A Closer Look at Hoarding BehaviorPresented By:

Patrick Arbore, Ed.D.Institute on Aging

San Francisco, CA

Center for Elderly Suicide Prevention & Grief Related Services (CESP)

CESP is currently a program of the Institute on Aging, San Francisco.

CESP’s inaugural services was the 24-hour Friendship Line, which began in 1973.

• (415) 752-3778 Local Line and (800) 971-0016 Nat’l Line• (415) 750-4111 Assessment & Information• Grief Services for People of Any Age – 8-week group;

Saturday Drop-In Grief Group (10:30-Noon); Individual Grief Counseling – Call (415) 750-4111 for information

• Director & Founder – Patrick Arbore (415) 750-4180x230 parbore@ioaging.org

Definitions

• HOARDERS – Can be referred to as hunter/gatherers

• PACK RATS – Stockpile haphazardly and seldom use the things that are stored

• CLUTTERES – An out of control need to accumulate things

• COLLECTORS – Orderly, systematic organization of things…often on display

A Closer Look At Those Who Clutter

• Hiding may be what people who clutter are pursuing• Shame may be what motivates their desire to hide• Fear, anger, sadness are additional emotional

obstacles• Most compulsive behavior involves a kind of desperate

longing to fill the holes in the soul (Moore, The Inner Loneliness)

• Inner Loneliness cannot be eased through clutter, people, possessions, games, achievement, work, television viewing, the internet, excessive exercise, etc.

Primary Characteristics of Hoarding

Three main types of problems:

1. Compulsive acquisition

2. Saving behavior or difficulty discarding possessions

3. Disorganization in many areas of life, but that mainly manifests in extensive clutter

Differences between Cluttering & Hoarding

• Cluttered conditions may result from a variety of causes including physical fraility, dementia or hoarding behavior.

• Clutter becomes problematic when areas of the home cannot be used for their intended purpose.

• Possessions pose a safety hazard or endanger a person’s living situation.

Differences Continued

• Hoarding is a behavior characterized by – collecting things that either do not serve a purpose or are redundant; collecting but not discarding; extreme emotional attachment to the items collected and an inability to part with them without significant anxiety and stress.

The Person Who Hoards

• Because hoarding is a long-term behavior, it is seen particularly in the older adult. However, the hoarding behavior started decades earlier.

• Hoarders exhibit socially eccentric behavior.• Is the behavior gender specific? Often seen in older

women…(women generally outlive their male partners). No empirical data on gender.

• Hoarders are (generally) mentally competent.• Hoarders exhibit an indifferent attitude toward their

behaviors• Hoarders don’t understand why anyone should be

concerned about their behavior.

The Person Who Hoards Continued

• Usually lacks self-care skills (but may appear well groomed in public).

• Perceives themselves to be socially isolated.• The hoarder can see no difference between “treasure

and trash.”• Appears to be no socio-economic differences.• Most do not meet the diagnosis for

Obsessive/Compulsive Disorder but may have features.• Hoarding behavior is increased in older people with

dementia.

Dynamics of the Hoarder

There are three important concepts:

1. Dirt – Can be identified with aggression and defiance, which can lead to guilt, shame, and fear. People can react by defying authority.

2. Time – Dawdling and procrastination show the struggle with control and mastery.

3. Money – Rather than love, money and status are the foundation of emotional security.

Reasons for Hoarding

• Items are perceived as valuable• Items provide a source of security• Fear of forgetting or losing items• Constant need to collect and keep things• Obtaining love not found from people• Fear others will obtain their personal information• Physical limitations and frailty• Inability to organize• Self-neglect• Stressful life events

Negative Aspects of Hoarders

• Experience a high degree of shame and embarrassment• They know that something isn’t normal• Overwhelm – they don’t know where or how to start to think this

through• Feel out of control• They ask themselves “Am I crazy or not?”• Fear being “found out”• They live in dread that a repair person or a paramedic may come• They are easily distracted• They often smoke and/or abuse substances including alcohol• They cannot seem to initiate organizational behavior

Feelings Associated with Those Who Clutter/Hoard

• Anxiety• Boredom• Distractedness• Fatigue• Grief• Hopelessness• Overwhelmed• Resistance• Shame/Guilt• Anger/Rage/Hostility• Sorrow

Resistance

What is it?• Milton Erickson – Resistance is a vitally important

communication of a part of the person’s problems and often can be used as an opening into their defenses.

• Resistance is a defense against “insight”.• A person will become more resistant is a helper

becomes pejorative – “Look at all this trash!”• The helper must help the person become friendly with

the resistance – Explore the unknown may be a better approach

Resistance Continued

• A resistance, regardless of its source, is triggered by anxiety, conscious or unconscious.

• Resistance may take the form of overt hostility or more subtle communication of frustrating feelings.

• Resistance can also be a healthy sign that the person has a lot of energy.

Resistance and the Hoarder

• People with problematic hoarding behavior often refuse help.

• Researchers have found that it may be effective to help the clutterer sort through possessions rather than discuss discarding all the redundant material.

Inquiring about Clutter

Be non-judgmental when you ask these questions:• Are you reluctant to have people come over

because of clutter in your living space?• Are you able to use your kitchen appliances?• Is there a place to sit down and eat?• Do you have to move things off the furniture to

sit?• Are you able to sleep in your bed?• Are there clear pathways to the bedroom and

bathroom?

Questions Continued

• Can you easily use your toilet, tub and shower?

• Do you have trouble finding things because of too much “stuff” in your home?

• Have you fallen over the clutter in your home?

• Are you behind in paying your bills because you cannot find your mail?

Minimum Safety Guidelines

General Guidelines include:• Working toilet and sink• Adequate walking paths in rooms used on a

regular basis• Safe walkway (flooring uncluttered)• No infestations of insects and/or rodents• No excessive accumulation of garbage• Absence of fire hazards, including – no

combustibles near radiators or stoves, no blocked exits, no overloading of outlets

Guidelines Continued

• For home care professionals, a chair surface without clutter for the worker to sit on (if necessary)

• Working phone or nearby access to one

Shame

• To feel shame is to feel seen in a painfully diminished sense.

• The self feels exposed both to itself and to anyone else present.

• It is this sudden, unexpected feeling of exposure and accompanying self-consciousness that characterizes the essential nature of the affect of shame.

• We feel deficient in some vital way.• To live with shame is to experience the very essence or

heart of the self as wanting.

Characteristics of Shame

• The binding effect of shame involves the whole self.• Sustained eye contact with others becomes intolerable.• The head is hung.• Spontaneous movement is interrupted.• Speech is silenced.• Feeling exposed opens the self to painful inner scrutiny.• We are suddenly watching ourselves, scrutinizing

critically the minutest detail of our being.• Exposure heightens our awareness of being looked at or

seen.

Shame: An Impotence-Making Experience

• To the person who hoards/clutters, it feels as though there is no way to relieve the inner pain – except to hide within the clutter.

• One has simply failed as a human being.• There is nothing they can think of to do to make

up for this dreadful feeling.

Shame/Rage

• The greater the individual’s shame, the more savagely and frequently they rage.

• Rage increases the experience of shame.• Shame, however, cannot be eliminated by raging.• This shame/rage spirals into misery.• This misery continues feeding the conflict that one feels

with the world/family/caregivers.• Until the pattern of shame/rage can be broken, the

person may: (1) be emotionally/physically abusive; (2) dependent on alcohol and other substances; and (3) experience suicidal thoughts.

The Role of Grief & Loss

What is Grief?• A process of experiencing the psychological,

behavioral, social, and physical reactions to the perception of loss.

• Grief is a continuing development – it is not a static state – it involves changes over time.

• It is natural and expectable reaction.• It is a reaction to all type of loss.• It is dependent upon the individual’s unique

perception of loss.

The “Dark” Emotions

According to Miriam Greenspan (2003):• Suppressed Grief – often turns into depression, anxiety,

or addiction.• Benumbed Fear – can lead to irrational prejudice, toxic

rage, and acts of violence.• Overwhelming Despair – can lead to severe psychic

numbing or expresses itself through destructive acts to oneself (suicide) or others (abusive behaviors).

An inability to express and experience grief, fear and despair in a healthy manner can lead to depression, anxiety, addiction, irrational violence, and psychic numbing.

How Hoarders are Perceived by Others

• They are perceived by family members, neighbors, other non-professionals as crazy, lazy, mentally ill.

• There is a distinct and unpleasant odor in their environment – People want to get away from them.

How Professionals Perceive Hoarders

Professionals find these individuals:• Interesting and curious• Bright, creative, artistic• Living their lives in their own way• Fiercely independent• Strong willed

How Hoarders Perceive Professional Helpers

• At best, nice but not very helpful• Judgmental• Arrogant• Pushy• Impatient, Hasty• Not understanding• Perceived as though they do not want to understand• Negative/nagging• Threatening/bullying• Disrespectful• Invasive• Overly serious “way, way too serious”

Tips – The Do Not’s

• Don’t work with the hoarders/clutterers if you feel negatively about this behavior

• Don’t belittle• Don’t talk patronize• Don’t expect overnight miracles• Don’t overwhelm or threaten them• Don’t take anything away without a discussion• Don’t get into power struggles• Don’t do “surprise” clean ups• Don’t tackle this on your own• Don’t force interventions• Don’t use the person’s first name unless give the okay

Do Not’s Continued

• Don’t talk to others who are in the room about the person as if she/he is not present

• Don’t criticize the environment

• Be aware of your non-verbal behaviors (facial expressions of disgust)

Tips – The Do’s

• Establish a positive relationship• Maintain respect• See their point of view (use empathy)• Name the problem and define the standards

(e.g. at this facility there are safety codes that we have to meet for the protection of all residents, etc.)

• Help them maintain some sense of control over the setting

The Do’s Continued

• Help in setting goals• Establish boundaries, time frames for getting this started• Work collaboratively• Offer physical help/emotional support• Be persistent• Use a soft, gentle approach; let the person tell their story• Respect the meaning and attachment to possession by

the person – may be as intense as human attachment• Be calm factual, caring and supportive• Praise effort often and sincerely

The Do’s Continued

• Offer referrals to professional organizers if needed

• Gently suggest the importance of professional help such as – grief counseling, individual therapy, 12-step program, physician, psychiatrist

• Family intervention

Affirmations for Hoarders/Clutterers

• I understand that there are too many things in my living space.

• I am ready, willing, and able to clear and clean these areas.

• I will pare down my “stuff” to a more manageable and usable quantity.

• I gladly give away, recycle, or toss out what can be used by others and given back to the environment.

Affirmations Continued

• I will do this with commitment, purpose, and without regret, because what I am doing clears space in my life for other people, events, and usable things to enter.

• I rejoice that I have been able to lessen the load of possessions that hamper living my life in a way that I know or dream that I can.

The Role of Spirituality

Mel Ash, The Zen of Recovery, has said:“In surrendering to one’s own original sense

of order and harmony, one’s compulsion is abated.”

• Recovery from clutter is more than removing “stuff” from our living space.

• It is removing old ways of thinking and believing from our minds in order to free our souls.

What is Spirituality?

• May mean different things to different people.

• Spirituality may be defined as a motivating force that searches for meaning and purpose in life through connectedness.

• Spirituality is a dynamic lifelong search process that arises from life and spiritual experiences.

What is Religion?

• Religion originates in an attempt to represent and order beliefs, feelings, imaginings and actions that arise in response to direct experience of the sacred and the spiritual.

• It becomes a process that creates meaning for itself on a sustaining basis – in its originating experiences and its own continuing responses

Wonderment

• The hoarder/clutterer/pack rat does not have an attitude of wonderment – of the immediacy of life and a new ability to live in the present moment.

• When living in the moment, one is aware of the elemental realities of life and their significance – family, friends, co-workers, plants, nature, music, physical and emotional touching, the textures of color and shape.

• The price of this birth of wonder is an acceptance of life’s limitations – something the hoarder/clutterer does not yet understand.

Wonderment Continued

• The discipline of acknowledging certain limits simplifies life – our vision is uncluttered.

• Wonder is the prelude to gratitude.

• Encourage the clutterer to develop an attitude of gratitude.

Vision

According to William Penn Mott Jr., California State Park Director:

“A vision is a powerful thing. It is a dream based on clear perceptions of the future combined with a commitment to take the necessary steps to make it happen.”

Fear of Letting Go

Ralph Waldo Emerson – “You must let go of a thing for a new one to come to you.”

• Clutterers fear letting go of things because it involves taking a risk.

• Despite many offers for help over the years clutterers hold on to their overwhelming possessions and resentments – they move farther and farther away from help.

Spirituality of Aging

• Must begin with our very existence as older persons.• How do we define this complex process called aging?• Many older people regard age as a mental concept.• How we age depends upon the way we internalize society’s images

of the old.• If we start to see ourselves as used up and useless, we begin to act

accordingly. • Changes associated with aging do not occur all at once and no two

individuals experience exactly the same changes at the same stage of their lives.

• The decades of one’s fifties and sixties can be very different from the seventh, eighth and ninth decades of life.

Challenges

• To recognize how our society has distorted the experience of aging – Ageism

• In The Coming of Age, Simone de Beauvoir stated that confronting the reality of aging in our culture means changing the whole fabric of existence.

• A spirituality of aging calls into question the deepest values of our civilization.

• If the aging process reveals to us the mystery of life, then life’s ultimate meaning cannot lie in speed, consumerism, youth, achievement, celebrity, and physical beauty.

Challenges Continued

• The present situation of many older people, old and young alike, has been described as a disease of the imagination.

• People have accepted the negative images of old age, made them their own, and begun to live out of these images of incompetence and insignificance.

• The task of a spirituality of aging is to convert the imaginations of both old and young to a new vision of the human.

• This can only happen if the old themselves refuse to let society define them—and instead internalize new images of the later years.

Confronting Our Own Mortality and Eventual Death

• Face the awareness of our own mortality and a willingness to discuss it without hesitation.

• Cultivate an affirmative outlook on death; review your understanding of death based on your spiritual beliefs.

• Speak to loved ones about funeral arrangements.

• Tell personal stories about the past and present.• Reach out for help from family, friends,

caregivers and others.

Psychic Clutter

• Clutter doesn’t just happen on the physical plane. The physical is a reflection of their conscious mind.

• The clutterer holds on to old grudges, resentments, long lost relationships, old disappointments.

• Clutterers carry a never ending supply of hurt and sadness that sours their souls.

A Clutterer’s Approach to Fixing Things

• In one word – MORE – more of everything physical

• Clutterers put their faith in broken chairs, unusable cabinets, more money, different relationships, stacks of newspapers, engines from cars, and so on.

• They clutter their souls with resentments, fears, shame, and grudges because they believe that no one can help them.

Five Basic Emotional Needs

• There are five basic emotional needs that are deeply ingrained in us – attention, approval, acceptance, admiration, and affirmation

• To feel fully alive and human, we need to give and receive these emotional “gifts”

• If these basic needs are unmet, life becomes meaningless

• Everyone needs these gifts – There temporary absence can be tolerated for a little while

Needs Continued

• We become depleted if we are deprived of attention, approval, acceptance, admiration, and affirmation

• People become emotionally starved when they don’t get enough of these “emotional supplies”

• Emotional hunger is the breeding ground for emotional desperation and that sets the stage for rage

Meaningful Conversation

• Communication that is deeper, richer and more sincere

• Originates from a deeper place inside us• Open, inviting, friendly, caring• Based upon interest in the other person• Free of cliches or superficiality• Alive both in the speaking & listening

components

Immersion in Behavior

• People derive instrumental, intrinsic, and spiritual value when they are: (1) absorbed in a conversation; (2) captivated by a lecture; (3) transfixed by the music, (4) caught up in the game, or (5) lost in the pursuit of a question.

• Anything that might disrupt this immersion, e.g. illness, grief, shame, resentment, may diminish the notion of meaning.

Do I Believe?

C.S. Lewis writes (1949) –The moment one asks oneself “Do I believe?” all belief

seems to go. I think this is because one is trying to turn round and look at something which is there to be used and work from—trying to take out one’s eyes instead of keeping them in the right place and seeing with them. I find that it happens about other matters as well as faith. In my experience only very robust pleasures will stand the question, “Am I really enjoying this?” Or attention—the moment I begin thinking about my attention (to a book or lecture) I have ipso facto ceased attending.

C.S. Lewis Continued

St. Paul speaks of “Faith actualized in Love.” And “the heart is deceitful”; you know better than I how very unreliable introspection is. I should be much more alarmed about your progress if you wrote claiming to be overflowing with Faith, Hope, and Charity.

Maintaining Connection

• Communication – both verbal and non-verbal – enables caring to develop and be maintained

• As communication and caring develop, a deep connection and commitment may begin to unfold

Necessary skill to an Intimate Relationship

• The central communication skill in an intimate relationship is telling the truth.

• This skill includes telling the truth in any given moment in a way that does not blame the other.

• Stay with the communication until the other person comprehends your words and your intention.

• It is important to maintain truthful communication especially during times of distress and upset.

Helping Clutterers Through Compassion

• Compassion contains and expresses feelings of openness, caring and interconnectedness

• Compassion is a sustained and practical determination to do whatever is possible to help alleviate someone’s suffering

• Compassion + Understanding = Love• People who suffer need to be shown as

unconditional love

People Who Clutter Suffer

• See the sufferer as a person just like you, with the same needs, the same fears, the same loneliness – Your heart will open to the person.

• Imagine that you are the sufferer. Imagine that you are in their pain and loneliness. What would you need?

• What the sufferer most wants is what you would want – to be loved and accepted.

• There is something about hoarding that often interferes with our ability to express compassion.

Insight into the Nature of Suffering

• Compassion stems from the recognition of suffering.

• If we recognize our own suffering, we will become more powerful and effective in recognizing the suffering of the others.

• Our compassion for others grows as our ability to recognize their suffering grows.

Insight Continued

• By maintaining compassion we will be able to be close to those who suffer as a result of their being continuously under the control of negative emotion. This form of suffering (being continuously under the control of negative emotion) is difficult to recognize. It is not the acute misery of the ill; this pervasive suffering is profound and permeates all aspects of life.

Caring for Others

• Understanding of their world

• “Be with” the other

• I am both with and for the other

Caring and Growing

• The basic pattern of caring is helping the other person grow.

• I experience the other’s development as bound up with my own sense of well-being.

• I respond affirmatively and with devotion to the other’s need, guided by the direction of his/her growth.

• Caring is always about someone or something specific that is cared for

Resentment

• Is chronic anger that may be entirely subjective.

• It is a combination of the emotions and actions and thought patterns resulting from our unresolved anger at an injustice.

• Resentment comes from anger just as smoke comes from fire.

Resentment

According to Paul Ekman (2003) –

• Resentment is a long-standing feeling of being treated unfairly and unjustly.

• Resentment can fester like a boil and occupy our mind all the time.

• Hatred, like resentment, is long standing.

• Hatred involves at least three emotions—disgust, anger, and contempt.

Unforgiveness

According to Worthington (2001) Five Steps to Forgiveness –

Unforgiveness is defined as delayed emotions involving resentment, bitterness, residual anger, residual fear, hatred, hostility and stress, which motivate people to reduce the unforgiveness.

Self-Forgiveness

According to Colin Tipping (2002) Radical Forgiveness:

Self-forgiveness is difficult – we are trying to be judge, jury, defendant and witness all in the same case.

Some people who speak of self-forgiveness actually indulge in self-blame and recrimination.

They may use self-forgiveness as another way to beat themselves up.

Self-Forgiveness Continued

Tipping’s appeal is made, not to our human self, but to our Higher Self – our I Am consciousness.

• This is the part of ourself that is with us at our core, observing us but never judging us.

• Self-forgiveness helps us move beyond the wounds that may have occurred in the childhood years.

• Once we experience self-forgiveness, a person can then be open to feel unconditional love and acceptance.

Self-Forgiveness Continued

According to Safer (1999) Forgiving and Not Forgiving:

• Forgiving yourself involves coming to terms with the one person you can never get away from – you can cut out everyone but there is no escaping yourself for the rest of your life.

• Three tasks are specific to self-forgiveness – (1) taking responsibility; (2) grieving for losses you have caused; and (3) hating yourself less as a result.

What Triggers Self-Forgiveness?

Safer states that moments of kindness or caring that a person expresses to another, whether they are registered consciously or not, may exert a subliminal beneficent influence later on.

Holding yourself accountable, without hatred or denial, for the damage you do to the person in the mirror is the prerequisite for every other act of forgiveness.

Some Rules to Live By

According to Carolyn Myss (1996) –• Make no judgments• Have no expectations• Give up the need to know why things happen as

they do• Trust that the unscheduled events of our lives

are a form of spiritual direction• Have the courage to make the choices we need

to make, accept what we cannot change, and have the wisdom to know the difference