Hoarding Workshop: Cognitive-Behavioral Strategies for Clutter, Lecture notes of Design of Wood Structures

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WORKING THROUGH THE CLUTTER:

A HANDS-ON HOARDING WORKSHOP

ELSPETH BELL, PH.D. BEHAVIOR THERAPY CENTER OF GREATER WASHINGTON

April 13, 2012

Objectives

 Describe cognitive-behavioral treatment strategies specific to in vivo interventions for hoarding behaviors

 Apply the understanding of underlying issues to the conceptualization of hoarding from a cognitive- behavioral perspective

 Implement treatment interventions that utilize cognitive-behavioral principles when working with hoardings in their homes

The Cognitive-Behavioral Model

Thoughts

Feelings Behaviors

Hoarding and Thoughts

 Thought Processes

 Perfectionism  All-or-Nothing  Fear of making mistakes  Missed opportunities  Distorted perception of others’ spaces

 Information

Processing

 Categorizing  Determining importance  Assumptions about items

Hoarding and Behaviors

 Churning

 Distracting self from decluttering

 Avoiding decisions and discarding

 Needing to remember/record

 Keeping items in-sight

 Creating visual cues

 Avoiding emotional discomfort

The Application of CBT Principles

Therapeutic Exercises

Valuing and Questioning

 If you were to write a handbook for living your life, what would be the predominant messages that reflect your values?

 Once you’ve identified these priorities, what questions can you ask yourself that encourage choices that support these themes?

Challenging Automatic Thoughts

 Downward Arrow  What thoughts occur when faced with getting rid of a particular item?  What would happen without this item?  What would it mean to you? Why would this be upsetting or distressing  If these thoughts are true, what’s so bad about them?  What’s the worst part about these thoughts?  What does it mean to you?

( Compulsive Hoarding and Acquiring Workbook , 2007)

Decluttering Role-Play

 Trading places

 Client practices coaching techniques in helping someone else (clinician) sort through clutter  Clinician demonstrates empathy and understanding of client’s circumstances  Client feels empowered to challenge and question self

 Using generic clutter

 Have a box on-hand in office

 Using client’s possessions

In-Session Decluttering

 Working through acquired items  Practicing skills addressed during session

 Address thoughts and feelings as they arise

 Coaching through process

 Helps initiate homework process  Setting the stage for success

 Client controls which items are addressed

 Less threatening than allowing clinician into home

Before Entering the Home

 Discussion of what to expect

 Identification of any “off-limits” spaces or items

 Plan what to do with items that are being let go of

 Donation sites  How to deliver items to these destinations

 Definition of decluttering team

 Family members or friends who may assist  Involvement of professional organizers, etc.

Rules of Engagement

 Therapist will not touch possessions without EXPLICIT permission  Decisions are made by owner of the items  Can be guided by therapist, not decided by therapist  Establish categories in advance  Proceed systematically  Agree on a “Plan of Attack”  OHIO rule ( O nly H andle I t O nce)  Be flexible and creative  PRACTICE, PRACTICE, PRACTICE  Sorting, Decluttering, Non-Acquisition

Therapy Bag & Temporary Discarding

 Items set aside during self-directed decluttering between sessions  Out-of-sight, out-of- mind  Reviewing challenges faced while working independently  Questioning how experience is different when in company of coach or clinician

 When considering letting go of an item but struggling with finality of commitment  Allowing clinician to hold onto item  Evaluate SUDS  Anticipated vs. actual  Question experience of temporary separation

1 Clinician – Empathetic, Supportive, Challenging

1 Client – Attached, Struggling, Overwhelmed

1 Bag of Clutter – Emotions, Memories, Uses

Trade roles half-way through

Role-Playing Exercise