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Many of the ideas and exercises that follow will fall to the helpers to carry out, but most will ultimately become the responsibility of the hoarders themselves.

▶ Positive Reinforcement

Family and friends, in fact anyone on the “team” that has a continuing relationship with a hoarder, needs to understand that, like a recovering addict, a hoarder is going to struggle for the rest of his or her life. The hoarder needs to move ahead one day at a time and revel in the small successes.

When two of my workers and I showed up to take Aimee out to a celebratory lunch after her cleanup, she tried her best to look presentable. Her lipstick was all over her teeth and halfway across her face, her hair was teased into a messy pile on top of her head, and her clothes were definitely out of fashion. Did we say anything? No way. We were celebrating her big moment and enjoyed our time together with someone who only a short while earlier was leaning off the edge of her bed to use the bathroom because she was too depressed to get up and walk ten feet to the toilet.

Nika and Andre sent us photos of the Thanksgiving dinner they hosted at their house a few weeks after the cleanup. Was the dining room pristine? Of course not, but we didn’t focus on the few boxes of shoes still in the corner, the worn carpet, or the peeling paint on the woodwork. We cheered them for finally inviting guests into their home.

When a hoarder first invites friends into the house, or chooses to throw away an old magazine, or tidies a two-foot-square space in the bedroom, those are all huge steps that everyone should recognize and celebrate. The goal is to build hope. There might be slipups, but positive reinforcement for even a tiny step forward encourages hoarders to realize that life can and will be better.

We leave notes around a house, in places like the bathroom mirror or inside the front door where the hoarder is sure to look every day. The notes read “You can do it!” or “You can stay clean!” This may sound corny, but hoarders tell us it makes a huge difference to be reminded that someone believes in them. The notes are a small way that we stay connected with hoarders, and they remember that we helped them clean up and that we know they can stay clean. We used to think that hoarders would eventually throw these notes out, but we have found that they keep them because they like to be reminded of how far they have come. Over time, I think the notes become small trophies throughout the home.

With hoarding, we are not just cleaning a home; we are teaching the hoarder that it is okay to love himself or herself again. We are encouraging someone who has felt worthless to feel that he or she has value and a life purpose. Positive reinforcement is about more than just giving compliments on how de-cluttered everything is. It’s about noticing and reinforcing the hoarder’s change in thinking and habits. It’s about the hoarder moving toward new life goals and becoming a different person.

▶ Task Reminders

Posting notes around the house also serves another purpose: reminding people what needs to be done.

Like most hoarders I’ve worked with, Katrina responded really well to positive reinforcement. She was also able to do many jobs on her own. But because she lived alone, there was nobody to remind Katrina of her daily tasks, and also nobody to give her praise and encouragement when she followed through. To make up for this, we posted small signs all over her house. For example, she had a tendency to stack paperwork and books on the basement stairs, so we put a note on the banister that said, “Do not put papers here! Take them downstairs!” We also put up positive reinforcement cheers to bolster her clutter-free habits.

Some hoarders need reminders of daily tasks. So, for Lucy, the crafting hoarder, we added more specific guidelines: We put a note over the kitchen sink that reminded her to finish the dishes every evening and another taped to the kitchen table prompting her to take any purchased items