​Hoarding—It’s So Much More Than Just Stuff

By: Cecilia Garrett, Clinical Director 

Hello! Let me introduce myself; I’m Cecilia Garrett, but everyone (even my mother) calls me Ceci. I am excited to join the team here at Cornerstone OCD & Anxiety in a dual role as Clinical Director and as a clinical social worker. I just earned my MSW in clinical social work from Campbellsville University in Kentucky this May.
 
Although I’m a new graduate, I am bringing with me nearly a decade's worth of community-based experience with seniors, housing relocation, and nonprofit management related to hoarding behaviors. Additionally, I have extensive experience in practice management and entrepreneurship. I founded a nonprofit in Spokane, Lightening the Load, which was a faith-based organization that offered paraprofessional-led groups and in-home coaching to individuals who self-identified as having hoarding behaviors.
 
At Cornerstone, I’m going to be working to strengthen our team, services, and to build our new group of programs called the Hoarding Wing. You may be aware that “Cornerstone” is an architectural element, so we have decided to stick with that as we named the new hoarding-focused programming, hence the Hoarding Wing. Our OCD-focused services include intermediate outpatient groups called “Foundations.”
 
Why a wing? Why not just a room?
Hoarding disorder (HD) is a unique disorder because of the environmental impact that surrounds those who fight valiantly against the unhelpful beliefs (cognitive distortions) that tend to underpin HD. Often the first contact is from a concerned family member or friend. Adult children and spouses often spend decades attempting to get their parent/spouse to admit that there is a problem or to seek help. Family members may be overwhelmed and lack the resources and training to help. 
 
We desire to view HD through a holistic lens, looking at the individual with HD, their needs, as well as those of their family members, housemates, and even community. Although skilled mental health treatment for HD is a necessity, addressing the impacts of HD may include working with family members to heal trauma wounds, make repairs to housing, or advocating for extensions to stabilize housing or stop eviction proceedings. 
 
We recognize that the environmental impacts that often accompany HD as well as symptoms of comorbid disorders that many with HD endure means that compassionately and professionally dealing with hoarding means creating programs for loved ones who have been affected in addition to those that support and treat the individual with HD. As a result, we are planning programs for families (and adult children specifically) impacted by HD. We don’t view families as part of the problem, but as a helpful addition to addressing hoarding holistically even when that means first, we must address the wounds and relational ruptures that co-occur in these families and relationships.
 
Additionally, HD has a unique outcome that has often been sensationalized by the media; even when the person with HD is removed from their house, evidence of the problem remains. Clutter. Sometimes that clutter is so severe that it becomes more appropriate to call it squalor. It is important to clarify here that clutter is an external symptom. Clutter is just evidence, after the fact, that faulty cognitions spurred on by strongly held personal values have positively reinforced new acquiring while anxiety has stopped the process of dissemination, redistribution, or letting go of acquired items. 
 
Things—like newspapers, craft supplies, tools—are unable to act on their own. Thus, the problem lies within the person and these person-centered behaviors act upon the environment. It would be so much easier if the physical symptom, clutter, were easily resolvable without the person present and invested in the process. Successful change requires us to remain vigilant that the challenge lies within the person even if it manifests itself so tangibly in the physical environment.
 
Treating the person with HD focuses then on two very separate fronts—internal thought processes and externally obvious behaviors. Attempts to deal with either separate from the other are generally unsuccessful. Removing the person and clearing out the accumulated possessions is a temporary fix at best and often results in the new intensified acquisition of possessions. The cost of such cleanouts is exorbitant. 
 
At times, individuals, families, and communities may be forced to engage in such cleanouts due to personal and public health and safety issues. We reserve these levels of intervention for those exceptions; most individuals with hoarding behaviors exist with lower levels of clutter and should not be approached with an aggressive style of intervention. For these individuals, specialized treatment that is based upon cognitive-behavioral therapy (CBT) is a viable option to help them take on unhelpful beliefs and begin to choose new responses and behaviors.
 
It is our hope as we plan and design services to address hoarding to give equal weight to those impacted by a loved one’s hoarding as we do to treating those with the diagnosis of HD. We believe that the best outcome requires us to see the unique challenges of family members, offer care to the person who is seeking services. Ethically, we cannot treat someone who is not seeking help. Relationally, it is essential to hear and validate the multiple experiences of those impacted by an individual’s hoarding. 
I am trained in both the specialized form of CBT for treating HD in the individual as well as in EMDR for dealing with traumatic components that may impact this work. Additionally, I am pleased to offer EMDR to adult children who find themselves experiencing symptoms of depression, anxiety, and other lasting effects of growing up with a parent with HD. In time, we will be offering group counseling for individuals and family members. 
 
Imagine trying to stuff all these elements into a single room. It would be too much! So, we believed it was necessary to call hoarding-related services something larger. Welcome to the Hoarding Wing!