How to Help a Loved One with HD

The process of helping a loved one with HD can be very frustrating for family members. Often it seems that no matter how much energy goes into solving the problem, the clutter continues to build. This can result in strained or broken relationships — family conflict is a frequent part of the HD picture. Complicating matters, family members often feel alone when it comes to dealing with the loved one’s HD. Finding the right treatment can be a challenge in and of itself, and often urging the loved one to get treatment seems to cause even more arguments in the family. The strategies suggested below are adapted from the “Family-As-Motivators” training protocol for therapists, developed by Dr. Gregory Chasson and colleagues.

Should I get rid of the clutter myself?
Sometimes family members get so concerned that they get rid of some of the clutter without the knowledge or consent of their loved one. This usually comes from good intentions — concerned family members want to improve the safety of the home and quality of life for their loved one. But unfortunately, unwelcomed cleanouts cause intense distress for the loved one with HD, and generate anger towards their relatives. In addition, although cleanouts may work in the short term, they rarely work in the long term.

It is important to remember that cleanouts do not address the deeper reasons that a loved one accumulates things. The clutter may be gone temporarily, but the behaviors and beliefs that contribute to HD are still there. Thus, days or weeks later, the clutter will likely reappear and begin to build again. The end result is frustration, hopelessness, and often anger in family members, as well as the loved one with HD.

What should families do, then, to best help their loved one?

Step Back and Examine Your (and your Family’s) Behavior
A first step is to consider things you or another family member might be doing that may contribute to the hoarding problem. For example, a sister might save newspapers and give them to her brother who suffers from HD, or a mother might pay the monthly bill for a storage unit to allow her daughter to store bottles and magazines. “Helping” the person by doing these things is referred to as family accommodation. Usually relatives accommodate because they think it helps or because it avoids arguments. Yet, in reality, accommodation reinforces hoarding behavior, allowing it to become more of a problem in the long run.A good way to start reducing these accommodations is to create a list of ways in which you may be accommodating the hoarding. It might be helpful to begin by answering the question “How do I change my routine, or what do I do differently, because of my loved one’s hoarding behavior?” Baby steps are often required to stop family accommodation at first — that is, it may be important not to remove all accommodation at once. As an example, a family member can calmly tell a loved one with HD that he or she can no longer pay for a storage unit and that payments will cease in three months. Giving that extra time allows loved ones to figure out new arrangements for their stuff. In this vein, involving the loved one with HD in this process is very important.

Improve your Family Communication
In addition to decreasing family accommodation, family members can also benefit from working to improve communication. Discussing the hoarding problem in an open and accepting way is an important first step. Respecting the hoarding loved one’s attachments to possessions is critical to being able to hold such discussions. This can help to establish respect for the rights of each member of the household as well. An atmosphere of understanding can help with negotiations to keep certain spaces clutter-free which will help maintain family harmony.A new, more effective way of communicating is based on a practice called motivational interviewing (MI). MI is a set of techniques that help gently nudge a loved one with HD toward wanting positive change. It involves helping a loved one recognize and close the gap between what their life is like now and what they want it to be like. HD can cause a big gap between these two versions of their life; when a loved one who hoards notices this, they may be more motivated to change. MI skills can help a loved one see this gap without arguments or criticism.MI requires a lot of patience — it involves not telling the loved one with hoarding what to do, but rather encouraging them to come to solutions in their own time. This means putting aside the frustrations that may have built up in the family. It requires careful listening, putting oneself in another person’s shoes, and accepting what is and is not possible. Although it does not guarantee success, when properly used, MI may be the best chance to motivate a loved one to seek treatment.It is important to remember that the path to change is not always a straight line. A loved one may be motivated one minute and ambivalent about changing behavior the next. There might even be periods of getting worse during the process. This pattern is normal. The overall improvement, more than the day-to-day changes, should be the goal. Often it is helpful to involve a mental health professional when considering using MI. They can help you to master the MI principles and concepts, as well as guide you through working with your loved one. Click here for more information on motivational interviewing (MI).

Change your Expectations
Sometimes it is important for family members to change their expectations about a loved one’s HD behaviors. It is common for family members to tell a loved one with hoarding to stop saving stuff because “hoarding is wrong,” “homes should be clean and organized,” or something similar. Expecting a loved one to show complete organization and cleanliness — that is, zero clutter — is not realistic, at least not at first. It thus might help family members to instead set goals and expectations that focus on reducing the harmful consequences of the hoarding, – a strategy known as harm reduction – rather than just “stopping hoarding.”Often, individuals with HD are more open to family members approaching them with concerns about their safety (for example, “I am worried about a fire; can we move the bottles from your stove?”) than expressing values-based concerns (for example, “Nobody should live in this kind of mess; can we move these bottles?”). Tension in the family can decrease when harm reduction becomes the focus of change rather than getting rid of things. Involving the loved one with HD in the harm reduction plan can make the process friendlier, which enhances their motivation for change.Often harm reduction gets a loved one started in the change process, and sometimes this energy leads to better decisions about what to acquire and save. But sometimes it doesn’t, and although the home is safer, it may still be cluttered. Harm reduction focuses on reducing danger and increasing safety without focusing on getting rid of clutter. This can be a difficult shift for some family members — adopting a harm reduction approach means that families must ask themselves if they can accept that a loved one lives in a safe, but still cluttered home.

Treatments that Work

In addition to the family-based strategies described above, there are treatments by professionals that have shown promise in research studies in helping loved ones with HD to manage their accumulated things, and thus, their disorder.

Family-As-Motivators Training
The Family-As-Motivators (FAM) Training was designed to help family members assist their loved ones who hoard by teaching them specific skills, such as those outlined above. These skills are taught by a clinician, and are designed to help family members meet two major go
1. Improve the well-being of the family members
2. Increase the likelihood that their loved one will seek help for their HD

Cognitive Behavioral Therapy (CBT)
CBT is a type of therapy that helps individuals to examine the way they think and behave, and to change the thought processes or behaviors that may be problematic. The goal of CBT is to help the individual with HD change the way they think and behave specifically with regards to their hoarding behaviors of acquiring things and/or not discarding them. To receive CBT, the individual will go to an independently licensed mental health professional (or a “therapist”).

Skills Training
Skills training for HD focuses on helping people learn how to organize their belongings within their homes, how to use problem solving methods to address common problems that arise in working on their clutter, and how to make decisions about keeping needed items and removing unwanted objects that contribute to clutter. The goal of skills training is to teach the individual skills that will be useful to them in their recovery from HD. To receive skills training, the individual will go to an independently licensed mental health professional (or a “therapist”).

Group Treatment
Groups can be professionally-led (by a therapist) or peer-led (by a person who has had hoarding problems and has gained reasonably good control over their symptoms). For both, the groups will consist of other people who live with hoarding issues who meet on a regular basis to receive training in learning skills to combat hoarding symptoms and to support each other’s learning. Groups follow a CBT format and focus on actively working on each of the elements outlined in the CBT approach. The goal of the groups is to connect individuals to others who understand what they are going through in a shame-free environment. Treatment groups offer a structured learning approach to making and achieving goals to recover from HD.

Medication
Psychiatric medications work to change an individual’s brain chemistry and activity. For many mental health conditions, including HD, the symptoms are hypothesized to be due to brain chemistry problems and/or certain areas of the brain not working as they should. The goal of psychiatric medications is to help the individual become more able to engage in the treatment process, whether by improving their mood or by reducing their severe anxiety. To receive medication, the individual will go to a board certified medical professional (such as a psychiatrist, a psychiatric nurse practitioner, etc.).

To find out more about treatment for HD, click here. More information about helping a family member with their HD can be found in the book “Digging Out” by Michael A. Tompkins, PhD and Tamara L. Hartl, PhD. For professionals who are interested in implementing the “Family-As-Motivators” Training in their practice, please contact Dr. Gregory Chasson at gchasson@gmail.com.

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