I am an OT working in community mental health with an interest in the field of compulsive hoarding. I am aware that there is a growing body of research particularly based on the CBT approach and I am CBT trained myself. However, considering how much I have come across hoarding throughout my OT career, there appears to be little guidance or information out there for OTs. I therefore have created this blog as a forum for OTs and other professionals working in this complex area, to share ideas, resources and thoughts .
A couple of questions for discussion;
1. Assessments: I have used parts of the Compulsive Hoarding and Acquiring guide by Steketee and Frost (2007) which overall I find really helpful. However, I find the checklists a bit daunting to use with my clients, so tend to use less standardised tools with an amalgam of different assessments. I also have used the MOHOST which I have adapted to cover areas related to hoarding (see assessment and case formulation page). Has anybody found or developed assessment tools which are user friendly for clients and reflect the OT role?
2. Resources: I have produced a page on recommended reading including online resources, books and articles . However, none of these specifically relate to OT. Are there any books , materials that you have found useful in your clinical practice?
Anyway please comment, contribute and feedback on the following pages so that we can work towards developing better resources and guidance for OTs.
Dora
Hi Dora,
ReplyDeleteI'm excited to read your blog and any updates you may post in the near future. I am an intern at a Residential Care Facility, and as my first "case", have been presented with an individual with severe hoarding tendencies. He's been diagnosed with OCD as well as schizophrenia. The problem is, nothing has worked for him so far, and so they're using me as a last-ditch effort to try and help him so we can allow him to stay here rather than being evicted and sent to a locked facility. He's relatively nonverbal, so I've been investigating alternative treatments for hoarding tendencies. That's why I was so excited to come across your blog! I'm sure it will give me lots of great ideas. :)
Hi Vienna
ReplyDeleteThank you for your post . As you can see this blog is a work in progress but your comments have inspired me to post more often. I will try and put something on about interventions when I have the time.
I am guessing you have been doing a fair amount of research in the area ; for me the recommended reading would be ;
Compulsive Hoarding and Acquiring: Therapist Guide (2007). G.Steketee and R.O. Frost: Oxford University Press
Employing Motivational Techniques with Psychotherapists and Professional Organizers (2008). S Geller Katz and S Schiff. Available online (depending on how verbal he is)
www.ocfoundation.org/hoarding
On a basic level it’s also important to understand the function of hoarding ie is it to reduce distress?/ feel useful? Provide a short term “high”. This should hopefully identify goals other than just reduction of clutter and acquiring eg developing an alternative role or routine.
You mentioned that there was no progress with other staff, but it is worth exploring whether there have been any tiny glimmers of hope and what those contributing factors may be ie approach of staff, particular people , time of day etc, and also whether approaches have been consistently applied by all staff. Obviously any goals should be tiny to allow for some sense of success, as progress even with relatively motivated individuals can be grindingly slow but at last it could be moving in the right direction. Working on the views of staff to look out for small changes can also be just as important as hoarding tends to evoke strong feelings of pessimism and futility amongst staff.
Although more recently there is increasing evidence that hoarding can be treatable to some extent –however there is a group of individuals who do not respond to current treatment approaches . In those cases a harm reduction approach may be useful- although it may not fully apply to your setting I found the following article a helpful read.
Working with Families of People who Hoard: A Harm Reduction Approach (2011). MA Tompkins.Journal of Clinical Psychology, 67,(5), 497-506.
Anyway I wish you the best of luck with your client, whatever the outcome, I’m sure you will learn a lot which will stand you in good stead if you work with people who hoard in the future.