Hoarding - see the person not the stuff
Published on 23 November 2021
To discuss the complex topic of hoarding we talked to Tabitha from Light and the Load to hear her experiences on working with clients who have hoarding issues.
How would you describe hoarding?
It’s a difficulty with letting go of items, regardless of their actual value. It’s also difficulty with compulsions around acquiring. People may need to ban themselves from going to op shops for instance. They just can’t stop themselves from buying something.
It becomes a problem if it’s causing significant stress and impairment of functioning. The clutter compromises use of living space for example.
Most people have some clutter, but when it gets to the point that you can’t use the space e.g. can’t sleep in the bedroom because there’s too much clutter on the bed, that’s when it’s seen as an issue.
What’s the impact on the person from hoarding?
For the person, they live in deep shame. Unlike other mental health conditions, they do have some insight. They worry about what people will think.
The physical problem of it can be suffocating, making it too hard to get started. There’s no physical space for organising and sorting. It all seems too much and it’s overwhelming.
It also gets in the way of social life. People are embarrassed to bring people home. It gets in the way of romance, love and relationships. It also affects neighbour relations and family relationships. It causes loneliness, anxiety and depression.
Some would like to move house but they can’t. Finances are also impacted. The person can’t find things, so they buy more and then store them up. It gets in the way of peace and rest, because there are always things to do, the mind is always in a state of stress.
It can also get in the way of study and work. Ultimately, it affects the person’s sense of purpose and identity in life.
Do you see people before they are hoarding?
No, not usually, I see them at that point where they are far down the line, unless they are seeing me for something else. I usually find trauma underneath the hoarding behaviour but that link often has not been made in the past.
Depression and anxiety are in the psychological framework for treatment as is the link to OCD, but in my experience the main common underlying issue is unresolved interpersonal early trauma.
Does having a mental illness put you at risk of hoarding behaviour?
I often find hoarding is psychological and emotional, and related to difficult childhood experiences, feeling unsafe, even unconsciously, or attachment issues that are unresolved. Often people have depression as well, which may have started before the hoarding, or be a consequence.
Anxiety and other anxiety disorders such as obsessive compulsive disorder, social anxiety and obsessive compulsive personality disorder, along with psychosis or schizophrenia, autism spectrum disorder or attention deficit/hyperactivity disorder may sit alongside the hoarding.
The person may have a physical issue such as chronic fatigue, fibromyalgia or a disability. They don’t have the energy or may be in pain. Often there is an issue with procrastination or not being able to prioritise.
They are not mental health disorders, but dynamics of life get in the way. They need help with organisation and in life generally.
What else contributes to hoarding behaviour?
One of the other things that can contribute is inheritance. All of a sudden you go from one household of stuff, to two households in one. Inherited stuff is hard to get rid of. You are making decisions for someone else. There’s guilt associated with throwing things away. There’s the inability to prioritise or organise.
Often people who hoard are deeply creative. They keep things because they think they can fix them or create something else or make something beautiful. They have often experienced damage, loss and hurt which can be projected onto items so they want to buy that item, fix it and make it good again.
It’s good to acknowledge the creative side of people because that’s a gift.
People can also be deeply sentimental, so there’s that aspect. They can also be thrifty and resourceful. One of the things that can happen is the person gets rid of something and they deeply regret it. It’s useful to talk to them about this.
Ask them the question, if you get rid of this today can you get it again cheaply?
What’s your approach?
There are lots of different approaches. There’s the approach of throwing everything in a skip, that’s the cheapest. But this usually creates more trauma and destroys trust. It can exacerbate the issue. The underlying reasons haven’t been addressed, there’s no relational repair and the hoarding can continue.
With our approach we spend time, sometimes months or years, working with the person. We work through the process of letting go while in a trusting therapeutic relationship.
We work to fix the addiction of acquiring. Acquiring gives you that little bit of gratification, that chemical boost in the brain. We can’t just clear the mind with a skip.
In my trauma work, I use the concept of the inner child. It’s the premise that we are our age now, but the age when trauma occurred is also within us. It’s the part of us that gets triggered and gets overwhelmed and in deep grief. So it’s healing that part us of us to help us now.
It’s also about delineating between the inner child and the adult self, so the adult self can do the work. The inner child can be loved and nurtured.
Why can’t it just be cleaned up?
Stuff represents things. There might be special people in their lives. Or they’ve had a difficult childhood and not enough love. Unconsciously it might feel safe to accumulate stuff. In that moment of acquiring something it feels good. Usually afterwards there’s regret.
Things can be linked to a person or an event or protection. Items can represent achievements or loss, keep them company when they are lonely. It's complex.
Can you walk us through an example of a client you have helped?
There’s a client I worked with who experienced trauma in their childhood. They lost their mother and experienced sexual abuse. They didn’t have a constant.
By the time they were in their 50s, they wanted to move and didn’t know where to start. They found it very hard to get rid of stuff, as it represented a lot of good experiences in the past and in the present they were not having such good experiences.
I would go to their house and spend 3 or 4 hours helping to de-clutter. It was both physical and emotional support. One box at a time. They would go through each item and share their experiences with me. Many items were able to be let go of after that. It was a process of honouring their life.
It’s a slow painstaking process. I found out that they had fame in their 20's. It was nice to know that. It’s a process of psychological and emotional companioning someone through that process.
We celebrated every win of letting go. We would do a chink or a high five. I would then take discarded items away to the op shop or put them in the recycling or rubbish. After all the work, my client was able to relocate.
I had another client who I worked with over the phone with counselling, I have never been to their house. We worked with psychological trauma healing processes, addressing deep trauma from when they were very young, a baby. As we did that they became more self-loving, self-accepting, peaceful and confident.
From that they were able to attack cleaning up their house without the need for physical help at all. Then we would celebrate their wins. They would sometimes check in with me, saying what they would do for the day, for some accountability. They would feel good when doing well which created momentum and increased their confidence.
What are the keys to success?
It’s all about that human connection. A non-judgemental positive healing connection. Calling people a hoarder is stigmatising and not helpful. It’s better to say “someone who has hoarding”.
It’s key to get the person to envision what they want their house to look like. Having a vision and a goal can be important. That gives them the motivation to work towards that goal and the vision of the new life.
Dealing with change can be hard. Getting rid of stuff, means their house will be different, the protection of things around them is disappearing. They may need counselling to deal with this. It’s like addiction, there’s no point getting rid of the addiction without other supports in place.
Addiction is connection, if you remove that they may destabilise. So we need to put something in before removing the addiction – some new outer and inner resources.
Is there any funding available?
People can get help through the NDIS as hoarding is recognised as a mental health issue. They may also obtain ‘help with daily living’.
There’s also the Medicare mental health rebate for a psychologist that can give people with hoarding rebatable services. It is imperative to find a therapist who understands trauma and can work with attachment issues and the emotions.
Is there an increased fire risk with hoarding?
There is increased risk with fire because of the fuel load. It’s recommended that people register with the Melbourne Fire Brigade, so that in the event there is a fire, they will know of the increased risk and to send more trucks.
Keeping a clearway to the front and back doors so people can get out and clearing around stoves and heaters is also important, along with getting faulty appliances fixed.
Are there any support groups available?
Yes, there are support groups are available. The Anxiety Recovery Centre (ARCVic) run a hoarding support group that meets the second and fourth Tuesdays of every month. It’s by gold coin donation. For specific dates visit the ARCVic website.
It’s much easier listening to experiences and suggestions from peers, than listening to advice from someone who doesn’t have any experience.
A lot of my knowledge has come from attending these support groups and hearing from people in this situation. People are very open in this situation, more so sometimes even than with a counsellor.
If people are concerned about a friend or family member what can they do?
The main thing is to be non-judgemental. Seeing the person and not the stuff and working with them and not taking over. It’s also important not to give unsolicited advice.
Compassionate understanding family members or friends coming to the home regularly for a short session, for example weekly for half an hour or so can be helpful if welcomed by the person with hoarding.
It can enhance their motivation by turning up, even if they are not comfortable with you actually touching their stuff - Just being with them, as someone who will listen while they are sorting and revisiting their past. It’s very honouring and acknowledging to do that.
What is also helpful is being informed and understanding the issues, having a supportive attitude and empowering independence and choice, rather than taking over and throwing things out.
Asking “what’s the value in this item?” “What does it mean to you?” “Are you ready to let go of it?” “Would you like me to take this out with me?” And giving reality checks.
If they don’t want to get rid of an umbrella for instance, you can ask how many they have and how many they need. Then once they have awareness and find a spot for their umbrella, they may be ready to get rid of the other umbrellas.
For more information on hoarding behaviours visit Lightly Centered.