TOUGH TALK HOW TO HAVE THE DIFFICULT CONVERSATION ABOUT HOARDING

Transcription

1 TOUGH TALK HOW TO HAVE THE DIFFICULT CONVERSATION ABOUT HOARDING Denise Burningham and Leslie Shapiro HOARDING DISORDER: THE BASICS Hallmarks of HD Difficulty Discarding Clutter Distress Excessive Acquisition Co-Occurring Diagnosis Severity and risk increases with age Caused by a variety of external and internal variables Biological Psychological Social 1

2 BIOLOGICAL FACTORS Family history Genetics Social learning Progresses with age Brain functioning Executive functioning deficits Maladaptive cognitive processes PSYCHOLOGICAL FACTORS Mental health Emotional distress Specific beliefs about possessions Attachment to possessions Hoarding behaviors are reinforced over time Acquiring = positive feelings Discarding = negative feelings 2

3 SOCIAL FACTORS Major life events/transitions Higher frequency of traumatic events Stressful events around onset of symptoms Burden on families Stress on family Social Stigma Some approaches to hoarding disorder on television have displayed people who hoard in a negative and inaccurate way. STIGMA This portrayal can contribute to the shame and fear of seeking help for both people who hoard and their family members, thus making them isolate more (and perhaps worsening the problem). 3

4 REACTIONS TO HOARDING BEHAVIORS Family Members Commonly Experience Anxiety Frustration Hostility Rejection of their family member who hoards Resilience is the ability to withstand difficulty, adversity and/or traumatic events. ê Resilience can be built through supportive relationships, learning new skills, and utilizing personal strengths. RESILIENCE ê Positive interpersonal relationships can serve as protective factors against the severity of hoarding behaviors (Sampson & Harris, 2012) ê Building support networks for yourself and your family member who hoards is key to resilience and working through issues related to hoarding disorder 4

5 QUESTIONS TO ASK Start by ASKING! Are any areas of your home difficult to walk through because of clutter? Are you unable to use any parts of your home for their intended purposes? For example: cooking, using furniture, washing dishes, sleeping in bed, etc. Do you find the act of throwing away or donating things very upsetting? Do you have strong urges to buy or collect free things for which you have no immediate use? Have you ever been in an argument with a loved one because of the clutter in your home? TALKING ABOUT HOARDING DISORDER Be direct Don t dance around the issue Simply state the facts Safety issues Health risks Potential other involved parties Housing Authority Adult Protective Services Child Protective Services Hazardous Waste Team City Code Enforcement Other Entities 5

6 TALKING ABOUT HOARDING DISORDER Be clear about concerns regarding The individual The home Others Promote healthy change Increase safety Reduce the risk of others getting involved What will motivate change? MOTIVATIONAL INTERVIEWING MI Areas useful for assessing and building motivation to change (Bratiotis, Schmalisch, & Steketee, 2012) Client s perception of importance of addressing the problem Client s confidence in ability to change Strategies (Frost & Steketee, 2007) Ask for elaboration Looking forward and looking backward Affirming self-efficacy (that they want to do it themselves) Evocative questions 6

7 HARM REDUCTION Set of practical strategies that reduce the negative consequences of a particular health issue (Harm Reduction Coalition, 2010) Goal: not to eliminate behavior itself but to minimize negative, unwanted consequences that accompany behavior Does not require the individual to have insight into reasons for hoarding Only recognize the potential for harm to them, others, or neighbors and to agree to minimize the risk Doesn t prevent new items from coming in or increase discarding Helpful for individual with cognitive impairments or for people who are unwilling to seek treatment HARM REDUCTION GOALS Safety Moving flammable materials away from heat sources Clearing walkways of trip hazards Clearing enough room around doors and window Health Clearing access to bathroom and washing facilities Ensuring proper food storage Addressing appropriate trash and waste disposal Eliminating pest infestations Comfort Addressing heating and cooling problems Designating and clearing appropriate places to sleep and eat Making space to conduct daily tasks 7

8 Supportive Family and Friends Therapists Adult Protective Services Housing Hazardous Waste Team Professional Organizer Support Group Wraparound Facilitator City Code Enforcement BUILDING A HARM REDUCTION TEAM RESOURCES Non-profit agencies: The Hoarding Project (local) International OCD Foundation Mental Health Association of San Francisco Institute of Challenging Disorganization Children of Hoarders Support Groups The Hoarding Project (local) Children of Hoarders Bay Area Resources Clutterers Anonymous Local Task Forces King/Pierce Hoarding Task Force Snohomish Hoarding Task Force 8

9 BOOK RESOURCES Treatment for Hoarding Disorder Workbook (2014), Frost & Steketee. Clinician s Guide to Severe Hoarding: A Harm Reduction Approach (2014), Tompkins Stuff: Compulsive Hoarding and the Meaning of Things (2010), Frost & Steketee Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding (2007) Tolin, Frost, & Steketee Digging out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring (2009), Tompkins & Hartl The Hoarding Handbook: A Guide for Human Service Professionals (2011), Bratiotis, Sorrentino Schmalisch, & Steketee Loss, Trauma and Resilience (2006), Boss Motivational Interviewing: Preparing People for Change, 2 nd ed. (2002), Miller & Rollnick Narrative Means to a Therapeutic End (1990), White & Epston Dirty Secret (2010), Jessie Sholl Coming Clean (2014), Kimberly Rae Miller 9