County program illustrates the challenge of treating hoarding

At home in her Clintonville condominium, Susan delicately threads her way through stacks of
boxes, piles of holiday decorations and mounds of clothes.

Since the late 1980s, the retiree has struggled with hoarding. She knows she has a problem and
wants to remedy it. Embarrassed by the condition of her home, she agreed to be interviewed for this
story only if The Dispatch agreed not to use her real name

One of her greatest fears is that she will have to call a repairman to the condo.

“I want all this to come to an end,” she said while navigating her belongings. “I really want

Susan is among an estimated 2 percent to 5 percent of the population who are considered
hoarders. In Franklin County, that amounts to as many as 24,000 households.

Officials are now discovering what Susan has known for years: Identifying hoarding is far easier
than treating it, much less “curing” it.

Two years after the Franklin County Environmental Court introduced a pioneering program to treat
hoarders who come before the court, the program awaits its first success story. No one has
graduated from the program, a few people have dropped out and eight remain in treatment.

Court officials and area mental-health experts remain confident that the program will succeed,
and they continue to tweak it. But they acknowledge the difficult birth.

“What we found in the first year of the program is that progress has been slow,” said Beth Lutz,
clinical director of Southeast Inc., which provides counseling services for the program.

Environmental Court Judge Daniel Hawkins announced the hoarding program in early 2014 in an
effort to target underlying causes of the code-violation cases that repeatedly land before him.

“We want to make it so they can solve the problem so we don’t see them again,” Hawkins said. “It
was clear that there was a tendency to fix the property but not fix the person. There was no place
for these people to get help.”

As a term of their probation, homeowners with hoarding symptoms who are convicted of code
violations must receive hoarding treatment if a court counselor determines they are are mentally

Hawkins and Josh Harmon, chief environmental specialist with the court, turned to the Alcohol,
Drug and Mental Health Board of Franklin County, which allocated $80,000 for treatment and hired
Southeast to develop the therapy.

For years, hoarding had not itself been considered a mental-health disorder but, rather, a
symptom of illnesses such as anxiety, depression or obsessive-compulsive disorders. That changed in
2013, when the American Psychiatric Association declared hoarding its own diagnosis.

Those who suffer from hoarding are locked into a perilous trio of behaviors: continual
acquisition of goods that aren’t immediately needed, inability to discard items and a failure to
organize the items. Most experts agree that such behavior becomes a problem — like other illnesses,
such as alcoholism — when it interferes with a person’s ability to function normally.

A common tactic used to diagnose hoarding is to determine whether the clutter prevents rooms and
furnishings from being used for their intended purpose. Are shower stalls full of papers? Do
clothes permanently cover the kitchen table? Do boxes block access to doors?

Once the diagnosis has been established, identifying and treating the underlying causes can be
difficult. Hoarders often describe what amounts to a paralysis when they’re around their

Randy Frost, a professor of psychology at Smith College in Massachusetts and one of the nation’s
leading experts on hoarding, said many hoarders possess extreme creativity.

The details they observe in objects — color, shape, history, potential uses and connections to
memories — add value, making the items more difficult to give up.

In addition, many hoarders identify trauma as a trigger for the behavior.

Susan says her hoarding started after a burglar broke into her house in the late 1980s and stole
jewelry, silver and other family heirlooms. She thinks she started accumulating objects as a way of
compensating for that loss.

Cindy, who also asked not to be identified by her real name, traces her hoarding to infancy and
young childhood.

“It was a lack of attention and affection as a child,” the Northwest Side resident said. “I
turned inward, to things.”

(Neither Susan nor Cindy is enrolled in the county program.)

Frost and others think hoarders can break the pattern of accumulation, but treatment requires

“The problem is, many family members go in there and start trying to change the person,” Frost
said, “but the relationship fractures and that can make the situation worse.”

Birdie Brennan, a Columbus professional organizer who has twice appeared on TV hoarding shows,
said she avoids touching items when she first meets clients.

“The client has to feel in control of their possessions, or it won’t work,” she said. “Their
desire to change is first and foremost.”

Because of that, the first step in the county program centers on establishing a trusting
relationship, said Lutz, of Southeast Inc.

After establishing trust and building the client’s desire to change, Southeast counselors work
to modify behavior, relying on a treatment program developed by Frost and Gail Steketee, dean of
the Boston University School of Social Work.

The program relies first on helping hoarders see their behavior in a different light, then
changing that behavior.

One tool, for example, is for hoarders to carry into stores a piece of paper with these
questions: Do I need this? Can I afford it? Do I have room for it? Do I have something at home that
serves the same purpose?

“They carry it with them everywhere they go and pull it out when they are about to buy
something,” Frost said. “It interrupts the impulse to buy.”

Although in its early stages, Frost said, the voluntary program has seen successful. He
estimated that 60 to 70 percent of those who go through it show significant improvement after 10
weeks of the 15- to 20-week program

Still, Frost and others take care not to speak in terms of cures.

“Even at the end of treatment, they still struggle,” he said.

Both Susan and Cindy cleaned out their homes once but, with little motivation to keep their
homes clean, have slipped back into old habits.

“It bothers me more and more,” Cindy said. “It would be nice not to bump into things when I’m
going to the bathroom.”

Frost thinks the power of the court could help push reluctant hoarders to change.

“In some ways, an external motivator can be a catalyst for change,” he said. “In other cases, it
won’t be.”

To help motivate hoarders in the program, the court recently started requiring them to regularly
meet with a court official to discuss their progress.

Southeast is also considering group therapy, a strategy that a Cuyahoga County program has had
some success with, said Bert Rahl, director of mental health with Eldercare Services Institute and
co-chairman of the Hoarding Connection of Cuyahoga County.

“These sessions are run by peers, with no therapists,” Rahl said. “The strength of the therapy
comes from the fact that leaders identify with the problem.”

Franklin County officials would like to point to a string of successes, but they know they’re
plowing virgin ground.

“We’re cautiously optimistic about where we are,” Hawkins said. “The fact is, we’ve completely
built this from scratch.”