Friday Continuing Education Series: Bringing Hoarding Out of the Closet, Sue Zee Poinsett, MA

MARIN CAMFT FRIDAY CONTINUING EDUCATION SERIES

Friday, May 10, 2019, Bringing Hoarding Out of the Closet, Sue Zee Poinsett, MA

Sue Zee will talk about her understanding of Hoarding Disorder (HD) as well as the impact on those with hoarding behavior, their loved ones and the risks of the disease.  She will touch on the clinical aspects of Hoarding Disorder as well as the vulnerability factors of HD.  She will also talk about what she believes is the impact of the creation of the classification of Hoarding Disorder in the DSM-V as a distinct disorder with distinct treatments and the role of therapist in the remediation of this terrible disease .  She hopes this will be an interactive session that will provide a better understanding of and compassion for those whose lives are impacted by Hoarding Disorder. 

At the conclusion of this presentation the attendees will:

1. have an awareness of the vulnerability factors affecting those with Hoarding Disorder
2. have increased knowledge of what intake questions to ask clients/patients
3. have an understanding of the causes and effective treatments for HD
4. have tools for working with those who hoard and families and friends who love those who hoard

Description-there is a continuum

• Accumulating and failing to discard seemingly useless possessions, causing extremely cluttered living areas and significant distress or functional problems caused by hoarding
  
• Squalor not part of definition-there can be Hoarding with or without squalor
  
• It is a mental health condition and not a moral issue

• “Fear of waste, the allure of opportunity and the comfort and safety provided by objects”
  
• “The passion of the collector, the procrastination of someone who hasn't taken time to put things away and the sentimentality of one who saves reminders of important events”
  
• The thoughts & feelings are common; the order of magnitude is what is exceptional
  
• Exaggeration of normal set of behaviors
  

Vulnerabilities

• Early Experience
• Beliefs
• Personality Traits – perfectionism, dependency, anxiety, sensitivity, paranoia, neuroticism, indecisiveness impulsiveness, depression, self consciousness
• Comorbidity

Demographics

• 2-6% of population (10-25% in elder communities)-one of the most common mental health problems worldwide (Marin Co 251,000-12,550 w/HD) – 3 times more common in adults 55-94 than ages 34-44
  
• 92% of those with hoarding have 1 or more mental health issue
• Age of onset 6-15 years old
• Education ranges widely
• Functional impairment and clutter get worse with age
• Not caused but can be made worse by a traumatic event (not PTSD)
• Crosses all races, ethnicities and socio-economic strata
• Uncertain about male/female distribution-more women seek help

Risks

• Health-falls, respiratory problems
• Quality of life-depression, loneliness, family issues
• Financial issues-spending money meant for other things
• Inability to use parts of home, lack of repairs, heat, water
• Fires-death in fires more common in hoarded situations
• Burden on public services and fire and law enforcement
• Loss of housing

Background

• Research began in mid 1990’s
• Conducted by researchers who noticed hoarding in people with OCD
• With the publication of Diagnostic & Statistical Manual V Hoarding Disorder was reclassified as a distinct disorder under the category “Obsessive Compulsive & Related Disorders”-less than 20% of those with OCD also have Hoarding Disorder
• Has increased public awareness, improved identification of cases, and stimulated research and the development of specific treatments for hoarding disorder

Editorial Comment:  This is freeing the research and understanding to go beyond OCD and I think it is moving closer to AD/HD than OCD

Nature of Person

• Getting and having stuff good, getting rid of stuff bad
  
• Typically does not see it as big of a problem as others see it

Causes – open question

• Very little evidence that history of material deprivation is a cause
• Disorder of cognition and behavior
• Lack of insight important aspect
• Have identified some brain abnormalities-limbic system & frontal lobe-person w/hoarding may actually see hoard differently
• There is a genetic component (55% have parents/sibs w/HD)
• Difficulties with Executive Function
• • Planning
  • Prioritizing
  • decision making
  • initiating
  • completion
  • attention
  • over-categorization
  • hyper focus

Meaning of Possessions

• Emotional – attachment & identity
• Instrumental – Responsibility & guilt
• Intrinsic – beauty and aesthetics

Challenges

• Beliefs – often erroneous, not helpful or exaggerated
• • About usefulness-every item is an opportunity
    
  • About need to be perfect & not make mistakes
    
  • About responsibility – waste, lost opportunity, inanimate object given feelings (anthropomorphism)
    
  • About possessions – utility, beauty, sentimental value
    
  • About vulnerability – safety/comfort, loss, family history
    
  • About memory – doubt memory, so out of sight out of mind
    
  • About  identity-defining self by what you have not what you do
    
  • About connection-my things connect me to others and the world
    
  • About solutions-others’ and theirs
    
  • About control-independence and autonomy
• Feelings
  
• • Resentment
  • Distrust
  • Fear
  • Hopelessness
  • Depression
  • Anxiety

• Hidden-happens in private as long as person keeps people away
• Embarrassment and shame may be present
• Change is long term and expensive
• Lack of trained professionals
• Lack of understanding and research
• Feeling of hopelessness

• Talk therapy not particularly helpful
• Necessary to use positive engagement techniques
• • Empathy
• Cognitive behavioral therapy-therapy to help person change beliefs (70-80% of those undergoing CBT were much or very much improved after 9-12 mos. of treatment
• Motivational interviewing to work with ambivalence
• Medications-some may be effective for depression, anxiety, ADD symptoms
• Skills education (categorizing, organizing, problem solving, prioritizing) and development (practicing sorting, decision making, etc.)
• Support groups
• Peer support
• Professional organizers/coaches

• Safety is first concern-not removal of items
• Gather stakeholders and agree on changes that are necessary for safety
• Process of written agreement, check-ins and understanding if mistakes are made

• Hopeful
• Hoarding Intervention Project
• Allows for long term work with people who hoard who want or need to change
• More trained professionals since now available to insurance
• More peer and volunteer support 
• More understanding

Summary

• Hoarding is your problem but not your fault
• People have hoarding they aren’t hoarders (people with hoarding)
• Hoarding is a house problem AND a person problem

Books

• Good description of harm reduction method:
• • Digging Out; Helping Your Loved Ones Manage Clutter, Hoarding & Compulsive Acquiring  Michael Tompkins, Ph. D. & Tamara Hartl, Ph. D
• Good description of hoarding:
• • Stuff; Compulsive Hoarding and the Meaning of Things  Randy Frost & Gail Steketee
• Support Group Protocol:
• • Buried in Treasures David Tolin, Randy Frost & Gail Steketee
• Facilitator guide available on line
• • Contact Information: Sue Zee Poinsett

Sue Zee Poinsett, MA (Masters in Marriage, Family & Child Counseling) began her career teaching in junior and senior high schools in the Los Angeles area.  She moved on to a career as a mortgage broker and then earned a Masters Degree in Marriage, Family and Child Counseling as well as one in Education. For the last 20+ years she has worked as a Professional Organizer specializing in work with adults with ADHD.  She became particularly interested in hoarding behavior in her work as an organizer and was one of the founding members of the Marin County Hoarding Alliance and has been an active member since its inception over 10 years ago. Her understanding is based on research and study and is informed by her many years of professional organizing.

• Time: Networking is from 11:30 to 12:00 p.m. Presentation begins at 12:00 pm &ends at 2:00 p.m.
• Cost: Free for Marin CAMFT members, $10 for non-members.
• Location: Corte Madera Town Center, 770 Tamalpais Drive, #201, Corte Madera, CA 94925 (map)
• Information: For more information about the Friday Continuing Education Series and about joining the Committee, please contact CE Director, Laurie Buntain.

• Continuing Education Goal: Marin CAMFT is committed to offering continuing education courses to train LMFTs, LCSWs, LPCCs and LEPs to treat any client in an ethically and clinically sound manner based upon current accepted standards of practice. Course completion certificates will be awarded at the conclusion of the training and upon participant’s submission of his or her completed evaluation. 
• Refund Policy: Requests for refunds must be in writing and received by the CE Director on no later than ten days before the program. There will be a $25.00 administrative fee to cancel registration for any program. The refund will be sent within ten days of the request.
• Accommodation for Special Needs: The special needs of persons with disabilities will be accommodated. The Program Committee will endeavor to assure that continuing education program materials, content and venue selections will meet the special needs of the disabled and that reasonable accommodation will be made. A request for accommodation can be made to the CE Director, who will work with the Committee and event venue to meet the need.All instructors will read and adhere to Marin CAMFT’s stated policies.
• Marin CAMFT encourages those who attend its events to respect the fact that some individuals may have allergies to fragrances and pet dander. We ask that you refrain from introducing these elements into our meeting room. Registered service animals are welcome, of course. 
• Grievance Procedure: Marin CAMFT will respond to complaints in a reasonable, ethical and timely manner, when submitted by program attendees in writing to the CE Director.
• Anti-Discrimination Policy: Marin CAMFT shall not discriminate against any individual or group with respect to any service, program or activity based on gender, race, creed, national origin, sexual orientation, religion, age or other prohibited basis. Marin CAMFT does not require attendees to adhere to any particular religion or creed in order to participate in training. Marin CAMFT will not promote or advocate for a single modality of treatment that is discriminatory or likely to harm clients based on current accepted standards or practice.
• CE: This workshop meets the qualifications for two hours of continuing education for LMFTs, LCSWs, LEPs and LPCCs. These will be provided by Marin CAMFT (CEP # 56895), which is approved by CAMFT to sponsor CE for LMFTs, LCSWs, LPCCs and LEPs. Marin CAMFT maintains responsibility for this program and its contents contact Laurie Buntain, Continuing Education Director for more information.