Table Of ContentCompulsive Hoarding
and Acquiring:
Therapist Guide
Gail Steketee
Randy O. Frost
OXFORD UNIVERSITY PRESS
Compulsive Hoarding and Acquiring
--
David H. Barlow, PhD
Anne Marie Albano, PhD
Jack M. Gorman, MD
Peter E. Nathan, PhD
Paul Salkovskis, PhD
Bonnie Spring, PhD
John R. Weisz, PhD
G. Terence Wilson, PhD
Compulsive
Hoarding and
Acquiring
T h e r a p i s t G u i d e
Gail Steketee • Randy O. Frost
1
1
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Library ofCongress Cataloging-in-Publication Data
Steketee, Gail.
Compulsive hoarding and acquiring : therapist guide / Gail Steketee,
Randy O. Frost.
p. cm.—(Treatments that work)
Includes bibliographical references.
ISBN-----; ISBN---X
ISBN-----; ISBN---(pbk.)
. Obsessive-compulsive disorder. . Compulsive behavior. I. Frost,
Randy O. II. Title. III. Series: Treatments that work.
[DNLM: . Compulsive Behavior—therapy—Case Reports.
. Behavior Therapy—methods—Case Reports. . Impulse Control
Disorders—therapy—Case Reports. WM Sc]
RC.S
.(cid:1)—dc
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on acid-free paper
About TreatmentsThatWork™
Stunning developments in health care have taken place during the last
several years, but many of our widely accepted interventions and strate-
gies in mental health and behavioral medicine have been brought into
question by research evidence as not only lacking benefit, but, perhaps,
inducing harm. Other strategies have been proved effective using the
best current standards of evidence, resulting in broad-based recommen-
dations to make these practices more available to the public. Several re-
cent developments are behind this revolution. First, we have arrived at a
much deeper understanding ofpathology, both psychological and phys-
ical, which has led to the development of new, more precisely targeted
interventions. Second, our research methodologies have improved sub-
stantially, such that we have reduced threats to internal and external va-
lidity, making the outcomes more directly applicable to clinical situa-
tions. Third, governments around the world and health care systems and
policymakers have decided that the quality of care should improve, that
it should be evidence based, and that it is in the public’s interest to en-
sure that this happens (Barlow, ; Institute of Medicine, ).
Ofcourse, the major stumbling block for clinicians everywhere is the ac-
cessibility of newly developed evidence-based psychological interven-
tions. Workshops and books can go only so far in acquainting responsi-
ble and conscientious practitioners with the latest behavioral health care
practices and their applicability to individual patients. This new series,
TreatmentsThatWork™, is devoted to communicating these exciting
new interventions to clinicians on the frontlines of practice.
The manuals and workbooks in this series contain step-by-step detailed
procedures for assessing and treating specific problems and diagnoses.
However, this series also goes beyond the books and manuals by provid-
ing ancillary materials that will approximate the supervisory process in
assisting practitioners in the implementation ofthese procedures in their
practice.
In our emerging health care system, the growing consensus is that evi-
dence-based practice offers the most responsible course of action for the
mental health professional. All behavioral health care clinicians deeply
desire to provide the best possible care for their patients. In this series,
our aim is to close the dissemination and information gap and make that
possible.
This therapist guide and the companion workbook for patients address
the puzzling and difficult problem ofcompulsive hoarding. This disorder,
characterized by a profound inability to discard material items that are
no longer useful, can result in severe disruption of interpersonal rela-
tionships, threats to health, and even death in some extreme cases from
the dangerous accumulation “clutter.” Although we know relatively little
about compulsive hoarding, the best estimate at this time is that this
problem afflicts as many as to% ofthe population, who seldom pres-
ents for treatment until late middle age when, evidently, patients have
had sufficient opportunity to accumulate overwhelming clutter.
The treatment program presented in this therapist guide and accompa-
nying workbook represents the first attempt to treat compulsive hoard-
ing with any systematic evidence ofefficacy. This program, originated by
world-renowned widely acknowledged experts in this area, leads to sub-
stantial improvement in most patients. In the most recent study, a group
receiving treatment achieved close to a % reduction in hoarding sys-
tems—far superior to the group not receiving treatment. Although we
have much to learn about the nature and treatment of compulsive
hoarding, this program represents the best hope for this intractable con-
dition at the current time.
David H. Barlow, Editor-in-Chief,
TreatmentsThatWork™
Boston, Massachusetts
vi
Acknowledgments
We are grateful to our families for tolerating our constant work and end-
less deadlines. Gail thanks her husband, Brian McCorkle, for his under-
standing and helpful comments. Randy thanks his wife, Sue Frost, for
her support and encouragement.
This book would not be possible without the participation of many
people who have sought help from us for compulsive hoarding problems
during the past decade. They are too numerous to name, but stand out
because oftheir compelling stories and their willingness to participate in
our research studies. We have learned a great deal from them and have
much more to learn. A special thanks is due the members ofthe H-C list
who have communicated with us in various ways over the years, and in
particular to Paula Kotakis for her dedication to helping people with this
problem and helping us sort out how therapists can help. We would like
to thank our collaborator, Dr. David Tolin; and our research team mem-
bers and therapists, Christiana Bratiotis, Ancy Cherian, Diane Cohen,
Amanda Gibson, Krista Gray, Scott Hannan, David Klemanski, Danielle
Koby, Terry Lewis, Nicholas Maltby, Suzanne Meunier, Matt Monteiro,
Jessica Rasmussen, and Cristina Sorrentino; as well as Robert Brady and
Stefanie Renaud, our research assistants; for the insights they have pro-
vided in developing this treatment.
Finally, we would like to thank our editors, Mariclaire Cloutier and
Cristina Wojdylo, for their tireless efforts to bring this manual to life.
vii
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Contents
Chapter Introductory Information for Clinicians
Chapter Assessing Hoarding
Chapter Case Formulation
Chapter Treatment Planning
Chapter Enhancing Motivation
Chapter Skills Training for Organizing and Problem Solving
Chapter Exposure Methods
Chapter Cognitive Strategies
Chapter Reducing Acquiring
Chapter Preventing Relapse
Appendix A Assessment Instruments
Appendix B Clinical Session Form
References
Readings and Resources
About the Authors
Description:The problem of compulsive hoarding and acquiring is more widespread than commonly believed. It often goes undiagnosed, either because sufferers are ashamed of their compulsions or because they dont believe it is a problem that merits professional attention. As much as two percent of the U.S. populat
