Dealing with the Dark Days

Leigh Hatcher interviews psychologist Sarah Piper and her client “Robyn” who came to Sarah looking for support through her depression. Gain insight into what happens in a session with a psychologist, by listening to a re-creation of a segment of a past session with “Robyn”. They also discuss the importance of getting the right “fit” when choosing a practitioner to work with.

Forgiveness – how it works in abusive relationships

In the second of this three part series of weekly podcasts on forgiveness, Lyn Worsley discusses how forgiveness can work in abusive relationships, both personal and work related ones. Starting with self respect. forgiveness enables both parties to move towards growth.

Forgiveness – the process of “letting go”

Clinical psychologist, Lyn Worsley talks to Leigh Hatcher about forgiveness in this three part series of weekly podcasts. Forgiveness is so much a part of healthy relationships and in the first of the series Lyn discusses the process of moving to a place of “letting go” and how even in the psychological sphere of our minds, every action has an equal and opposite reaction.

Psychologists Are Human After All

Sarah Piper

Psychologists are regarded as experts in the human condition but they are still very human themselves. Psychologist Sarah Piper talks to Leigh Hatcher about her resilience journey, from working in indigenous and war torn communities, through parenthood, to psychologist at The Resilience Centre.

Hoarding or Collecting, what is the difference?

Lessons in sorting, throwing and storing.5/7/10 9:52:15 AM -- Wellesley, Massachusetts Gail Steketee recently published a book on hoarding and poses in the home of a hoarder.  Steketee is the Dean of the School of Social Work at Boston University. Photo by Melody Ko  for Boston University Photography

by Lyn  Worsley  (Clinical Psychologist)

Over the past 6 weeks I have had an insight into the sorting, throwing and storing world of a hoarder. We have been getting our house ready to move and downsize, which has meant sorting many items for sale, to throw, to keep and to store.

As I have been doing the multiple tasks of sorting, cleaning and throwing, my brain has been doing mental gymnastics. My brain has been on the trapeze with planning many things. My thought patterns go like something like this;

When I pick up an item I think

“What memories does it hold for me from the past?”, “How has it worn?”, “Is it old fashioned?”, “Is it useful?” and “Do I need this for the future?”.

Now these questions may seem fairly innocuous but for many people they are questions that cannot be answered, and if there is a definite answer there is a consequence, which can seem catastrophic. These people have a Hoarding disorder.

Now “Hoarding” is a term that is thrown around easily for people who just have a lot of stuff, and collect things they value. This is not hoarding it is just collecting. A “Hoarding disorder” refers to a way of thinking that can be repetitive, overwhelming, obsessive, crippling and stifling.

To help us to understand a bit more of what it is like to think like a hoarder, we go back to the simple questions I had when I was packing up my house. The questions bring with them a level of emotional connection as a lot of the things I have collected over the years have value for me. They represent memories of events, people I love, and the significance I had at a certain time of my life. As I look at the things I am reminded of time passing, and changes that have occurred, people I miss and hurts and joys. This means I have an attachment to my things. So for the average person sorting and throwing is actually quite hard. But we do it eventually and let them go.

To make it easier to understand I use the analogy of a flow or direction of thinking that occurs. When I sort and throw things out I have a hierarchy of value. It is a bit like a vertical line, with the most important things at the top and the least important things at the bottom. About half way down the line I can see that the items can be thrown out because I have only room for the things at the top. So my thought process sort out importance and I can make decisions.

But for the person with the hoarding disorder, they think on a horizontal line, as everything is of equal value. They cannot discern which is more important than another. Even to the point of people they love compared to things they have collected. Both have equal value. They have a strong attachment to the things around them as though they are people, which is why they find it difficult to make decisions to throw anything out.

Furthermore, there is a lot of significance of items they collect to them as a person. People with a hoarding disorder will often collect newspapers and junk mail, sometimes putting them into neat piles and in order (alphabetical or date). The theory of this is that the dates and events were significant and the newspaper reminds them of things that happen. If you throw out the newspaper you throw out the memory. So there becomes a fear of losing the memories.

Another aspect is that items can represent the person themselves. Most often people with a hoarding disorder have had some interference with their attachment to their main carer early in their life through trauma, abuse or neglect. This then transfers to them as they get older and they see the things they have as representing themselves in some way. Throwing them out would be like throwing a part of themselves out. So throwing out a newspaper or a cardboard box is like being personally discarded.

Finally there are always the plans and ideas of making, building and creating things. So these plans become all encompassing and the person with the hoarding disorder continues to collect the resources but does not actually sit down to make the item. It may be they see the potential for things and not the steps it will take to get there.

So how do we treat hoarding disorder? This is a good question because to date there doesn’t appear to be any long-term studies, which show the effectiveness of treatment over time. However some of the things we know do not work are

  • Taking over
  • Throwing things out
  • Organising them
  • Making judgemental comments about the things they have “collected”
  • Calling their stuff rubbish

I like to think of helping someone with a Hoarding disorder by getting straight to the core of the difficulties they experience. This may be slower but more effective over time.

The four aspects we have raised are attachment, memories, sense of self and creativity.

Attachment:

If there is some way to make sure that the person with a hoarding disorder feels connected and attached to real people on a regular basis, it will slow the hoarding process down. Church group, local club, volunteer agency etc all help to make a person feel they belong.

Memories:

Having a place for memories to be seen and discussed. Photo albums, photo walls, collages, journals etc, all serve the purpose of keeping memories alive.

Sense of self:

A sense of self comes when we are in relationship with others. Others mirror who we are and we get a glimpse of us as a person through another’s eyes. Sometimes this can be through a touch, eye to eye contact, a smile or a comment that is caring and loving go a long way to help someone feel valued.

Creativity:

Most often the creativity doesn’t have an outlet so providing opportunities for the creative work to come out. Going to workshops, art classes, studio’s etc can often allow the person to complete a task. Creating to give to another is always a useful way of helping them to let go of things as well.

Living with chronic pain

Sally (not her real name) walked slowly into my office and chose an upright, less comfortable chair. She took quite a while to find a comfortable posture and then looked at me with eyes that knows suffering. After the normal introductions I asked Sally how I can be of help. She started to speak and then, eyes brimming with tears, she continued to tell me about her struggle with her debilitating, excruciating and seemingly never ending chronic pain. It all started 18 months ago with a cycling accident and subsequent soft tissue injury to her back. The pain however never subsided and is in fact getting worse. Sally stopped cycling, spends a lot of time in her bed and had to resign from a job that she loved. “I am not even half the person I used to be” she said and “I am surprised my husband has not left me”

For most of us, our past experience of injury or surgery is that the pain fades away once we have recovered from the illness or the wound has healed. For people like Sally, who suffers from chronic pain, the pain just continues or just appeared out of the blue and is ongoing. In Australia three out of ten Australians have experienced chronic pain and twenty percent of us live with someone with chronic pain.

It is normal for people with chronic pain to experience a deep sense of loss of the old pain free self. Not knowing what sort of a day it will be makes it very difficult to plan ahead and hard to look forward to a holiday because of the knowledge that the pain will follow you there. It goes without saying that no one ever chooses to have chronic pain. One of the most challenging for us is to accept physical limitations and a body that is not functioning as it is supposed to.

Most people want their pain to be fixed. Many individuals try to fight the pain and believe that with enough tenacity they can break through the pain barrier. Unfortunately this mostly leads to aggravated pain and being worn out. Pain saps energy and all the willpower in the world will not make it go away. Ignoring pain only works in the short term. Chronic pain is tenacious in its ability to make itself known and will eventually be too much of a presence to ignore.

Chronic pain not only robs people of their sense of a wholesome self but often severely restricts their physical functioning and significantly impacts on their lifestyle. Remember Sally ?, her beloved bicycle lived in the shed and her memories of early morning rides with friends felt like a dream.

Living with chronic pain, really living, means that sufferers come to terms with the idea that despite the best efforts of the medical profession it is unlikely that their pain will go away in the foreseeable future. Accepting your pain does not mean that you are giving into it. It means that you adopt a stance of “it is what it is”. Instead of focusing on how badly you want the pain to stop, you accept the pain as is and find ways to continue living.

You need to find people who will take your condition seriously. Talk honestly about how you are feeling and obtain support for your actions to continue living. It may be a family member, your GP or someone at the many specialised pain management clinics (PMC’s) around Australia.

Psychologists are becoming increasingly more involved in helping people with chronic pain to live fulfilling lives. You will discover how to use Mindfulness to pay attention to your pain with inquisitiveness rather than judgement. Cognitive Behaviour Therapy techniques will help you to develop a positive mindset and a Solutions Focused approach will help you to action your plans. Over time you will be able to increase the amount and quality of things you can do. This may be different from the things you did before but your life can be full of meaning and enjoyment again.

Sally discovered that as a person she is infinitely more than her pain. Being curious rather than judgemental about her pain helped her to discover that her pain varies in intensity throughout the day and with good planning and resources many tasks can be accomplished.

You don’t have to be pain free to really live!

Joe is a Clinical Psychologist at Alpha Psychology.  He has extensive experience in helping people to manage chronic pain.