Two-Minute Shrink

Practical psychiatry articles for people seeking strategies, solutions, and healing now—not years from now.

Decluttering — Is it Therapy?

Organization professionals perform a valuable and, yes, therapeutic service.

I made a great professional connection recently that broadened my perspective about clutter and hoarding. Having long pondered the relationship between clutter, hoarding, and obsessive-compulsive personality disorder (OCPD) and obsessive compulsive disorder (OCD), I decided to consult with a professional decluttering expert, Gillian Wells, a member of the National Association of Professional Organizers, who aids people with issues of clutter. Ms. Wells studied architecture at New York's prestigious Cooper Union, and now runs a successful business organizing homes, apartments, and offices.

Why is a psychiatrist specializing in cognitive-behavioral therapy interested in decluttering? Over the years, I have worked with a number of OCPD hoarders. In my own work with these patients, I have used guided imagery aimed first at separating into categories items to be disposed of, and then linking a pleasant experience with the act of disposing of the items. In addition, I have used a cognitive-behavioral approach, challenging the absolute need for certain items with a broader range of possibilities and probabilities. For example, I'd say to the patients: "It's possible that you might need that item, but what is the probability that you would need it?" I've found this cognitive approach to be therapeutic when challenging all-or-nothing concepts involving fixed, rigid perceptions as it relates to holding on to clutter and hoarding.

Ms. Wells had lots to say about the cleanups she facilitates. My focus was on the mental health aspect involved in helping people with the accumulation of clutter or the process of hoarding---emotional conditions in which anxiety, shame, embarrassment, depression, and family stressors are at play. Ms. Wells quickly pointed out that her clients are highly motivated to change, and they seek her out to get help with their cluttered lifestyles. There isn't any talk about having a psychiatric or psychological problem. She also made it clear that she is not a mental health expert of any sort. Rather, she is simply a person who has been asked to consult and solve problems of disorganization.

Fair enough, I thought. After all, there are professionals who use desensitization techniques in treating people with flying phobias who have zero psychiatric training—and they are quite effective.

I asked Ms. Wells how she works. In an initial three-hour session, she assesses the client's personality style, needs, budget, and direction of the work to be done. As Ms. Wells described how she approaches clients, it sounded a lot like cognitive-behavioral therapy, a method I know well.

First, the client needs to be willing to "surrender" the "mess" in order to get organized. The client also might be surrendering some of her autonomy or control, but needs to be part of the process in order for it to work and for the client to feel comfortable surrendering. Second, Ms. Wells suggests that the client focus on one item at a time, for example, papers one day and clothes another day. Such a stepwise approach challenges the client in a positive way without overwhelming them. Often, Ms. Wells noted, many people have a rigid all-or-nothing approach to keeping the clutter. Third, she pointed out, many of her clients feel embarrassment or shame about the clutter, and she assures them that many people accumulate too much stuff. Her job is to simply help the client get on a road to less mess. If in the future this approach ripples over into other areas of the client's life to positive effect, great.

For the client, getting tangible, measurable, immediate help with what had seemed an insurmountable problem was, dare I say it, therapeutic—a lot like cognitive-behavioral therapy, in fact. It was a way to get things done in a positive, nonstressful manner—with the one addition of a visit to where the problem exists, something mental health experts rarely do these days. I asked Ms. Wells whether she ever gives up on a client because the emotional issues are deep-rooted and complicated, and her answer was, "Of course, yes." Just like other professionals, organizational experts find that they are unable to work with some people.

Ms. Wells told me that she ran into a former client recently who reminded her about the cleanup and apartment sale a year ago where a lot of clothes, books, and jewelry had been sold. Interestingly, the client remarked: "I can't remember any of it and don't miss it."

Professional organizers go right to the home or office to do their work. Their approach is not unlike those used years ago, when behavioral therapists rode elevators or traveled through tunnels with their phobic patients or clients in the desensitization process. It's important that mental health professionals do not ignore the people from many disciplines and training who are in the business of helping people with potential psychiatric disorders.

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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.

 

Robert London, M.D., has been a practicing physician/psychiatrist for more than three decades.

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