Abstract
IntroductionClinical research suggests that hoarding disorder is a complicated, multi-faceted issue with early onset and lifelong progression affecting physical, psychological and environmental aspects of people’s lives. The treatment of hoarding is often hampered by high drop-out rates (Mataix-Cols et al, 2002), therapy interfering behaviours (Christensen & Greist, 2001) and initial refusal to engage in treatment (Steketee et al, 2010).
A wide range of professional’s work with individuals presenting with hoarding behaviour, including: professional organizers, counsellors, occupational therapists, support workers, psychologists, community nurses, social service workers and housing associations. Professionals frequently report that they find working with individuals who hoard frustrating and give high rates of negative appraisals of hoarding behaviour while being comfortable working with other presenting issues (Frost et al, 2010). Indeed, mental health clinicians have been reported to feel reluctant to treat patients with hoarding symptoms and it is more likely that hoarding behaviours are treated by non-mental health professionals (Tolin, Frost & Steketee, 2012). Professionals report that working with disorders can be challenging. Poor working alliances, the clients lack of insight and understanding of the issues and therapy-interfering behaviours are all reported when working with HD (Frost et al, 2010, Tolin et al., 2012). Working with HD also requires a psychologically informed understanding of the person who hoards and mental health. However, training and specialist guidance is often not accessible to professionals such as those in housing support. Haighton et als (2023) study investigating key stakeholders’ identification, assessment and intervention of hoarding disorder found that Key stakeholders responsible for the management and support of hoarding situations in the community, such as housing, health, emergency services, and social care had no clear consensus for what constituted a hoarding disorder presentation. As a result, each service adopted procedures to manage clutter. One clear consensus among the services was the focus on quickly resolving hoarding disorder by decluttering properties, eviction and other legal action. This raised major concerns regarding the lack of multiagency working to address the many factors contributing to hoarding behaviour, further complicating the management of risk and wellbeing for professionals and the individuals with HD (Haighton et al, 2023).
Similarly, Hanson & Porter (2022) study of professionals working with HD observed that housing staff frequently assume responsibility for the management of hoarding cases. Individuals who hoard are often first identified and supported by frontline professionals such as housing officers, rather than mental health clinicians. These professionals more often than not, do not receive sufficient training, supervision, or have mental health expertise. As a result, professionals can find themselves having to make mental health-related decisions beyond the remit of their role, and often report relying on a trial-and-error approach when navigating the emotional and relational demands of this work. Housing officers also report struggling to balance tenants' autonomy with the legal and safety responsibilities of their role, often without multi-agency collaboration, which can leave professionals feeling isolated and morally conflicted, as they are forced to act as both enforcers and caregivers without adequate support or clarity in their role (Hansen & Porter (2022). Professionals can experience great emotional strain working within hoarded homes as it is both physically and emotionally demanding with increased risk to physical safety and mental wellbeing. Coupled with the lack of systemic support and guidance can lead to high levels of stress, emotional strain, burnout, and difficulty maintaining professional boundaries, suggesting that current frameworks place unrealistic expectations on non-mental health professionals tasked with addressing hoarding behaviours (Hansen & Porter, 2022, Denton et al, 2002, Kellett et al, 2016). There is a possibility that a professional’s emotionally taxing experiences, shock and frustration with clients may result in more strained working alliances or less successful clinical outcomes. It is therefore important to consider how professionals lived experience of working with hoarding behaviour impacts working relationships and personal perceptions of HD.
Research Aim
Studies have focused on understanding the neurobiology and cognitive processes associated with HB, and the impact of treatment. However, studies focusing on professionals’ experiences of engagement with people with hoarding behaviour are growing, but remain limited. Therefore, the study aims to develop an understanding of how professionals working with hoarding behaviour perceive the hoarding phenomenon and their client’s experience.
Study
Using a phenomenological methodology, specifically interpretive phenomenological analysis (IPA), in-depth interviews were conducted with three members of staff of Linc Cymru housing association who have worked directly with tenants exhibiting hoarding behaviours and living in cluttered environments.
Findings
Data analysis identified four superordinate themes: i) Hoarding behaviour results from an underlying cause; ii) The duality of staff’s roles: providing support and enforcing policy; iii) Conflicting goals/perceptions between staff and tenants, iiii) Perceived barriers to collaboration.
Overall, participants perceived hoarding disorder to be a complex issue resulting from underlying mental health problems and a desire to maintain a sense of safety and comfort from their environments. Staff were committed to working collaboratively, forming strong working alliances based on trust. The implementation of clear, personalised behavioural action plans alongside a collaborative working relationship were thought to produce more positive results.
However, participants reported having little to no professional training in evidence-based practice to work with tenants displaying possible hoarding behaviour. Furthermore, staff had received no professional training in identifying the diagnostic criteria of hoarding disorder or other co-morbid mental health issues. Despite this, staff are required to take both a supportive and enforcing role in order to meet policy standards which risked the collaborative working alliance between staff and tenants. Tennant’s who disengaged and were resistant to receiving support to de-clutter caused feelings of frustration and disappointment among participants who believed that an improved environment would improve quality of life for their tenants. At times, staff’s perceptions conflicted with tenants’ own perceptions of their needs and wants.
Improvements to education on the subject of hoarding and other mental health conditions, and access to local supportive resources may develop upon and improve working alliances, long term maintenance of clutter and support outcomes. From a Counselling Psychology approach the nurturing of a holistic working alliance between professional and person with hoarding behaviour is an important factor in long-term engagement and improved wellbeing; as well as developing an understanding of hoarding disorder and treatment guidelines. However, professionals can often find their own values and beliefs affected by the multi-faceted expectations of their roles as tenancy officers. Further research is required to explore the lived experience of professionals. How attitudes, beliefs and values, understanding of hoarding disorder impact the experience and outcome of working with hoarding behaviour.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Philip Tyson (Supervisor) & Annie Beyer (Supervisor) |