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Hoarding and Shame

Working as a therapist, it is not unusual for me to hear clients share stories where they are experiencing feelings of shame, guilt, and sadness. Many clients express feelings of hopelessness and helplessness at least some of the time. But, there is also a sense of shared experience. Therapy is seen as a safe place where they can explore those feelings. Hoarding disorder can test this idea.

When working with clients who hoard, learning about the hoarding can take more trust than you might expect. I have worked with clients for years before they are ready to share what is happening in their homes. Clients who have felt safe disclosing trauma, substance abuse, and their eating disorder have struggled to talk about their hoarding. All the same, it is an equally important issue that impacts them daily. Hoarding may be, to them, their most shameful behavior.

Hoarding Disorder: Statistics

Research shows that individuals experiencing hoarding disorder often feel judged and isolated from friends and family. This happens at rates that are even higher than those experiencing schizophrenia. As a result, it is not surprising that hoarding is a secret that is closely kept.

Hoarding disorder affects between 2 and 5% of the population. It is more common than many people are aware, and there are levels of severity as with any illness. Often times, when working with clients, they will reassure me, “I’m not like the show. I’m not that bad.” I always try to emphasize that no matter the hoard, I will not judge them. This is crucial.

Many times, before the work on addressing the hoarding can begin, there has to be a clear understanding that there is no judgment or critique of what is happening in their home. Rather, there is an understanding and acceptance of the internal distress and frustration hoarding causes. Whether their hoarding is causing health problems, issues with environmental safety, or is a source of embarrassment, the primary concern is the pain it is causing and how to address it.

Hoarding disorder also does not exist in isolation or as a stand-alone illness; rather, it is significantly correlated with anxiety, depression, OCD, and ADHD. These co-morbid disorders can often be the primary reason clients seek out support initially, and clients may be hesitant or reticent to start to address the hoarding, itself. Further, for many, there is a significant discrepancy between their external presentation- professional and put together- and their deeply protected, often completely hidden from others, personal space. When all of these factors are combined, it is clear why hoarding disorder is such a hidden illness and why, for those experiencing it, it can feel so hard to overcome.

What Can Be Done?

In September of 2017, a new group protocol was released to address hoarding disorder in a group format. Chrysalis Center is excited to be among the first offering this “Declutter Class”. The group provides resources, strategies, and hope for change with hoarding disorder. This treatment is research driven, proven to provide results, and addresses 7 “targets” or areas of functioning to reduce the impact of hoarding and improve functioning, overall. While seeking treatment and support for hoarding can be difficult, we are hopeful that this group will offer a safe, non-judgmental space where hoarding can be addressed effectively.

 

For Follow Up

If you are interested in the group or would like more information, please contact Rachel Hendricks, LCSW at (910) 790-9500. You can also reach her via email at Rachel.Hendricks@chrysaliscenter-nc.com.

Rachel Hendricks, LCSW specializes in working with clients who have had their eating disorder for ten or more years, clients with co-occurring substance use behaviors, as well as working with couples and families. She facilitates two groups: Motivation to Change and Declutter Class, and she is currently accepting referrals for both. Rachel is excited to be making the transition to Wilmington from the Center for Eating Disorders in Baltimore, Maryland. She looks forward to continuing her reputation for providing excellent clinical care in the field of behavioral health.



 

A Tale of Two Changes (ish)

A couple of months ago, I was talking to a friend about my yoga practice. I am hardly an aficionado, but I really enjoy practicing yoga, and when I regularly do yoga, I notice my mood is so much better, I feel better in my body, and my distress tolerance increases significantly. And yet, I think the last time I did yoga was at least a month ago with the previous time being a month or two before that.

On the other hand, I used to be someone who was chronically late. I used to joke that it was in my DNA to be late because I was even born late. Then, one day, someone said something to me, and it stuck with me in just such a way, that over time, I have shifted out of the pattern of being late to being on time (I do think I should clarify, though, that I’m still not an early person).

How can I enjoy doing something so much and still not follow through with actually doing it? How was I able to make the change with becoming more on time even though doing so was physically painful at times?

Breaking It Down

Both of these questions have to do with the question of motivation and sustainability. Why are we sometimes able to make change and keep it going, and other times, it feels like a constant struggle or something that we try and fail to follow through with?

In brief, it is our motivation to change and how we approach the change process that makes a difference.

Next Steps

Starting in September, there will be a Motivation to Change group that explores the change process, strategies to make and maintain change, and focuses on goal setting and follow through to meet goals.

By breaking down the steps it takes to make change, becoming aware of our individual values, and increasing our skills and supports, each of us has the capacity to make significant changes.

To be fair, though, it’s both exactly what I said and also more complex. I still am not doing yoga the way I wanted to several months ago, but I also have shifted my focus towards being more flexible with the activities I am incorporating and being less rigid about it necessarily being yoga where I find my peace and tranquility. As a result, I have made change, continue to make efforts at change, and also have further clarified my values to better match up with my goals for change.

Putting It Together

Clearly, as outlined above, I am still human- just a person who is able to make some changes but struggles with others. However, through this group, I am confident that you can gain better understanding of what motivates you in the moment, keeps you motivated over time, and helps you maintain progress towards your goals.

Wishing everyone wellness, flexibility, and motivation during this season and moving forward!

 

For Follow Up

If you are struggling to make change, or if you just want to know more about the process, please reach out, and I am happy to follow up with you. Also, if you would like to work through a group focused on change (and flexibility and self-care and all the things), then please let me know, and I am happy to discuss options for that, as well!

 

 

Rachel Hendricks, LCSW is a new addition to the clinical team at Chrysalis and has been working on the topic of motivation to change for the entirety of her clinical practice. She also specializes in working with clients who have had their eating disorder for ten or more years, clients with co-occurring substance use behaviors, as well as working with couples and families. She is excited to be making the transition to Wilmington from the Center for Eating Disorders in Baltimore, Maryland and looks forward to becoming more familiar with the area as well as continuing her reputation for providing excellent clinical care in the field of eating disorders.



Chrysalis Center will be hosting Wilmington’s 5th Walk From Obesity and Fitness Fun Run on Saturday, October 14 at our office in the Burnt Mill Business Park. This event benefits the American Society for Metabolic & Bariatric Surgery (ASMBS), an organization that is committed to improving public health and well-being. This is done through research and education, awareness, and access to care. Chrysalis Center is a member of the ASMBS and an advocate of these initiatives as we strive to help clients both physically and psychologically become healthy.

This year, our theme for the Walk is “Fight the Stigma”. Today in America, there are many types of discrimination and stigma against specific populations of people. We see this in many scenarios for children and adults who are obese. While any healthcare provider wants to help individuals become healthy and avoid risks associated with obesity, it is very important to fight weight based discrimination. In the workplace, it is becoming one of the top reasons why candidates are passed over. In fact, “it has become a leading cause of either discrimination or termination from jobs for the female population, representing the third most common form of discrimination for women in the workplace, after sex discrimination and age discrimination.” (HG.org)

The ASMBS and Obesity Action Coalition (OAC) are committed to raising awareness for employers and law makers about the dangers of weight based discrimination. By participating in the Walk From Obesity as an individual or as an organization, you are helping to advance this issue so that fewer Americans will be treated unfairly because of their weight. It is important for people who are obese to feel confident in participating in activities (for work or pleasure) despite their weight. We can raise awareness for this by encouraging business to consider thinking outside the box in their marketing efforts. We are already seeing this in some national advertising campaigns who are committed to including plus sized models. Through our fundraising, the ASMBS and OAC can continue to fight the stigma, raise awareness, and provide access to care to those struggling with obesity.

Are you ready to show your support and participate this year? Sign up as a participant here and use the code EARLYBIRD at checkout for a discount by 9/14/17! We’ll have a silent auction, prizes and fun on the day of the event. If you have a business that would like to participate, please email me at alexis@chrysaliscenter-nc.com for more information on those opportunities.

If you are struggling with obesity and you are ready to make a change, contact our office. We have a team of mental health therapists and registered dietitians who want to help you reach your personal and professional goals. We’re here and we believe in you.

 

Alexis is the Director of Professional Relations at Chrysalis Center and oversees all Marketing and Human Resource efforts. 



 

Do you ever feel like you don’t have relationships, like you are alone or isolated, or that you are often misunderstood, overlooked, or unable to connect with others?

Does it ever seem that everyone else your age is doing other things while you feel “stuck” or left behind?

Have you ever seen someone look at you or heard someone say something to you, and your mind was suddenly flooded with eating disorder thoughts?

Or, maybe you experienced a loss, and seemingly the only solution was to turn to your eating disorder to manage your grief.

For many with eating disorders, you already know how interactions with others can impact you. In fact, there is a fair amount of research that shows that people with eating disorders have a vulnerability to over-assessing the verbal and nonverbal feedback from others as a way of checking to see if they are okay.

Research also shows that eating disorders can start or re-occur in the context of major life transitions such as during the grieving process, in mid-life, or starting middle school, high school, or college. One of the reasons these transition periods can be so fraught is because of how our roles and identities change, creating space for an eating disorder to slip in if one is struggling with the transition.

While many people have heard of using CBT (cognitive behavior therapy) or DBT (dialectical behavior therapy) for treating eating disorders, there is another treatment that can be just as helpful but is often not as well known. This therapy is IPT (interpersonal psychotherapy). IPT is a therapy that focuses on relationships and how relationships can affect one’s eating disorder or life, in general.

IPT targets five major domains of functioning:

interpersonal deficits and/or lack of intimacy

interpersonal role disputes (conflict)

role transitions

grief

life goals (like role transitions but for those who missed out on role transitions due to interference from their eating disorder or other barriers)

Like CBT and DBT, it is a time-limited intervention that has multiple phases. Usually, the treatment lasts 16-20 sessions and is broken into identifying the problem area on which to focus, understanding and addressing the interpersonal challenges that were identified, and reviewing the treatment and planning how to maintain the gains made with the treatment.

Generally, one area will be the focus of the treatment though at times 2 areas might be addressed, or an additional area might be addressed after focusing on another area (for example, working initially on grieving and adding life goals as you progress through treatment).

While IPT does not always have the same effect initially as CBT, research shows that the positive effect of IPT grows with time. That means the more you use the skills and strategies you learn with the sessions, the more effective the treatment is- even well after you stop getting additional IPT.

IPT is also a good option for people who struggle with the structure of CBT or DBT or who are unsure about addressing their eating disorder directly, and it has been shown to be helpful for depression, some personality disorders, and social anxiety, as well. Further, IPT is an excellent option for people who have completed CBT but still need supplementary work.

If you have questions about IPT and whether it might be a good fit for you, please don’t hesitate to reach out or consult with your treatment team about if IPT is the right option for you!

Rachel Hendricks, LCSW is a new addition to the clinical team at Chrysalis and loves providing IPT to clients when it is appropriate! She also specializes in working with clients who have had their eating disorder for ten or more years, clients with co-occurring substance use behaviors, as well as working with couples and families. She is excited to be making the transition to Wilmington from the Center for Eating Disorders in Baltimore, Maryland and looks forward to becoming more familiar with the area as well as continuing her reputation for providing excellent clinical care in the field of eating disorders.

For additional research, information, or references for this blog:

https://www.eatingdisorderhope.com/information/anorexia/social-relations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886290/



It’s easy to shy away from learning about health insurance – it’s overwhelming just to get past all the acronyms that flood your mailbox when your new insurance cards arrive. Between ACA, EAPs, EOBs and HSAs, sometimes it’s easier to throw our hands up in the air and avoid determining how to best use health insurance. Instead, take a few minutes to look for key terms in your benefits booklet, talk with your HR representative, or the representative who sold you the policy.

In order to determine your cost for health care services, here are some questions you’ll want to ask your potential healthcare provider:

  • What type of service am I receiving?
  • Where will I receive this service?
  • Who is performing that service?
  • Does my insurance company consider the provider IN or OUT of network?

These are questions that any provider’s office will be able to answer, so ask them! Then you will be able to find out from your health insurance company what you’ll need to pay to receive specific services. You can call the number on the back of your health insurance card, go to the website for members, or look in the benefits booklet you received when your policy began.

Your insurance company will be able to provide you with your individual benefit for different types of services. Unless your insurance company covers certain services at 100%, you will be expected to pay a co-payment, co-insurance or the full amount for a service which will go toward your deductible. So what’s the difference between all these things? Let’s define these terms.

  • Co-payment: A fixed amount required by a health insurer to be paid by the insured for each visit or drug prescription.
  • Deductible: A specified amount of money that the insured must pay before an insurance company will pay a claim.
  • Coinsurance: A specified percentage of the total cost of the medical expenses after a deductible has been reached.

It’s important to understand that these rates are determined by your insurance carrier, not your health care provider. Healthcare providers can determine the amount they will bill your insurance company or any non-billable fees they may require from you, but your insurance company determines the amount you are required to pay as long as you see an IN-network provider.

The Chrysalis Center offers mental health counseling and nutrition counseling in an office setting with licensed therapists and registered dietitians. Mental Health counseling and Nutrition Counseling are separate benefits.  Our administrative staff will help you determine the cost you are responsible for when it comes to either service. We are in network with Blue Cross/Blue Shield, United Healthcare, Aetna, Medcost, Tricare and Medicare.

If you are considering mental health or nutrition services, take the time to find out how you can use your health insurance to pay a portion or even cover it in full. You may just find out that you have excellent benefits for these services!

About the author

Alexis is the Practice Manager at Chrysalis Center and performs multiple functions to support the business. Among those are supervising the administrative staff, acting as the Intake Coordinator, Human Resources and Marketing. Alexis was born and raised in Wilmington, graduating from NC State University in 2003. While not leading the team at Chrysalis Center, she enjoys spending time with her husband, Wes and her two boys: Mason (5) and Banks (2)

Alexis Hunter Practice Manager

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About Us

At Chrysalis, we believe that a supportive, healing environment is essential in order for change and growth to occur. We seek to offer such an environment to clients and help them create that in their lives and relationships. Read More

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