Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring

224 Pages·2009·3.6 MB·English

by  Michael A. Tompkins

“If your loved one has a problem with compulsive saving, this book
can help you both save what really counts—yourselves! With equal
parts compassion, wisdom, and practicality, Michael Tompkins and
Tamara Hartl offer step-by-step instructions for helping family
members and friends with hoarding challenges. The authors’ passion
for their work comes through on every page, and their extensive
experience is evident in every nugget of advice they offer.”
—Jeff Bell, author of When in Doubt, Make Belief: An
OCD-Inspired Approach to Living with Uncertainty
“An essential guide for loved ones of those who compulsively hoard.
Digging Out takes a compassionate approach to both the hoarder and
the family member’s perspective and offers practical tools that really
work to reduce harm associated with clutter and improve family
relationships.”
—Belinda Lyons, executive director of the Mental Health
Association of San Francisco
“Digging Out is a remarkable book. Michael Tompkins and Tamara
Hartl walk the reader step-by-step through the difficult process of
letting go of unrealistic expectations, healing old wounds, and helping
loved ones get much-needed help for compulsive hoarding. This book
is likely to become a must-read for family members of people with
significant hoarding problems.”
—David F. Tolin, Ph.D., ABPP, director of the anxiety
disorders center at The Institute of Living and adjunct
associate professor of psychiatry at Yale University
School of Medicine
“This excellent book is a boon to people that hoard, their families, and
mental health professionals. It provides a clear method, harm
reduction, that has been proven effective in reducing the dangerous
consequences of hoarding, yet also promotes positive relationships
between the hoarder and his or her loved ones. The authors are to be
commended for the benefits offered by Digging Out to the many
people who have to cope with this disabling disorder.”
—Paul R. Munford, Ph.D., clinical psychologist and director
of the Cognitive Behavioral Therapy Center for OCD and
Anxiety in San Rafael, CA
“Digging Out is a wonderful book for those who have family members
or other loved ones with compulsive hoarding and cluttering problems.
It provides a practical, realistic, in-depth, and empathic approach to
helping manage this serious and often debilitating problem using
harm-reduction techniques. This book manages that most difficult of
combinations—providing hope and guidance without minimizing
potential obstacles to success.”
—Carol A. Mathews, MD, associate professor of psychiatry
at the University of California, San Francisco School of
Medicine
“Undoubtedly, Digging Out is one of the best available texts for
assisting the families of those suffering from hoarding and cluttering to
declutter and help their loved ones live in a healthy environment. I
highly recommend the book for all who work with or may come across
people struggling with hoarding and cluttering.”
—Johnson Ojo, REHS, special programs manager, San
Francisco Department of Public Health

Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject
matter covered. It is sold with the understanding that the publisher is not engaged in rendering
psychological, financial, legal, or other professional services. If expert assistance or counseling is needed,
the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books Copyright © 2009 by Michael A. Tompkins & Tamara L. Hartl
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com All Rights Reserved
Acquired by Tesilya Hanauer; Cover design by Amy Shoup; Edited by Nelda Street; Text design by Tracy
Marie Carlson epub ISBN: 9781608825424
Library of Congress Cataloging-in-Publication Data for the print version is on file with the publisher
To Luann, Madeleine, and Olivia, who make the trip worthwhile.
—Michael A. Tompkins
To the memory of my grandfather, Linwood Wotton, whose wisdom continues to influence which
challenges I choose to accept.
—Tamara L. Hartl
Foreword
Acknowledgments
Introduction
• For Those Who Are Open to Help: Treatments That Work • Why They Refuse Help • Digging Out • How
to Use This Book CHAPTER 1 What Is Compulsive Hoarding
• Defining Compulsive Hoarding • Why Save That• • Why People Keep Hoarding • How Do You Know if
Your Loved One Has the Problem• • Could It Be Something Else•
CHAPTER 2 Harm Reduction
• What Is Harm Reduction• • Applying Harm Reduction to Compulsive Hoarding • Why Harm Reduction
Can Help CHAPTER 3 Setting the Stage for Harm Reduction
• Let Go • Understand • Forgive • Grab Hold
CHAPTER 4 Helping Them Accept Help
• Engaging Your Loved One in the Harm Reduction Approach • Introducing Your Loved One to the Harm
Reduction Approach CHAPTER 5 Assessing Harm Potential
• Conducting the Home Assessment • Acquisition Pathways • Identifying Harm Reduction Targets
CHAPTER 6 Creating a Harm Reduction Plan
• Features of a Harm Reduction Plan • Putting the Harm Reduction Team Together • Creating the Harm
Reduction Plan • Formalizing the Harm Reduction Contract CHAPTER 7 Keeping the Harm Reduction
Targets Clear
• Step Carefully: Seven Steps to Successful Home Visits • Why Do You Have This Here• • L.E.A.R.N.:
Listen, Empathize, Affirm, Redirect, and Negotiate • Skills for the Long Term CHAPTER 8 Managing
the Bumps in the Road
• Six Common Reasons for Contract Failures • Working Through Contract Failures • Avoiding Contract
Burnout • Using Appropriate Pressure • Making the Best of a Public Situation CHAPTER 9 All in the
Family and Other Complications
• When People Who Hoard Live Together • When People Who Hoard Live in Assisted-Care Facilities •
When the Person Who Hoards Is an Older Adult • How Frailty Influences Harm Reduction CHAPTER
10 When the Landlord Knocks, and Other Terrors
• There Are No “Bad Guys,” Only Potential Team Members • Adult and Child Protective Services • Health
and Safety Codes • Guardianship or conservatorship • Eviction Notices • Clear-Out Interventions
Resources
• Recommended Reading • Professionals Who Can Help • Support Groups • Other Resources • Tips for
Managing Paper, Mail, and E-mail • Where to Donate or Recycle References
Foreword
Until a few short years ago, hoarding was virtually unknown to the mental health
community. Even now, many mental health treatment providers do not know
how to treat hoarding, although it is quite likely that some of their clients have
had hoarding problems that they did not divulge. In contrast, hoarding has been
all too real to family members of people who struggle with their possessions.
Every year we receive hundreds of pleas from desperate and frustrated family
members who are worried about the health and safety of their hoarding loved
ones. Their fears are well founded. Hoarding is a serious condition that threatens
the health, the safety, and even the lives of people who suffer from it. Home
conditions of someone with a serious hoarding problem can also threaten the
health and safety of family members and neighbors, not to mention others, such
as firefighters, who must enter and exit such dwellings in an emergency.
Hoarding also carries the risk of eviction.
Hoarding has an enormous impact on relationships as well. Many people who
hoard have great difficulty establishing and maintaining a marriage. They are
less likely to marry and more likely to divorce (Kim, Steketee, and Frost 2001).
The primary culprit in these undeveloped and fractured relationships is the
cluttered condition of the home and the fact that normal living—eating, sleeping,
bathing, and socializing—becomes too difficult. When the excessive acquiring
and clutter pushes out the partner, and the person who hoards ends up alone, the
level of clutter often escalates, putting the person at even greater risk.
Family members who call us are mostly the sons and daughters of a middle-
aged or older parent who has developed a serious hoarding problem. The callers
are frustrated and angry, but at the same time worried about their parent’s future.
Most have made numerous attempts to help. These efforts follow a common
storyline.
First, family members offer to assist in cleaning and discarding. Before long,
tension develops as the son or daughter tries to discard something of value to the
parent. The adult child sees little value in the item and tries to convince the
parent to get rid of it. The parent becomes focused on stopping such interference.
A battle of wills ensues, with little chance of success on either side. Frustrated
and sometimes angry, family members often attempt to remove items without
the knowledge of their loved one. Discovery provokes an angry exchange and a
refusal to allow the son or daughter back into the house—or sometimes into the
parent’s life. At this point family members may give up and declare their parent
incorrigible or call the authorities to investigate. The upshot is strained
relationships, or worse yet, complete estrangement.
These well-meaning attempts fail because the hoarding loved one and the
concerned family member have vastly different perspectives about possessions,
neither able to acknowledge or understand the other’s views. To the family
member, the problem is clutter, and as soon as it is cleared out, their loved one
will be safe and happy. To the hoarding loved one, the problem is control over
cherished possessions, which will be secure only when the family member stops
trying to make decisions about these belongings.
It is a pleasure to herald Digging Out, a much needed volume for anyone who
has struggled with family members about hoarding. Michael A. Tompkins and
Tamara L. Hartl have created a protocol that offers hope for family members
who have long felt hopeless. They give direction and purpose to those struggling
with and frustrated by a family member who can’t control his or her attachment
to things. The tasks laid out in this book are not easy. In fact, following these
wise recommendations may be the hardest thing family members have ever
done. But the approach described in this book will produce a deeper
understanding of the hoarding syndrome and potentially a relationship beneficial
to both the person who hoards and the family member. Tompkins and Hartl’s
harm reduction approach provides a way to repair family relationships and use
them to effectively manage the most troublesome parts of the hoarding problem.
It is a must-read for people who care about their family member who hoards.
—Randy O. Frost, Ph.D. Harold and Elsa Siipola Israel Professor of
Psychology Smith College
—Gail Steketee, Ph.D. Professor and Dean Boston University School of
Social Work
Acknowledgments
This book wouldn’t have been possible without the seminal work of a number of
researchers who’ve dedicated their professional lives to understanding the
problem of compulsive hoarding and to developing ways to help those who
suffer with it. Although this is a long list, we want to thank, in particular, Randy
O. Frost, Gail Steketee, and David F. Tolin for their generous and consistent
support of our ideas.
We thank Belinda Lyons, executive director of the Mental Health Association
of San Francisco (MHA-SF), for her enthusiastic support of our book. In
addition, we acknowledge MHA-SF and its key role in disseminating
information about compulsive hoarding. We thank the members of the San
Francisco Task Force on Compulsive Hoarding, under the aegis of the San
Francisco Department of Aging and Adult Services, MHA-SF, and other
professionals, for their support of this project. These professionals include Gary
Hartz, Thomas L. Hafemeister, Joe Cuff, Martha Legallet, Joel Liberson, Jason
Wolford, Cindy E. Rasmussen, Aregawie Yosef, and Monika Eckfield. We also
thank Alan and Linda Merrifield of Peninsula Community Services for
maintaining an informative website devoted to providing resources for people
who hoard and their families.
We thank our editor, Tesilya Hanauer, for her enthusiastic support of this
book and for her tolerance of our many missteps along the way. We thank Jess
Beebe, senior editor at New Harbinger, for improving the quality of the book in
general.
I, Michael, thank my colleagues at the San Francisco Bay Area Center for
Cognitive Therapy, beginning with Jacqueline B. Persons, director, who
continues to encourage me to try things that seem to me to be just beyond my
reach. I thank my other colleagues at the center (Joan Davidson, Janie Hong,
Katherine Martinez, and Daniel Weiner) for their continued support of my
professional development. I would also like to thank my wife, Luann L. DeVoss,
and my daughters, Madeleine and Olivia, for tolerating yet another book project.
They are troopers and I love them dearly.
I, Tam, thank my colleagues at the VA Palo Alto Health Care System (Judith
Chapman, Bob Hall, and Jeanette Hsu) for their ongoing support, and Jim Moses
for being the first person to order the book before we even completed it. I also
thank Randy O. Frost, George J. Allen, and Toni Zeiss for their invaluable