WEEK SIX JPSY650 DISCUSSION
marham1
casestudyforweek6discussionpsy650.docxWEEK SIX DISCUSSION PSY650
The case that I chose is Hoarding disorder:
table 3-1 Dx
1.
2. 3.
Checklist
Hoarding Disorder
Persons are repeatedly unable to give up or throw out their possessions, even worthless ones, because they feel a need to save them and want to avoid the discomfort of disposal.
Persons accumulate an extraordinary number of possessions that severely clutter and crowd their homes.
Significant distress or impairment.
(Based on APA, 2013.)
Jenny, now 35, had a privileged but lonely childhood. The only child of Paul and Grace Irvine, she grew up attending various social and charity functions with her parents. For the first few years of her life, Jenny was Daddy’s girl, but as she got older, she often felt sad and lonely because her dad was frequently away on business. Paul was a well-known photographer who started his business by taking engagement and wedding pictures in the Charlotte area. By the time Jenny was 4 years old, Paul was being asked to photograph weddings and other momentous events throughout North Carolina and neighboring states. Her mother, Grace, worked full time as an assistant bank manager and was rarely home before 6:00 p.m. Before Paul became a renowned photographer, he stayed home during the day to take care of Jenny while Grace went to work. This arrangement continued until Paul’s work required more travel, at which time Ms. Teresa was hired as a full-time nanny for Jenny. Jenny liked Ms. Teresa very much but found that she was busy much of the day keeping the house and doing the laundry. Jenny spent a lot of time in her room playing with the numerous toys she received from her parents and other family members.
Jenny early difficulties in School
Jenny started kindergarten when she was 5 years old. Grace would drop her off every morning and Ms. Teresa would pick her up at the end of each day. Jenny enjoyed being at school; she was a sociable child and made friends easily. While she performed adequately in her academic subjects, Jenny’s teacher would often send notes home stating that she kept a messy desk and appeared to be thinking about other things when she should have been paying attention to the teacher. Her parents tended to brush these comments off, as they knew their daughter had a very active imagination. They did, however, talk with
(Comer 32)
Comer, Ronald J. Case Studies in Abnormal Psychology: The Empirically Supported Ap, 2nd Edition. Worth Publishers, 2015. VitalBook file.
The citation provided is a guideline. Please check each citation for accuracy before use.
Ms. Teresa about beginning to give Jenny responsibility for picking up her own toys at the end of the day.
By the second grade, Jenny was starting to fall behind in a variety of school subjects. Her teacher requested a number of parent-teacher conferences and attempted to explain to Paul and Grace how Jenny’s apparent attentional problems were affecting her academic performance. The evenings after a parent-teacher conference tended to go the same way each time: Her parents would lecture Jenny about needing to pay more attention in school and then Paul would go up to her room, find one her favorite toys, and take it away to “donate to another little girl who appreciated the importance of a good education.” Jenny developed the habit of hiding her most precious toys from her father. She remembered one afternoon in particular when she realized that she had forgotten to put her dollhouse back in her closet before she left for school. She hurried up to her room and found that it was gone. With her heart pounding she ran downstairs and asked her mother if she knew what had happened to her dollhouse. Grace responded in a soft voice that they received a call from the principal, who expressed concern about Jenny advancing to the third grade. The principal suggested they have Jenny tested for attention-deficit/hyperactivity disorder (ADHD). For the first time ever, Grace wondered if there really was some kind of problem, but Paul had responded with his typical anger. He marched upstairs to Jenny’s room and left the house with her cherished dollhouse. Jenny remembered crying herself to sleep that night and many nights thereafter. To outsiders, it seemed as though she had everything she could ever want, but on the inside she felt that she could lose anything at any time no matter how hard she tried to hold on to it.
Two months later, Grace took Jenny to see Dr. Davis, a neuropsychologist, who after hours of testing, diagnosed her with ADHD, predominantly inattentive presentation. Dr. Davis explained that Jenny had a neurodevelopmental disorder that made it difficult for her to sustain attention for any length of time. Her ADHD was likely also contributing to her constant state of disorganization and mess. Given the impact of her symptoms on her academic functioning, Dr. Davis recommended they consult a child psychiatrist to discuss whether a trial of stimulant medication would work for Jenny’s condition.
The waitlist for an appointment with a child psychiatrist was 6 months, so Grace took Jenny to her pediatrician, who was comfortable prescribing a trial of methylphenidate (Concerta). They agreed to give the medication a try for the remainder of the school year, with a plan to take a drug holiday over the summer.
Jenny the Beginning of Acquiring
The medication Jenny took for her ADHD was very helpful over the next several years. By the fourth grade, her grades had improved significantly, primarily as a result of being able to better focus in the classroom. She still struggled with keeping all of her books, notes, and personal belongings organized, both at school and home. By the eighth grade, it became evident just how much Jenny struggled with making the most basic decisions. What should she wear to school that day? What would she like for dinner? Which toys or electronics does she no longer play with, so they can be donated? As she was a child, many of her decisions were made for her, but now Jenny struggled with anxiety about making the right decision and the consequences of making the wrong one. One thing she struggled with in particular was throwing away boxes, mostly the small boxes that held jewelry but also the original boxes for her toys. She started out by saving the little jewelry boxes, along with empty toilet paper and paper towel rolls, thinking they would be great for various art projects, such as paper maché animals. She rarely had the time to use these materials for projects at home, but she knew they would come in handy for something one day, so she held on to them—for years.
She also felt that it was important to keep all of the original packaging for her toys, because she made an arrangement with her parents that if she sold the toys she no longer used on Craigslist, she could keep the money. She knew that an item would typically sell at a higher price if it were in the original packaging. While this idea was good in theory, Jenny had only been able to sell one game on Craigslist. It wasn’t that her things weren’t worth selling; she was having a hard time deciding what to sell and then following through with listing it online. She felt so attached to her things. Even though she knew objectively that she didn’t play with a particular toy anymore, she couldn’t help anticipating the loss she would feel when it was gone. She also questioned her own judgment, thinking, “Well, I don’t play with this right now, but who is to say that I’m not going to want to play with it next week?”
Her “collections” didn’t present a problem until one day her mother went into Jenny’s room when she wasn’t at home. Grace had bought Jenny some designer clothes that she found on sale at a local department store. Wanting to surprise her daughter, Grace went into Jenny’s room to hang the clothes in her closet. Jenny’s closet was full of clothes, toys, and cardboard boxes, so Grace decided she would move some of last season’s clothes into her dresser to make room for the new clothes. She was shocked when every single dresser drawer she opened was full of small boxes and empty toilet paper and paper towel rolls. She had absolutely no idea why Jenny was saving all of these things. She was irritated that doing something nice for her daughter was now taking up so much of her time. She got a garbage bag and filled it with four drawers’ worth of empty boxes and cardboard rolls. When Jenny came home from school, Grace told her she had a surprise for her and took her up to her room. She proudly showed Jenny how she had arranged her closet and filled it with new designer outfits. She explained that to make room that she threw out all of the junk that Jenny had been saving in her drawers. When she heard this, rather than running to see the clothes, Jenny ran to her dresser and frantically opened drawer after drawer. “You threw out my things? How could you do that?” she screamed at her mother. “Those were mine. I was saving them for something, and now they are gone.” Jenny sat on the floor sobbing, without even noticing her new clothes. Grace just walked out of the room, astonished at how irrational her daughter could be and annoyed that Jenny didn’t appreciate the time and effort Grace had put into buying her new clothes.
When Jenny was 14 years old, her 17-year-old cousin, Andrew, was killed in a motorcycle accident. Andrew was the only child of Olivia, Grace’s sister. Grace and Olivia had an extremely close relationship and saw each other often, as they only lived about 20 miles from one another. Olivia and her husband, Brian, were completely devastated by the loss of their only child, and Grace grieved alongside her sister. For at least a month after Andrew’s death, Grace left work early to come home and cook dinner and then drive it out to Olivia’s house. Many nights Grace would just sleep at Olivia’s house and go straight to work from there in the morning. Jenny and Andrew were actually quite close, and she felt the pain of his death and a sadness for her aunt that she had never experienced before. After about 3 months, Jenny felt as though she never saw her mother. Grace was still spending a lot of time at Olivia’s house. Jenny decided that she would ask if she could come with her mom to help, which would give her the opportunity to spend some time with her mother. It was the first time she’d been back to her aunt and uncle’s house since the funeral, and she was surprised by how empty it felt. Jenny carried some laundry upstairs, and while she was up there, she decided she would peek into Andrew’s room. The door was shut, but she quietly opened it. She was shocked when she opened the door and saw that the room was almost completely full of boxes, which were all overflowing with what looked like Andrew’s things and anything loosely related to him. Jenny asked her mother about this on the way home and Grace replied that Aunt Olivia seemed to be grieving by collecting and buying anything that reminded her of Andrew. Grace told Jenny that if she was disturbed by that bedroom, she should definitely not go into their basement.
Jenny in Adulthood A Struggling Marriage
After graduating from college with a degree in English and Communications, Jenny was offered a job working in the graduate college at a local university. Her job entailed working with the doctoral students to ensure that their dissertations met the graduate school’s detailed formatting requirements. She enjoyed the work, as she tended to be a detail-oriented person, but she did find it a little monotonous at times. Steven, a doctoral student in biomedical sciences and chemistry, wasn’t the typical student she saw in her office. He actually made an appointment to ask for guidance before he started writing his dissertation. Most students she met with had already written the entire document, incorrectly of course, and were in a panic because the dissertation had to be submitted within a couple of days. Steven seemed to appreciate Jenny’s help, and Jenny enjoyed listening to Steven talk about his grand ideas of changing the world through his inventions. In fact, Steven was
working with one of his professors to develop a material that they hoped one day would be used in the 3D printing of human organs. Eventually, Jenny and Steven started dating, and he proposed to her the day after he received his doctorate.
Jenny and her mother were extremely excited to begin planning the wed- ding she had always dreamed of. Jenny started buying bridal magazines, following various wedding planning blogs, and printing pictures and ideas from Pinterest to show Steven and her mother. She became so consumed with wedding planning that she was having a hard time concentrating on her job. Furthermore, her office was beginning to look smaller and smaller as the magazines and papers piled up. She knew she needed to clean it up because she met with students in her office, but she kept telling herself that once she “got organized,” there would be much less clutter. She tried to keep the door to her office shut as much as possible, but her boss did make a comment one day about her office not giving the right message to students. Jenny agreed with his observation and was happy when she was able to secure a small conference room that she could use for student meetings.
Jenny and Steven were married by the time she turned 26, and they were thrilled to be able to buy a house. Jenny was grateful to her parents for the financial help with the down payment, as she did not make a lot of money at the university. Steven’s invention was about to be patented, but it cost much more money than it brought in at that point. The weekend Jenny and Steven moved into their new home was much more stressful than either had expected. Steven was shocked to see box after box after box coming out of Jenny’s parents’ home. He thought to himself, “How could any 26-year-old possibly have that much stuff?” He knew Jenny’s family came from a different socioeconomic background than he did, so he assumed she would have more to move than he would. But this was even more than he could have imagined. He wondered where they were going to store everything and how long it would take Jenny to unpack. As they moved boxes into their small basement storage area, Steven couldn’t help but open a few just to take a look inside. He was shocked to see what looked like boxes of garbage and old papers. There seemed to be no rhyme or reason to the way things were packed, and one huge box was full of empty toilet paper and paper towel rolls! When Steven confronted Jenny with his discovery, she became defensive and angry. She told him that it was none of his business and that he shouldn’t be going through her things. He responded by telling her that now that they were married, it was his business, especially if all of those things were taking up more than half of their house.
Jenny and Steven’s first year of marriage was stressful on many levels. They were learning how to live together and how to divide household duties, and Steven was acclimating to Jenny’s packrat nature. She did make significant progress in terms of unpacking boxes, but as a result, almost all of their open space was occupied with her possessions. Steven wondered what was going to happen when they had children.
Two years later, they had their first child, a daughter named Claire. Jenny struggled with balancing the demands of motherhood and a full-time job. Steven’s invention was now receiving a lot of good press, and he was starting to travel more to make presentations to hospitals and biomedical research centers. Jenny had days when she felt pretty down and alone. She wondered if she had postpartum depression. She recalled some of these same feelings from when she was a child and her father spent a lot of time away from home. She took care of herself and Claire but didn’t have much motivation to keep up the house. The clutter began to pile up, and despite Steven’s comments when he returned from a business trip, she justified the mess by claiming that she was still a new mother and was having to take care of everything at home because he was off gallivanting around with his friends and colleagues.
While Jenny’s mood improved over the coming months, Steven noticed that anytime there was a significant change in the household, Jenny started collecting things that she believed were important. Furthermore, she refused to throw any of these things away, and the house became more and more cluttered. She repeated this same pattern two years later, after their son, Jeremy, was born. By this time, Steven’s invention was being sold to a number of large medical research institutes and they could afford for Jenny to quit her job. Jenny had developed a hobby of scouring the Internet, particularly eBay and Craigslist, for baby and toddler gear. She prided herself on always being able to find fantastic deals on items that would sell for double on Amazon. Steven told her that she didn’t need to worry about money so much anymore, but she explained to him that the thrill was related to getting a great deal, not about whether they could afford it. As a result of this newfound hobby, Jenny and Steven began acquiring a number of items that they didn’t need or use. These items ultimately ended up being stored in the garage. Jenny assured Steven that she was going to sell many of these items for a profit on eBay or Craigslist. Steven had heard this before many times, but never once had he seen Jenny actually sell anything.
Steven through a Husband’s eyes
I felt myself becoming more and more emotionally distant from Jenny. I’m sure she could feel it too, but she didn’t seem to care. The only thing she really seemed to care about was her stuff. She is a good person and has been a good mother to our children, but I believe they too are starting to suffer the consequences of her issues. Our daughter, Claire, is now in first grade, and she would come home talking about how all of her friends were having playdates at their houses. When I told her that she was welcome to invite friends over to our house, she put her head down and mumbled that she was embarrassed to invite her friends over because of how messy our house was. Hearing that broke my heart, and when I looked around our house that night I felt like I was really seeing it for the first time. It was appall- ing, really; every counter and every table was completely covered with junk. The kitchen garbage was starting to smell; it had been there for weeks because it was hidden behind so much stuff. How did Jenny even cook in there? I had to admit to myself how blind I had been over the past year. I had been traveling a lot, which I guess I used as an escape. Then when I was home, I just forced myself not to look around. But now that I had seen it, I mean really seen it, there was no going back. I went through every room of the house, opened every closet door, and looked down in the basement. I realized I hadn’t been in the basement since we moved into the house after we got married. I will never be able to get that scene out of my head. There was stuff, brand new stuff that I’d never seen, literally stacked from floor to ceiling. I felt as though I couldn’t breathe. How could I have been so blind to this? How much money has she spent on all of this stuff? But the most difficult thought I had was: “How could I have let my children live in this condition?” That was enough to cause me to fall to my knees and start sobbing. I knew at that moment that as much as I loved Jenny, I couldn’t allow our kids to grow up like this. By the time Jenny and the kids got home that evening, I had packed up a few things I could actually find in the piles around the house. I told her that I was taking the kids to my parents for a while so she and I could work out a plan about what we were going to do. I remember she just looked at me like I was crazy. She said she didn’t understand what I was talking about and that it was fine if I wanted to leave but there was no way I was taking the children. She really didn’t get it and was starting to get angry. I threatened to call the Department of Family Services and report her if she didn’t let me leave with the kids.
The kids and I lived with my parents for the next few weeks while Jenny and I tried to work out a plan. I told her that I had done some research on psychological disorders and that I thought she had hoarding disorder. She responded in her typical way, which was angry and defensive. I suggested that we go see a marriage counselor to help us work through this rough patch in our marriage. I was shocked that she reluctantly agreed, and this gave me a glimmer of hope.
Unfortunately, that glimmer of hope faded. In the middle of our second session, Jenny stormed out after the therapist asked her if she thought her hoarding tendencies played a role in our marital problems. She later claimed that the therapist didn’t know what he was talking about and that he was obviously on my side because he was a man. I tried to explain to her that I thought her hoarding problem was one of the major reasons our marriage was failing, but she just refused to acknowledge that fact. I felt like I had no choice; I had to do what was best for my children. I had been offered a job in Raleigh, and I made the decision to accept the job, file for separation, and move with the kids to Raleigh. It was by far the hardest thing I’ve ever done in my life. I don’t think it was until the kids and I drove away pulling a trailer of our things that Jenny finally realized what she had lost.
Jenny treatment as a Last Resort
In the weeks after Steven left with the kids, Jenny was devastated and had difficulty getting through the day. She rarely left her house and had trouble sleeping. She ignored her mother’s phone calls and only answered the phone if she saw that it was Steven calling. He was good about having the kids call her every day or two. Her mother frequently called ahead and then brought food over and left it at the front door. But one day, she showed up at Jenny’s house unannounced. It had probably been over a year since she had been inside the house, because Jenny never invited anyone over. Grace was worried about her daughter and kept banging on the door telling Jenny she wasn’t leaving until she let her inside. Eventually, Jenny conceded and let Grace in. Steven had tried to prepare Grace for what she would see, but no one could have been adequately prepared. Her jaw dropped as she looked around and saw only a small pathway from the front door leading into the living room and kitchen. Her daughter’s house looked like it could have been on one of those reality TV shows. Grace looked at her daughter, a ghost of who she once was, and begged her to get some help. She told Jenny that there was no way a judge was going to grant her any custody rights to her children as long as she was living in those conditions. Jenny broke down sobbing, and with tears streaming down her face, she agreed to go get treatment.
Sessions 1 and 2
Jenny agreed to go see Dr. Michael Strader, who specialized in the cognitive-behavioral treatment of hoarding disorder. According to his Web site, he worked with a whole team of people, including professional organizers and a psychiatrist. Grace attended the initial assessment with Jenny, primarily because she was afraid Jenny would cancel if left to herself. When Dr. Strader asked Jenny what brought her to treatment, she responded, “I’ve lost my husband and my children because my house is a mess.” Dr. Strader had a difficult time pulling the entire story out of Jenny, but he knew this type of defensiveness and lack of insight were common in individuals who had hoarding disorder. Grace was willing to fill in some of the important information that Jenny was leaving out of the conversation. At the end of the 50-minute session, Dr. Strader told Jenny and Grace that he believed Jenny had hoarding disorder but that he was confident that his team could help her. He was careful not to guarantee that she would be completely symptom-free after therapy, because he knew that while cognitive-behavioral therapy was an empirically supported treatment for hoarding, complete remission was rare. However, Dr. Strader believed that with a multidimensional cognitive- behavioral approach Jenny could have significant emotional relief, clean up her living environment, and function at a higher level. Jenny agreed to give it a try to get her family back and scheduled an appointment with Dr. Strader for the following week.
In the second session, Dr. Strader described the cognitive-behavioral model of hoarding to both Jenny and her mother. He explained that hoarding consists of excessive acquisition and difficulty discarding items, which result in extreme clutter in the living environment. He went on to say that there is a lot of evidence to suggest that hoarding stems from a combination of information-processing deficits, problematic beliefs and behaviors, and emotional distress and avoidance. Jenny appeared confused and slightly agitated.
Jenny: I have no idea what any of that means.
Dr.Strader: Okay, well let me put it another way. People who develop hoarding behaviors tend to have a history of difficulty sustaining attention, making decisions, and organizing their belongings.
Jenny: Well, that definitely describes my life.
Dr.Strader: Furthermore, the cognitive-behavioral model suggests that individuals who hoard have very strong emotions about their possessions. On the one hand, they have powerful negative emotional reactions, such as anxiety, grief, or guilt, that lead to avoidance of discarding or organizing things. On the other hand, they have very positive emotions, such as pleasure and joy, from acquiring and saving possessions. The relief that results from the avoidance of discarding and the pleasure from bring- ing new items into the home are a powerful combination that makes this a difficult problem to change on your own.
Jenny: Now I understand what you are talking about, and that has pretty much been my experience for the past few years.
Grace:I would have to say that your description pretty accurately describes how Jenny has been for most of her life.
Dr Strader: It is common for many of these behaviors and beliefs to begin in adolescence or even childhood. You can probably trace these behaviors back a long time; it is just that now they have reached a point where they are having very negative consequences for your life.
Jenny:(Sniffing as she nods) I just don’t know anything different at this point.
Dr Strader: That makes perfect sense, and that’s why this treatment is educational as well as therapeutic. Lifelong problems take a long time to change. So we can move at a pace that is comfortable for you. Does that sound okay?
Jenny: Yes, that sounds good to me.
Sessions 3 to 6
Jenny attended the next few sessions by herself. She was pleasantly surprised that Dr. Strader didn’t want to come to her house and make her throw out all of her stuff like they did on those reality shows. Instead, he asked her a lot of questions regarding her understanding of how her hoarding began and the kinds of things in her life that maintained the behavior. Dr. Strader attempted to understand Jenny’s core values, or what was most important to her in life, and asked her about her personal goals. Where did she want to be in 5 years? What were some of her dreams that she never imagined were attainable because of her disorder? Dr. Strader knew that most patients with hoarding disorder struggled with being ready to make changes, so he wanted to move slowly. But he also wanted Jenny to recognize both the pros and cons of changing and that it was okay if a part of her didn’t want to change. He asked her to brainstorm a list of all of the possible pros of changing and then all of the possible cons. The most striking part of the exercise was when Jenny came to the realization that there were many pros and many cons. This recognition allowed Dr. Strader to empathize with Jenny about her ambivalence about changing. It also gave him the opportunity to work with her to shift the balance toward the good things about changing in an effort to increase her motivation for the work to come.
Sessions 7 to 10
The next four sessions were devoted to teaching Jenny some specific skills that would help her through decluttering and maintaining the decluttered environment. Dr. Strader had Jenny meet with Susan, a professional organizer, to talk about developing organizational skills. Susan would assign Jenny a very small task to practice at home between sessions, such as finding one box to put by the front door in which she would keep all of the mail that was brought into the house.
Dr. Strader also worked with Jenny on decision-making and problem-solving skills. These were issues that Jenny had struggled with since childhood. She felt some relief finally to have a system to use to make a decision or solve a problem. They also started to work on cognitive restructuring of some of the beliefs Jenny held about the importance of acquiring and keeping possessions. Dr. Strader helped Jenny figure out what some of those beliefs were.
Dr, Strader: Can you give me an example of something in your home that you are holding onto that other people would think you should throw out?
Jenny: Well, that probably describes most of the things in my house. But I guess if I had to pick something I would say the broken bicycle in my living room.
Dr. Strader: Okay. How long has your bicycle been broken?
Jenny: It’s actually not my bicycle; it’s my cousin Andrew’s. He’s the one I told you about who was killed when I was 14 years old.
Dr. Strader: Yes, I remember you telling me about him and how difficult that time was for you and your family. So why do you think you’re holding on to his broken bicycle?
Jenny: Yes that sounds good to me.
Sessions 3 to 6
Jenny attended the next few sessions by herself. She was pleasantly surprised that Dr. Strader didn’t want to come to her house and make her throw out all of her stuff like they did on those reality shows. Instead, he asked her a lot of questions regarding her understanding of how her hoarding began and the kinds of things in her life that maintained the behavior. Dr. Strader attempted to understand Jenny’s core values, or what was most important to her in life, and asked her about her personal goals. Where did she want to be in 5 years? What were some of her dreams that she never imagined were attainable because of her disorder? Dr. Strader knew that most patients with hoarding disorder struggled with being ready to make changes, so he wanted to move slowly. But he also wanted Jenny to recognize both the pros and cons of changing and that it was okay if a part of her didn’t want to change. He asked her to brainstorm a list of all of the possible pros of changing and then all of the possible cons. The most striking part of the exercise was when Jenny came to the realization that there were many pros and many cons. This recognition allowed Dr. Strader to empathize with Jenny about her ambivalence about changing. It also gave him the opportunity to work with her to shift the balance toward the good things about changing in an effort to increase her motivation for the work to come.
Sessions 7 to 10
The next four sessions were devoted to teaching Jenny some specific skills that would help her through decluttering and maintaining the decluttered environment. Dr. Strader had Jenny meet with Susan, a professional organizer, to talk about developing organizational skills. Susan would assign Jenny a very small task to practice at home between sessions, such as finding one box to put by the front door in which she would keep all of the mail that was brought into the house.
Dr. Strader also worked with Jenny on decision-making and problem-solving skills. These were issues that Jenny had struggled with since childhood. She felt some relief finally to have a system to use to make a decision or solve a problem. They also started to work on cognitive restructuring of some of the beliefs Jenny held about the importance of acquiring and keeping possessions. Dr. Strader helped Jenny figure out what some of those beliefs were.
Dr. Strader: Can you give me an example of something in your home that you are holding onto that other people think you should throw out?
Jenny: Well, that probably describes most of the things in my house. But I guess if I had to pick something I would say the broken bicycle in my living room.
Dr Strader: Okay. How long has your bicycle been broken?
Jenny: It’s actually not my bicycle; it’s my cousin Andrew’s. He’s the one I told you about who was killed when I was 14 years old.
Dr. Strader: Yes, I remember you telling me about him and how difficult that time was for you and your family. So why do you think you’re holding on to his broken bicycle?
Jenny: I don’t know, I guess I just feel like throwing it out would be like throwing him out, and I don’t have many things of his because my aunt had a hard time letting anyone take anything out of his room.
Dr. Strader: So in some way, you feel like throwing away a broken possession of his would be disrespectful to him.
Jenny: a little bit, I guess
Dr. Strader: it also sounds like you have some fear that if you were to throw the bicycle away, you would be choosing to lose some of your memories of Andrew,or even worse, forget about him altogether?
Jenny: ( Choking back tears) Yes, that could be it.
Dr.Strader: Where do you think the memories of Andrew are held? Are they stored in the bicycle? Or, are they stored within you?
Jenny: Well, they are within me of course. But the bicycle helps me remember him.
Dr. Strader: So the bicycle serves as a reminder for you to not forget Andrew.
Jenny: Yes I guess it does.
Dr. Strader: Are there any times during the day or week that you think about Andrew when the bicycle the bicycle isn’t around?
Jenny: Sure, sometimes outside will remind me of him, or I’ll just have a random memory about something from childhood.
Dr. Strader: So I wonder if you aren’t giving yourself enough credit to trust that memories of Andrew will be with you forever and that you don’t need a reminder every time you walk in your house to remembered him. My guess is you don’t look at the broken bicycle every time you walk in your house to remember him.
Jenny:No not at all, I can hardly even see the bicycle now because it is behind so much other stuff.
Dr. Strader: That’s right. So how about we try this? When you get home today, can you move the bicycle to a place where it is completely out of your sight? Then we can really test whether or not it is the bicycle that helps you to remember Andrew. Then, anytime during the next few weeks that you think about or have a memory of Andrew, make a note of it in your phone. If at the end of that time you have had thoughts or memories of him that weren’t triggered by the bicycle,you’ll bring the bicycle into our next session and we’ll discard it together.
Jenny: just hearing you say that makes me nervous, but I’ll willing to give it a try.
Sessions 11 to 14
After collecting her own data, Jenny was able to let go of her belief that it was necessary to hold on to a broken bicycle to remember her cousin. She took the bicycle to her twelfth session with Dr. Strader, and together they threw it away in the dumpster behind his building. Jenny felt significant anxiety during this process, but Dr. Strader helped her to use the coping strategies that she had learned in treatment so far.
The next sessions took place in Jenny’s home. Dr. Strader attended the first of these sessions with Susan, who was going to work with Jenny to develop an organizational system. Dr. Strader and Susan helped Jenny to learn the difference between things that she needs and things that she wants. They also reminded her that her identity did not come from her possessions. With Dr. Stader’s help, Jenny began to realize that she could get rid of some of these things, still be who she is, and have a much happier life because her children would be able to come back.
Over the next couple of months, Susan helped Jenny to sort the things in her house, room by room. Susan brought in large bins that were labeled Trash, Recycle, Donate, Sell, and Undecided. The Sell and Undecided bins were significantly smaller than the others, and once they were full, Susan didn’t allow Jenny to put anything else in there. Over the course of the next month, Jenny was surprised by the progress she had made. She could actually see the floor in some places, and some small countertop space was visible. At times, she struggled with feeling overwhelmed at the sheer amount of work to be accomplished, but if she stayed focused on the task at hand, by using some of the strategies Dr. Strader taught her, she managed quite well.
Sessions 15 to 26:
Jenny had found her rhythm. With Susan’s help she developed an organizational system, and she worked on it for at least 30 minutes each day. Jenny agreed to spend a minimum of 30 minutes a day organizing as homework, but many days she found herself organizing for hours. Dr. Strader had asked Jenny to take before and after pictures. He asked her to text him the before picture prior to beginning the cleanup of that area and then text him the after picture once she felt that she had made enough progress to move on to another area of the house. This strategy was helpful for Jenny because it gave her some accountability and she really wanted Dr. Strader to be pleased with her progress. This strategy enabled Dr. Strader to maintain regular contact and monitor what was going on in Jenny’s home without having to make numerous trips.
In addition to decluttering her home, Jenny worked with Dr. Strader to develop skills to stop herself from acquiring new possessions. Jenny found it very difficult to throw things away, but she was surprised that it was almost as difficult at times to resist bringing new things into her home. Jenny identified her high-risk situations for acquiring new items, such as eBay, Craigslist, the local freecycle site, flea markets, and garage sales. She agreed to deactivate her accounts on eBay, Craigslist, and the freecycle site for a while to help reduce her urge to acquire stuff, and she avoided flea markets and garage sales. Dr. Strader helped her develop a hierarchy of stores she could visit with the goal of not buying anything. The hierarchy started with stores that were only minor triggers and ended with those where Jenny would always buy something. Jenny began these exposures a few times each week, and as she felt confident that she could visit a store without the urge to take something home, she was able to move up to the next store on the hierarchy. With each passing week, Jenny began to feel more confident and truly started to believe that she could change her life for good.
Epilogue:
Jenny attended regular therapy appointments for over a year. Even after she met all of her goals, which included decluttering her home, having it professionally cleaned, and maintaining the organization and cleanliness, she continued to meet with Dr. Strader once every few months just to check in. She found that the little bit of accountability helped her keep on track if she started to slip back into old habits. Not falling back into her old ways was a daily battle for Jenny, but as each month passed, she felt that this battle got easier to fight.
Despite what was once thought of as an important etiological factor, material deprivation has not been found as a risk factor for hoarding. However, trauma and other stressful life events have been shown to be important correlates of hoarding behaviors (Landau et al., 2011).
While hoarding disorder is often comorbid with obsessive-compulsive disorder, studies have found that among individuals with hoarding disorder who have no history of obsessive-compulsive disorder, 28 percent were diagnosed with attention deficit disorder, inattentive type (Frost, Steketee, & Tolin, 2011).
Methylphenidate is a stimulant drug that often restricts the growth of children when taken for ADHD. These children tend to gain less weight and height than peers who don’t take stimulant medication. Growth retardation is thought to result from decreased appetite, a side effect of methylphenidate. Some people believe taking a drug holiday, during which the medicine
is discontinued over the summer, can help a child catch up to peers in terms of height and weight.
(
