Findings have consistently shown that people who hoard respond poorly to Exposure and Response Prevention (ERP), CBT and Selective Serotonin Reuptake Inhibitors (SSRI) medications. If clinical data isn’t particularly useful in terms of clarifying the ‘what is’ of compulsive hoarding, information on treatment doesn’t necessarily point a coherent ‘what to do’ either. Even if treatment were readily available the efficacy of CBT intervention leaves much to be desired. One study details 43 clients entering a trial. Before commencement it notes a 14% dropout rate. At week 12 a 26% reduction in hoarding symptoms was experienced by the 37 remaining participants. After 26 sessions, with only 17 patients remaining, the result was a 45% reduction in hoarding behaviours. While a 45% reduction is a noteable result, almost the same percentage of participants did not complete the treatment.
Dr. Carl Rogers, one of the first practioners to explore clinically researched methodology in counselling practice, found that a lack of personal insight can be "a powerful determinant" in the success or failure of counselling. Lack of insight has consistently been proven in regard to compulsive hoarding. In one study only fifteen percent of elderly compulsive hoarders were able to identify the practice as problematic.
Dr Naomi Fineberg, a specialist in OCD stated “When you are looking at obsessional patients, hoarders seem to stand apart, and they don't respond well - if at all - to standard anti-obsessional treatments...many hoarders tended to believe they were acting rationally, and did not need help.”
In the US Neziroglu et. al have adapted their intervention strategy from substance abuse models. They state exlicitly that there is not a one size fits all structure and that the interventions can vary from client to client.
In non-hoarding research, Baines, a person with OCD and a Clinical Psychologist, found that the most significant change seemed to result from ‘a collaborative counselling relationship’ with clients describing an intense need to feel heard and understood. While not discounting the impact of some CBT interventions Baines stated that “ Two earlier views have been reinforced; that the process of therapy is at least as important in relieving distress as the interventions employed and that not all interventions are equally acceptable to clients and should be tailored to the individual.” Hoarding UK is looking to create a collaborate group of relevant participants who together will work to create a 'Hoarding Task Force' at local level throughout the UK.
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"Out of clutter, find simplicity; From discord, find harmony;
In the middle of difficulty, lies opportunity." Albert Einstein