How do you approach the role of professional home organizers in the treatment of patients with hoarding disorder?

This is a great question on a very rich topic! Here’s a brief summary of my approach.

For treating hoarding disorder (HD), professional home organizers can serve as a valuable adjunct to standard care, but their role requires careful clinical framing, appropriate patient selection, and active coordination.

Why PHOs matter: Most psychiatrists don’t make home visits, and even therapists providing HD-specific CBT do so only periodically. PHOs fill a critical gap by providing between-session, hands-on support with sorting, decision-making systems, and organizational skills. Their role is behavioral scaffolding - not therapy.

Patient selection is everything. PHO referral is most appropriate when the patient has reasonable insight, is at least in...