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A course like the one that Roger’s family undertook can be a success story because it progressed, albeit slowly, as a collaborative effort. But far too many other well-intentioned and caring families don’t fare so well, and the approaches they take to the problem are often misguided.

▶ The Ultimatum

“If you love me, you’ll clean up the basement/attic/house.”

“I’m leaving if you don’t clear out this mess!”

Frustrated family members frequently threaten to stop communicating with the hoarder or, worse, cut all ties. They threaten to stop bringing the grandkids over to visit, or refuse to help pay the hoarder’s bills.

Sometimes it seems like hoarders are choosing their possessions over the people they love most, which is why families are driven to these ultimatums. They want the hoarder to choose, but the hoarder can’t—and they end up alone amid their junk.

Ultimatums arise from sincere and rational thinking. When Katrina’s daughter threatened to keep the grandchildren from visiting, in the hope that she would see reason and put her house in order, what the daughter didn’t comprehend was that Katrina wasn’t thinking along rational lines. The ultimatum only created a goal in Katrina’s mind that she could not achieve on her own. In her heart of hearts Katrina wanted to have a clean home and interaction with her grandchildren, but her brain couldn’t process the idea of a cleanup like a normal person. She couldn’t visualize the steps it would take to make this happen.

Once an ultimatum is thrown down, the hoarder who has been living in clutter and filth for years isn’t going to be moved, but the person presenting the ultimatum now has to follow through. The truth is that few people want to cut off their family member—no matter how bad the circumstances. If Katrina’s daughter did follow through and no longer brought the children to visit, she would only be breaking an important connection to someone she and her children love. Everyone loses.

Hoarders truly believe that they can clean up and will someday. When they can’t, and when the people they love abandon them, depression kicks in. And then they start to wonder, why bother cleaning up? In their isolation, if they think that nobody cares, they can descend quickly into an ever-tightening spiral of depression and an expanding circle of mess.

However, for families who fall into the ultimatum trap, it’s never too late to turn it around. A simple apology can work wonders. Even if a daughter doesn’t really understand her mother’s illness, she can admit that it’s not laziness or obstinacy on her mother’s part, show patience, and accept her, mess and all. All the while, she can be keeping in mind the story of Roger and his sisters, whose patience and careful planning eventually saw things to a positive outcome. Katrina’s daughter has the opportunity to show her mother that she respects her intelligence and independence by allowing her to visit her grandchildren at their home. While the visit is on the daughter’s terms, the cleanup will be on Katrina’s because she understands that her family wants her to have a better life and that, together, they will find a way to achieve that goal.

Many hoarders have significant emotional and psychological issues, but they are neither stupid nor ignorant. In fact, most hoarders are very intelligent and can see through any mental games someone tries to play. Late-stage hoarders have already played those games on themselves for years. Forget the tricks. Respect the hoarder and spell out the game plan from the beginning. Straightforward conversations and respectful dialogue may start off slowly, but they can save years of wasted effort.

▶ The Secret Cleanup

My own family is a textbook case of how not to help a hoarder. When I was a teenager, I had a great-aunt who was a hoarder, although we didn’t know that word at the time. She saved everything: newspapers, plastic bags, and paper towel tubes, to name some of what I recall seeing in her house. I am sure that she had every intention of recycling or donating stuff, but she