Lisa Bonchek Adams

My mother and I discuss psychology often. We’ve had a few conversations lately about the shows Hoarders and Obsessed (both appear on A&E, a second show Hoarders: Buried Alive airs on TLC). I used to like and watch both, but lately Hoarders has started to bore me. It seems like such a script in terms of the show; it’s like a Mad Libs where the only variables are name, sex, and age of the hoarder. The rest of the situations seems strikingly familiar each time.

The thing that frustrates us with the show Hoarders is that there’s no real therapy. There’s no discussion of treatment, no display of a change of thinking for the hoarder. Instead, over the course of 4-5 days (often it’s only 2 days) the hoarder is expected to suddenly “be ready to change” and start throwing things away with some prompting from a therapist and team of cleaners.

Why the therapists or family members seem surprised when initial enthusiasm wanes and the hoarders are reticent to part with their cherished belongings (often, literally, trash) is beyond me. Hoarding is a manifestation of a mental illness, and needs to be treated with counseling over a period of time. Like that of an addict, the pattern of behavior will not shift overnight, without education and a true desire to change.

Obsessed, on the other hand, shows the power of both a good therapist and a patient who is really ready to change. The process that they use takes about three months. With slow immersion into situations that are anxiety-provoking to the person with OCD, therapists use increasingly challenging situations to “untrain” the person. It may mean having an agoraphobic drive for a distance beyond his/her comfort zone or preventing a person with washing compulsions to wash his hands after doing a task that gets him dirty. Slowly building up to more traumatic and anxiety-provoking situations allows the patient to feel a sense of accomplishment and pride at making progress toward undoing these compulsions. At the end, the patient performs the task that they stated was their “dream goal” to achieve. This goal might be getting on an airplane to visit a relative or risking a dirty, germy home by inviting guests over for a party.

For me, a key takeaway from the show is that the body cannot stay in a period of highest anxiety for a long period of time. Even during all-out panic attacks that patients may have, if they can ride it out, focus on breathing and realize that they are okay, eventually their anxiety level will diminish. It may take minutes or hours, but eventually patients report that their self-rated anxiety levels revert to tolerable amounts. Individuals will see that they confronted their fear and remained safe. Therapists use cognitive behavioral therapy as their guide to teach patients that their particular fears are unfounded (if you don’t flip the light switch a certain number of times, no harm actually does come to your loved one, for example).

My point with this discussion is to say that not all OCD reality shows are the same. It’s unrealistic to expect a condition that’s been in place for years, perhaps decades, to be undone in a few days while cameras are watching. There’s a reason so many people relapse after going to rehab — it’s hard work. To me, showing the arc of recovery with cognitive behavioral therapy is a more realistic and appealing process, and ultimately a more beneficial one to the patient.