuses to let Annie clean the house, and he claims he is too old for treatment.
Each of these cases illustrates a hoarder’s resistance to treatment and how it affects family members. When a hoarder resists the idea of getting help, a family member may contact a therapist about staging an intervention.
First, family members meet with a therapist to learn more about hoarding and treatment options, who should be involved and what to say at an intervention, and how to prepare for what may become an ordeal. They must have the conviction that they are doing the right thing because a hoarder cannot be helped if the family fears anger or consequences of an intervention. Often family members attend a practice session before the intervention takes place.
The goal is to have the hoarder make one visit to an experienced therapist. Arrangements for treatment are usually made before an intervention takes place; ideally a session follows immediately.
At a prearranged time, family members approach the hoarder to talk about the effect of clutter on their lives and explain that help and support are available. Each person explains in a nonconfrontational and nonjudgmental manner why he or she is concerned. It is important that all participants make it clear that treatment is mandatory.
Details of an intervention can vary: The consulting professional may or may not be present; it may take place in an office or a home; and the hoarder may or may not be made aware of the upcoming event.
Facing a cohesive group, a hoarder cannot hide or minimize the problem. Intervention is a big step in the right direction, but the hoarder and those involved have much work to do. The hoarder must commit to treatment, and family members must address personal issues and learn to handle issues that may come up as the treatment progresses.
Elements of Treatment
During the initial visit, the therapist reassures the hoarder that family members want to help and that no possessions will be thrown away without permission. The client will learn organizational and decision-making skills while trying to understand the reason for hoarding.
The therapist discusses the pros and cons of hoarding, reasons to give up some of the behavior and to discard items, as well as how the behavior interferes with the client’s goals and values. In collaboration with family members, the therapist works to get the client to subsequent sessions and on the path to a safer, more fulfilling life.
Fugen Neziroglu, PhD, ABBP, ABPP, is Director of the Bio-Behavioral Institute, in Great Neck, New York
Overcoming Compulsive Hoarding: Why You Save and How You Can Stop,  by Fugen Neziroglu, Jerome Bubrick, Jose A. Yaryura-Tobias, (New Harbinger Publications, July 2004)