Group Treatment for Hoarding Disorder

Therapist Guide

Jordana Muroff, Patty Underwood, and Gail Steketee

Treatments That Work

Hoarding Disorder is now a DSM-5 diagnosis and more people will be recommended for treatment
This group program is an evidence-based treatment for hoarding disorder
Therapy methods are based on research and two decades of clinical experience with HD
Written by top experts in the field of group treatment for hoarding
Integrates CBT strategies and group process
Can be used with the Treatment for Hoarding Disorder: Workbook, Second Edition

Group Treatment for Hoarding Disorder

Therapist Guide

Jordana Muroff, Patty Underwood, and Gail Steketee

Description

For the first time, Hoarding Disorder (HD) is now recognized as a distinct disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), separate from OCD. HD has also received much more attention and exposure in recent years. Consequently, more people will be recommended for treatment, increasing the demand and need for clinicians who deliver this specialized intervention.

Group Treatment for Hoarding Disorder: Therapist Guide outlines a cognitive-behavioral therapy program for HD using a group model. Clinicians deliver group therapy over 20 weekly sessions of 1.5 to 2 hours each. A single experienced clinician can lead the group or a co-therapy model can be used with two clinicians, one experienced and one in training. Groups of 6 to 8 participants:

· receive education about HD and about the CBT model
· discuss therapy goals and personal values
· practice motivational enhancement methods including identifying barriers to progress
· receive training in organizing and problem-solving about hoarding problems
· learn cognitive therapy strategies to reduce problematic hoarding beliefs and to replace acquiring with more adaptive behaviors
· practice sorting, removing clutter, and not acquiring, beginning with easier tasks
· and identify in-home supports.

Final sessions focus on reviewing the most effective therapy methods, coping with change, and highlighting strategies for maintaining gains. Group members use the Treatment for Hoarding Disorder: Workbook, Second Edition to assist with practice exercises. All of the necessary forms and worksheets are provided in the books and online. Treatment proceeds in a flexible session-by-session fashion with attention to group process. Written for psychologists, social workers, psychiatrists, counselors, and psychiatric nurses, this Therapist Guide will promote effective group treatment of people with hoarding disorder.

Group Treatment for Hoarding Disorder

Therapist Guide

Jordana Muroff, Patty Underwood, and Gail Steketee

Treatments That Work

Acknowledgments
Chapter 1 Introduction
Chapter 2 Group Formation and Assessment
Chapter 3 Group Process
Chapter 4 Session 1: Introduction and Education
Chapter 5 Session 2: Model Building
Chapter 6 Session 3: Motivation
Chapter 7 Session 4: Goals and Treatment Planning
Chapter 8 Session 5: Reducing Acquisition
Chapter 9 Session 6: More on Acquisition
Chapter10 Session 7: Exposure Practice for Non-Acquisition
Chapter 11 Session 8: Decisions about Saving and Discarding
Chapter 12 Session 9: More on Decisions about Saving and Discarding
Chapter 13 Session 10: Skills Training for Organizing
Chapter 14 Session 11: Organizing Paper
Chapter 15 Session 12: Cognitive Strategies
Chapter 16 Session 13: Cognitive Therapy Skills for Letting Go
Chapter 17 Session 14: Coaching and Letting Go
Chapter 18 Session 15: Non-Acquisition Practice
Chapter 19 Session 16: Barriers to Progress
Chapter 20 Session 17: Maintaining Systems and Gains
Chapter 21 Session 18: Review of Treatment Methods
Chapter 22 Session 19: Assessment and Review of Progress
Chapter 23 Session 20: Graduation and Next Steps

Appendices
1. Hoarding Interview
2. Hoarding Rating Scale
3. Saving Inventory - Revised (SI-R)
4. Clutter Image Rating (CIR) Instructions, and pictures of LR, Kit, BR
5. Saving Cognitions Inventory (SCI)
6. Activities of Daily Living for Hoarding (ADL-H)
7. Safety Questions
8. Home Environment Inventory (HEI)
9. Binder Information Sheet (Session 1)
10. Session schedule (Session 1)
11. Group Session Forms [samples for each session]
12. Group Session Form [blank]
13. Confidentiality contract (Session 1)
14. Hoarding Disorder DSM-5 Criteria (Session 1)
15. Clinician's Group Progress Notes
16. Clinician's Group Progress Note [Example]
17. Blank Hoarding Model (Workbook, Ch. 3, p.31)
18. Brief Thought Record (Workbook, Ch. 3, p. 37)
19. Clutter Visualization Form (Workbook Ch. 4, p. 44)
20. Unclutter Visualization Form (Workbook, Ch. 4, p. 45)
21. Table of Signals of Ambivalence and Strategies (Session 3)
22. Table of Motivational Enhancement Strategies (Session 3)
23. Advantages and Disadvantages of Change Worksheet (Session 3)
24. Instructions to Coaches
25. Acquiring Form (Workbook, Ch. 5, p. 52)
26. Acquiring Visualization Form (Workbook, Ch. 4, p. 46)
27. Thought Listing Exercise Form (Session 8)
28. Behavioral Experiment Form (Workbook, Ch. 7, p. 83)
29. Table of Problematic Thinking Styles (Session 12; Workbook, Ch. 8, p. 86)
30. Thought Record (Workbook, Ch. 8, p. 93)
31. Non-acquiring Help Card (Session 15)
32. Practice Form (Workbook, Ch. 4, p. 47)
33. Personal worksheet for managing barriers (Session 16)
34. Family Response to Hoarding Scale (FRHS) (Session 16)
35. Weekly Scheduler (Session 17)
36. List of Treatment Techniques (Session 18)
37. Certificate of completion (Session 20)

References
Readings and Resources
About the Authors
Index

Group Treatment for Hoarding Disorder

Therapist Guide

Jordana Muroff, Patty Underwood, and Gail Steketee

Treatments That Work

Author Information

Jordana Muroff, PhD, is an Assistant Professor at Boston University School of Social Work in the Clinical Practice Department. Trained in cognitive behavioral therapy methods (CBT), Dr. Muroff is a licensed social worker and trained psychologist with extensive clinical experience. Her research on mental health interventions has established the efficacy of group treatment for hoarding disorder.

Patty Underwood, MSW, is a licensed independent clinical social worker in Massachusetts and a highly experienced clinician at Riverside Community Care, a large community-based mental health agency. She is a part-time lecturer at Boston University School of Social Work (BUSSW), teaching courses in clinical practice. She also serves on the Dean's Advisory Board at the Boston University School of Social Work.

Gail Steketee, PhD, is Dean and Professor of the Boston University School of Social Work. Her research has focused on understanding the causes and consequences of obsessive-compulsive (OC) spectrum conditions, especially hoarding disorder, and on developing and testing evidence-based treatments for these conditions.

Group Treatment for Hoarding Disorder

Therapist Guide

Jordana Muroff, Patty Underwood, and Gail Steketee

Treatments That Work

Reviews and Awards

"There has been a significant need for a treatment manual like this describing how to treat hoarding disorder in a group setting. The group focus will be especially appealing to social service agencies that have to contend with large volumes of patients. It's quite comprehensive and covers the requisite topics, and the evidence for this treatment is strong, especially given this difficult-to-treat population. The authors are leaders in this field, and the manual is straightforward, pragmatic, and ready-to-use in treatment."-Eric Storch, PhD, All Children's Hospital Guild Endowed Chair and Professor of Clinical Psychology, Departments of Pediatrics, Psychiatry & Behavioral Neurosciences, and Psychology, University of South Florida

"The burden and pain for those struggling with hoarding disorder and for their families is poignant, complicated by how mysterious the affliction seems to others. Yet the brain is plastic, and even seemingly intransigent behaviors can yield to cost-effective and evidence-based therapies. This goal and the tools to accomplish it are brilliantly articulated in Group Treatment for Hoarding Disorder: Therapist Guide, by Jordana Muroff, Patty Underwood, and Gail Steketee."-Jerrold F. Rosenbaum, MD, Chief of Psychiatry, Massachusetts General Hospital, and Stanley Cobb Professor of Psychiatry, Harvard Medical School

"If you had any concerns about running an effective hoarding disorder therapy group, put them to rest. This thorough step-by-step approach takes all of the doubt out of treatment of this disorder."--Gerald Nestadt, MD, MPH, Professor and Director of the Obsessive-Compulsive Disorder Program, Johns Hopkins Medicine

"It is beautifully conceptualized and executed. For those who know little about HD, it is an essential resource. For those who have experience and knowledge of HD, the manual will deepen their understanding and broaden their skill set. Chapters of this text should be adopted into the curriculum of MSW programs and counseling psychology programs. It should be included in group work courses, clinical practice courses, CBT courses, Motivational Interviewing training, and most importantly, as an exemplar for creating non-traditional, client-centered, empowering, respectful, and empathically resonant therapeutic relationships in any practice context, with any client system, not just those who struggle with HD." -- Social Work with Groups