Ambivalence – and a great deal of it – is a typical feature of hoarding disorder. Given the considerable ambivalence of most clients with this condition, clinicians want to take care to avoid inadvertently shutting down the client’s motivation to work on the problem. Here are typical ways clinicians shut down motivation when treating hoarding disorder.
Focus prematurely on hoarding behavior. When first meeting the client, it is essential that you not over focus on hoarding behavior. Most people that seek treatment for hoarding disorder because they hope to reconnect with family and friends, reconnect with a lost hobby or interest, or reconnect with other important personal values. Spend time discussing with the client what she hopes working on the hoarding disorder will bring into her life.
Label the problem when the person does not find this helpful. Ambivalence may reflect a wish to avoid the shame that accompanies stigmatization. Avoid labeling the person a “hoarder,” unless they find this helpful. Ask the client to tell you what they would like to call the problem and how they see themselves. If they see themselves as a packrat rather than a client with hoarding disorder, accept this and move ahead with working on the problem
Argue. Do not argue with the client about what to keep and what to discard or about the pace of progress. Instead, teach skills that assist the client to make effective decisions about what to keep and discard himself. Similarly, do not argue about the pace of the treatment. The client may think you are going too fast one day and too slow the next. At times, you may also think this way. Redirect the client back to the task and invite her to discuss these issues later in the session.