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A Closer Look at Hoarding Behavior

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Title: A Closer Look at Hoarding Behavior


1
A Closer Look at Hoarding Behavior
  • Presented By
  • Patrick Arbore, Ed.D.
  • Institute on Aging
  • San Francisco, CA

2
Center for Elderly Suicide Prevention Grief
Related Services (CESP)
  • CESP is currently a program of the Institute on
    Aging, San Francisco.
  • CESPs inaugural services was the 24-hour
    Friendship Line, which began in 1973.
  • (415) 752-3778 Local Line and (800) 971-0016
    Natl Line
  • (415) 750-4111 Assessment Information
  • Grief Services for People of Any Age 8-week
    group Saturday Drop-In Grief Group (1030-Noon)
    Individual Grief Counseling Call (415) 750-4111
    for information
  • Director Founder Patrick Arbore (415)
    750-4180x230 parbore_at_ioaging.org

3
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
    thingsoften on display

4
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.

5
Primary Characteristics of Hoarding
  • Three main types of problems
  • Compulsive acquisition
  • Saving behavior or difficulty discarding
    possessions
  • Disorganization in many areas of life, but that
    mainly manifests in extensive clutter

6
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
    persons living situation.

7
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.

8
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 dont understand why anyone should be
    concerned about their behavior.

9
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.

10
Dynamics of the Hoarder
  • There are three important concepts
  • Dirt Can be identified with aggression and
    defiance, which can lead to guilt, shame, and
    fear. People can react by defying authority.
  • Time Dawdling and procrastination show the
    struggle with control and mastery.
  • Money Rather than love, money and status are
    the foundation of emotional security.

11
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

12
Negative Aspects of Hoarders
  • Experience a high degree of shame and
    embarrassment
  • They know that something isnt normal
  • Overwhelm they dont 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

13
Feelings Associated with Those Who Clutter/Hoard
  • Anxiety
  • Boredom
  • Distractedness
  • Fatigue
  • Grief
  • Hopelessness
  • Overwhelmed
  • Resistance
  • Shame/Guilt
  • Anger/Rage/Hostility
  • Sorrow

14
Resistance
  • What is it?
  • Milton Erickson Resistance is a vitally
    important communication of a part of the persons
    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

15
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.

16
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.

17
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?

18
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?

19
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

20
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

21
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.

22
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.

23
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.

24
Shame/Rage
  • The greater the individuals 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.

25
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 individuals unique
    perception of loss.

26
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.

27
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.

28
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

29
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

30
Tips The Do Nots
  • Dont work with the hoarders/clutterers if you
    feel negatively about this behavior
  • Dont belittle
  • Dont talk patronize
  • Dont expect overnight miracles
  • Dont overwhelm or threaten them
  • Dont take anything away without a discussion
  • Dont get into power struggles
  • Dont do surprise clean ups
  • Dont tackle this on your own
  • Dont force interventions
  • Dont use the persons first name unless give the
    okay

31
Do Nots Continued
  • Dont talk to others who are in the room about
    the person as if she/he is not present
  • Dont criticize the environment
  • Be aware of your non-verbal behaviors (facial
    expressions of disgust)

32
Tips The Dos
  • 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

33
The Dos 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

34
The Dos 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

35
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.

36
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.

37
The Role of Spirituality
  • Mel Ash, The Zen of Recovery, has said
  • In surrendering to ones own original sense of
    order and harmony, ones 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.

38
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.

39
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

40
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 lifes limitations something the
    hoarder/clutterer does not yet understand.

41
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.

42
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.

43
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.

44
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
    societys 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 ones fifties and sixties can be
    very different from the seventh, eighth and ninth
    decades of life.

45
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 lifes ultimate meaning cannot lie in
    speed, consumerism, youth, achievement,
    celebrity, and physical beauty.

46
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 themand instead
    internalize new images of the later years.

47
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.

48
Psychic Clutter
  • Clutter doesnt 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.

49
A Clutterers 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.

50
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

51
Needs Continued
  • We become depleted if we are deprived of
    attention, approval, acceptance, admiration, and
    affirmation
  • People become emotionally starved when they dont
    get enough of these emotional supplies
  • Emotional hunger is the breeding ground for
    emotional desperation and that sets the stage for
    rage

52
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

53
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.

54
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 fromtrying to
    take out ones 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 attentionthe moment I begin thinking about my
    attention (to a book or lecture) I have ipso
    facto ceased attending.

55
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.

56
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

57
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.

58
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 someones suffering
  • Compassion Understanding Love
  • People who suffer need to be shown as
    unconditional love

59
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.

60
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.

61
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.

62
Caring for Others
  • Understanding of their world
  • Be with the other
  • I am both with and for the other

63
Caring and Growing
  • The basic pattern of caring is helping the other
    person grow.
  • I experience the others development as bound up
    with my own sense of well-being.
  • I respond affirmatively and with devotion to the
    others need, guided by the direction of his/her
    growth.
  • Caring is always about someone or something
    specific that is cared for

64
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.

65
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 emotionsdisgust,
    anger, and contempt.

66
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.

67
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.

68
Self-Forgiveness Continued
  • Tippings 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.

69
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.

70
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.

71
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
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