Magazines, household supplies, cardboard boxes and old mail scattered around the house may not seem unusual. But when an individual amasses plastic bags and other clutter, it may be a sign of hoarding disorder.
Jack Sherratt with Project ORE in New York City directs one of the few programs in the world specifically designed to help older adults with hoarding and cluttering issues. He spoke with Right at Home in late April, sharing his insights on ways families, friends and caregivers can assist loved ones with a hoarding condition.
When It Is Time for Professional Help
“What we hear from many well-meaning family members is that they want to send Dad away for the weekend and clear out his clutter while he is gone,” Sherratt says. “Just cleaning up clutter for a loved one does not work though. Decluttering will only leave the person feeling violated. The loved one will be in the same place emotionally, or actually in a worse place because there is now broken trust.” Some eventually lock themselves in their clutter over time, isolating themselves from family and friends.
Sherratt says individuals with hoarding issues need assessment from a mental health professional. “We have to look at the underlying thoughts and feelings that contribute to the behavior and evaluate the severity of the behavior and type of attachment,” Sherratt notes. “For some, clutter items hold sentimental value, or maybe there’s a utilitarian purpose or actual value. We help people determine these important value factors in the decision-making process. And then we practice with them the act of decluttering. It’s like building a muscle. The more a person practices, the easier it gets. We develop a relationship and we are partners in this. We don’t force anything on anyone. Everything is voluntary.”
Encourage the Individual to Make the De-clutter Choices
Sherratt continues, “We work with a client to say, ‘What’s important to you?’ And we respond with, ‘Let’s do that. You make all the choices; I’m not going to come in and throw anything away. I’m not going to touch anything until you say it’s OK. Maybe once we’ve been working together for a while, you will trust me to handle some things and then the next time you’ll even let me decide because I know now how you feel about the tools, clothes and books and where they all go.’ You learn from the client on what’s important, and then true relationship building and practice can help you move through the process more quickly.”
Randy Frost, a leading researcher in hoarding disorder, developed the Clutter Image Rating Scale (CIRS), which ranges from 1-9. The rating goes up with the level of clutter. When Sherratt is working with a client, he often employs CIRS in the assessment. “We ask clients to identify a CIRS level for themselves—to pick a number that corresponds to their level of clutter, and then the clinician will do the same,” Sherratt says. “In comparison, we can gauge the level of insight and readiness for change and we can get some type of understanding of what the client thinks is going on. The clinical team will also get a sense of where to start for treatment. If we see a 7—which means the clutter is almost to the ceiling—but the client sees only a 2, then it reveals that the client doesn’t really grasp what is going on and this will require a longer course of treatment.”
How Family, Friends and Caregivers Can Help
Friends, families and caregivers can provide support such as personal encouragement and help with cleaning during the treatment process. “It is important for family, friends and caregivers to know that the disordered behavior requires a clinical response,” Sherratt emphasizes. “Telling a hoarder that their home is dirty or disgusting is not a place to start a conversation about this. Instead, you listen to people, and you try to understand the relationship to their stuff and their resistance to getting rid of clutter. Then you work with that information. You more likely will be set up for success by not imposing your own wish onto the situation—a wish such as saying, ‘You need to clean this up.’ Just knowing how to have that conversation is critical to not isolate people further or limit further their willingness to get care.”
Sherratt’s team has a 100 percent success rate on preventing evictions and recidivism. “It’s possible to do this work successfully,” Sherratt says. “It does require patience, compassion, and typically, a clinical strategy and support. A hoarding condition is not something that is easy to treat, and people are not generally amenable to treatment. You can expect resistance, but understand that resistance is something we all sort of experience when it comes to difficult decision making. A critical piece is using a person’s own motivation and interests for a starting point.”
An award-winning journalist who has documented stories in nearly 20 countries, Beth Lueders is an author, writer and speaker who frequently reports on diverse topics, including aging and health issues for both U.S. and international corporations.