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Although Jackson had agreed to make the phone call, he kept putting it off. Finally, Mike encouraged Jackson to just pick up the phone and call. He reassured Jackson that he loved him and that he would be there to support him. Getting Jackson to make that call was the breakthrough that the couple needed. Once Jackson and I talked, Mike backed off and let us plan the cleanup.

In talking to a hoarder, it helps to focus the conversation on the clutter, not the person. Hoarders are then able to separate themselves from the mess. They can begin to think of themselves not just as a hoarder, but as a person who does (or can do) many other things as well. Most important, they can let go of the defensiveness that is preventing them from moving ahead.

This process can take months. Mike had an advantage in that he was living with Jackson and had time to build other aspects of their relationship. They spent a lot of fun time talking, cooking, and going out—activities that had nothing to do with hoarding. An important part of hoarding recovery is forming and growing outside relationships and finding healthy substitute behavior, which is what Mike and Jackson were working on without even realizing it. Then every once in a while Mike would mention the house. And when Jackson tried to ignore it or change the subject, Mike would remind him gently that he was going to keep bringing it up until they dealt with it.

Kathy, Roger’s sister, had quite different challenges. Of his two sisters, she had always gotten along with him best, so it was Kathy who was likely to get him to open up more in conversation.

After their parents’ deaths, as Kathy and her sister were trying to deal with the estate, Kathy took the job of staying in touch with Roger, starting with weekly phone calls when she would always make a point to encourage Roger to take care of himself: eat well and get out of the house for some exercise or just to engage with other people at any level. She would also update him with any information she was getting on how to de-clutter and, of course, ask him when he thought he would be ready to start a cleanup.

Kathy knew her brother well and sensed that he would be comfortable at least talking about the cleanup with her. She had good instincts on how hard to push him and what he might be open to hearing. Most important, she cared deeply about him and was committed to his well-being over the long term. That’s ideal for the contact person.

In conversations with hoarders, it helps to focus on the potential future, talking about how the hoarder’s life might look later, or about the process of organizing and de-cluttering, which is much less threatening than using the term “hoarding.” Talking about the future, but keeping the conversations positive and not about existing hoarding behaviors, is difficult but important.

Early-stage hoarders usually aren’t in complete denial, so introducing the topic is not as difficult. With late-stage hoarders, one has to be more careful about language. Hoarders at this point don’t trust many people, if anyone. They have been judged and rejected for hoarding more times than we can count. Their self-esteem is pretty low and they are emotionally fragile. Discussions with late-stage hoarders have to be carefully worded to be positive and supportive and avoid judgmental comments that will cause the hoarder to shut down.

While most initial contact is made by family members, sometimes an impartial outsider can talk about the hoarding with no emotions attached to those discussions. A social worker and a cleanup expert can be the bad cops to the family’s good cops. The early involvement of a third party serves as a foil for the family members—someone for the hoarder to lash out at so the family relationships stay intact.

▶ When Is a Hoarder Ready?

Mike knew that Jackson was ready to call in help because Jackson had started talking about his future and about how he wanted his life to look. He confessed to Mike that