Area Agency on Aging offers hoarding therapy group

By: 
CARY HINES, Assistant editor

Mary Coalson
Licensed professional counselor for Area Agency on Aging, Region One

Anyone who has seen the television show “Hoarders” knows hoarding isn’t the real problem, but is instead a symptom of an underlying condition.
“This has nothing to do with the stuff, it has to do with the underlying issues,” said Mary Coalson, licensed professional counselor for Area Agency on Aging, Region One.
Coalson will facilitate Too Many Treasures, 14-week therapy groups offered by Area Agency on Aging for senior citizens with hoarding disorder. Groups will meet beginning in September at two confidential locations in Glendale and Phoenix.
Although the reality TV show has shed light on the topic, Coalson said hoarding is not a new disorder.
“I think that we, like a lot of other things, are recognizing the impact that it has on individuals and the community. With mental health services, we are able to address the underlying issues, which really is the cause of hoarding behaviors. I think as a community, as mental health professionals, we are more aware and that’s why it’s in the DSM now,” Coalson said, referring to the Diagnostic and Statistical Manual of Mental Disorders, a publication of the American Psychiatric Association that defines and classifies mental disorders.
People hoard for a variety of reasons, Coalson said. For some, the attachment to items is emotional, wherein the item or items remind the person of a happier time, person or situation. Others feel a sense of responsibility to items they hoard because those items were given to them and they feel like a caretaker who needs to be responsible for them. For others, hoarding is about safety and security.
“There’s a thousand reasons why people hoard,” Coalson said. “It’s the underlying component — the trauma, grief, depression, anxiety — that may be reinforcing the need to hold onto items beyond their usefulness or their benefit.”
Sometimes, people don’t question whether or not the item is still serving them, she said, adding it just reminds them of a good memory.
“But they don’t re-evaluate if the item is serving them or if it is causing them more pain than pleasure,” she said.
Too Many Treasures is for people who may have been hoarding for decades, but are still active, accessing the community, working or volunteering, driving or taking the bus, and physically capable of decluttering their homes, Coalson said.
“They are not in a crisis state,” she said. “There’s not an eviction happening, there’s not a health and safety where home health can’t come in, or their home is infested, so they have the 14 weeks to learn how to change their behavior.”
The support group has three stages.
“What they’re learning in the initial phase is the big question, ‘How’d it get like this?’” Coalson said. “And so we’re talking about the underlying issues, we’re talking about the obstacles, the acquiring, the different components to hoarding behavior, and they’re identifying which component is theirs.”
The second phase of the program teaches coping techniques.
“What can I use to help me to declutter? How do I go about viewing my home and viewing my items? What relaxation techniques can I employ? How do I get the balance in my life so it’s not overwhelmingly cluttered and then I get burnt out and I do nothing? How do I accept the judgments of other people? And how do I set boundaries and communicate effectively with those people who are concerned about me?” Coalson said.
The third phase focuses on relapse prevention.
“What happens if I start slipping? What happens if I notice that I’m not discarding items? What happens if I know that there are little piles that come up?” Coalson said.
Over the 14 weeks, participants will be educated, as well as practice what they have learned. Homework is assigned every week and group members will discuss what they learned about emotions and different ways of approaching a pile of items, as well as the importance of making sure no regret or emotional distress occurs.
“It is difficult,” Coalson said. “It’s a clinical program for a reason. It’s run by myself, a licensed therapist, for a reason. We’re uncovering a lot of the emotional distress, the self-esteem issues that may have been happening since childhood, so they’re doing some tough work.”
Anyone wanting to participate in the group must be at least 60 years, a resident of Maricopa County and complete an intake process by Aug. 27. A full psychological/social assessment, which takes one to one and a half hours, will be conducted by phone. The person must self-identify as wanting to change his or her behavior and must be diagnosed with hoarding disorder.
“People who call in may think they have hoarding disorder, but they may not,” Coalson said.
Anyone who completes the 14-week program is invited to a booster group, which meets twice a year and usually lasts four weeks. Specific topics are addressed to help participants gain new skills or improve the skills they already have.
Those who finish the 14-week program are also invited to join a support group. Different groups are offered based on stages of change.
“We have an action group, where people who are in the group are on the action phase, they’re actively decluttering, or they’re making choices and decisions based on their overall needs,” Coalson said. “And we have a contemplation group for people who are moving back between action and thinking about it. What’s my next step? How do I approach this? How important is this to me?”
Both groups affirm and support where the person is in the process, she said.
The level of treatment for hoarding disorder varies from person to person, Coalson said.
“I think everything can be maintained and treated,” Coalson said. “I see hoarding behavior like diabetes. It has different levels of impairment. People can seek treatment and change behavior. Depression, anxiety can be minimized or maintained with some medication, so can diabetes. With the coping mechanisms and some cognitive therapy, hoarding behavior, the instant gratification, can be minimized. The need to soothe can be minimized, and with those coping skills, people cannot acquire, can engage in effective ways of relaxation and can change their behavior. However, like diabetes, if people stop using those coping skills and stop believing in themselves, then the hoarding behavior can return. So I think it can be maintained, but it has to be maintained after treatment.”
For more information, call 602-241-5577, email hoarding@aaaphx.org or visit www.aaaphx.org.

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