A Failure of Empathy

My first video blog post!

For professional organizers and other nonclinical in-home/onsite professionals: Recognizing inadequate empathy in a mental health professional’s description of a client.

Video link: A Failure of Empathy

 

Do You Have to Deserve It?

Do you have to earn a thing in order to deserve it? Do you have to need it in order to deserve it? Or can you simply have it, with “earn,” “need,” and “deserve” being irrelevant?

I love it when client conversations turn philosophical, and this was an especially good one last week. A client shared that she feels she does not deserve some of the things she has. She hasn’t done anything immoral or illegal to acquire them, but she has a nagging guilt about deserving only the things she needs and has earned.

Within our hour, we ranged over socialism, karma, the butterfly effect, social resource scarcity, luck, and the good ol’ American work ethic, exploring the meanings of “deserve,” “earn,” and “need,” and we discovered that deservedness is clearest when it results from direct, extraordinary effort. It’s easy to understand that a person deserves what s/he has earned.

“But” (I said with a grin because I love a good intellectual monkey wrench), “does unearned always equal undeserved?” My client, as she often does, rewarded me with an emphatic “Hmm…!”

If you find $100 on the ground in a field on public land out in the middle of nowhere (i.e. no one to return it to), should you keep it? You didn’t work to earn it. Following my client’s hypothesis, then, you don’t deserve it. But (adding my hypothesis), you also don’t NOT deserve it.

You could stand there in the throes of this conflict, getting eaten alive by mosquitoes, and eventually hike on by. Or you could let go of the belief that every blessing must be quantifiably earned and simply, happily, gratefully, delightedly accept that $100.

But then, suppose it dawns on you that you really don’t need another hundred bucks. You have plenty of money in the bank, you have a great job (obviously, since you get to go tromping around in remote fields on a whim), and there are lots of people for whom $100 would be life-changing. By the time you get back to your car, you’re thinking you should donate this $100, and while you’re at it you should donate some more.

Which brings us back to my client’s living room. Often when people are sorting through stuff, whether they’re changing a hoarding habit or just getting organized, they’ll pick up an item and say, “I don’t need this.” Sometimes what they mean is, “I don’t deserve this.” The danger at this moment is that the statements will merge and the belief will become, “I don’t need this AND THEREFORE I don’t deserve it.” Or, more elaborately, “I don’t need this because I have been irresponsible in acquiring too much stuff, and therefore I don’t deserve this and must give it to someone who does.”

That’s a toxic belief, and one that clients often fall into. Unfortunately, some family members, professional organizers, and reality TV shows perpetuate this belief to manipulate people into parting with belongings. Here’s what I believe:

• There is room in every life for some things that are unneeded but enjoyed, neither deserved nor undeserved.
• Donation should be a celebration of gratitude and abundance, not an exercise in shame and atonement.
• Over-owning, disorganization, and hoarding are not character flaws.

Radical ideas? Hmm…!

 

Mission Accomplished

Here’s something I wrote circa 2007 in “counseling school”–I found it as I was cleaning out old files. In this essay, I was talking only about chronic disorganization, not hoarding, but both were on my mind throughout the degree program. Four years later, I’m happy to report that this vision is now my reality.

As a mental health counselor, I intend to work with the same clientele I see now as a chronic disorganization consultant, but I will be able to address their mental health needs directly rather than always referring them to someone else. I have not yet met any counselors who focus on chronic disorganization as a specialty; many therapists specialize in AD/HD or OCD, and these conditions among others often cause chronic disorganization, but to my knowledge there has not yet been a person who began as a professional organizer and pursued a counseling degree in order to better serve the same clients. Therefore, as the first, I have the privilege of defining the mission of a chronic disorganization counselor: To provide chronically disorganized clients with a multimodal change experience by combining

• the extensive theory and accumulated wisdom of psychology,
• the empathic and client-centered emphasis of mental health counseling, and
• the practical time- and space-management techniques of professional organizing.

Since chronic disorganization is not a diagnosis but rather a non-clinical description of the symptomatology of a number of conditions, I will need to be well-versed in all of the mental health conditions that cause or co-occur with the phenomenon identified by the professional organizing industry as chronic disorganization. With this knowledge, I will be able to provide a complete psychotherapeutic treatment while retaining the paradigm of chronic disorganization as the definition of the problem.

As a counselor for chronically disorganized clients, my role will be to perform all of the functions of a counselor, including intake and assessment, treatment planning, and psychotherapy, but it will also include advocacy and psychoeducation for clients, families, and the community. I have extensive experience as a speaker and writer, so I will also continue to utilize those modalities to deliver my message.

One way in which my approach will differ from standard psychotherapy is in my intended working environment. Although I am duly warned of obstacles including managed care approval, I intend to work in my clients’ environments in addition to having them come to my office for counseling. The benefits outweigh the disadvantages, and as an organizer who has already worked this way for over 10 years, I am uniquely qualified to adapt my experience to the provision of psychotherapy in the field.

 

Informed Consent: It’s Your Right, Whether You Know It or Not

Professional organizer Randi Lyman posed an interesting question on her blog: Is it ever appropriate to refer a hoarding client to a reality television show? She expressed concern over the potential for harm but also wondered if it might be a good solution for folks of limited financial resources. I commented:

Randi, as you know there are numerous ethical pitfalls when clients and reality shows come together, but I’d like to mention one: informed consent. There are many facets to informed consent and it’s not easy to explain succinctly, but the basic idea is that the client is told everything that could conceivably happen so as to have an informed basis for consenting, and any promises made to the client are kept. One promise often broken with these shows is “We won’t throw anything away without your okay.” This is a stark violation of another key ethical tenet: the person’s right to autonomy. In my experience, people who hoard very often have unresolved trauma, and the last thing they need is to be retraumatized by such a profound violation of informed consent and of their autonomy.

Informed consent is a requirement in mental health treatment. It is the client’s right, and it is the provider’s obligation to ensure it is provided. It’s not a secret password or word-of-mouth perk: The client shouldn’t have to know what to ask for. Reality shows and similar endeavors that muck around in people’s psyches should be held to the same standard.