A hoarder simply cannot and will not be able to succussfuly change without a support system in place. They have often become so isolated and reclusive that they may not see this is a necessary step, but it most certainly is. The hoarder has allowed them into this position by most often shutting everyone out of their lives and while some can function and operate a cleanup by themselves it is extremely rare. A hoarder should have a support network in place to help congratulate them when they make progress and tell them it is ok when they have setbacks. Family members hold a lot of emotion surrounding the situation so they may not always be the best for the support network. I recommend giving the hoarder some sense of accountability to put just a small amount of pressure on them to succeed on any given task. In our online support group, we give hoarders one small task to complete each week before they log into the next meeting. For the first time, they want to be successful because they have to report back to us with the status of their given task. This responsibility has not been placed on them for some time and they truly want to succeed. When they do, and they tell the group about it, they feel a huge sense of accomplishment and are given praise which they many not have heard or felt for a long time. This reward and feeling of utter happiness motivated them to continue with another task. On a large cleanup effort where people are helping the hoarder, it is imperitive that someone is at the home, during the entire process that the hoarder trusts and that can stay supportive no matter how much the hoarder struggles. The cleanup can be one of the most stressful events the hoarder will go through and having that supportive friend, or family member present can make all the difference in the world. The supporter can also simple provide their support over the phone or through the mail as a pen pal. The hoarder needs this recognition and someone to tell about the hard work they are doing or even the setbacks they are experiencing. When there is a setback of any kind, their support network must emphasize that it is ok. We all have bad days or weeks, and progress is not lost. This is the time when the supporter listens and lets them know it is ok, that the next day or week is going to be better. Without support, the cleanup process will most definitely fail.