In A&E's second episode, the psychologist talked about the significance of the hoarder to be the one who goes through her belongings and makes the decision of what to throw away. Just throwing away everything is traumatic and doesn't solve the problem. Hopefully through the process of discard and decision making a person is able to improve these skills. As seen on the show, though, this process is painfully arduous.
A hoarder has little intrinsic reason to change his hoarding behavior. Usually it's an outside influence, like a spouse threating to leave or eviction that causes a person to want to take action. In case of eviction a client may be under a tight time constraint to clean out his apartment. So, as case manager advocating for a client, what should happen? From my experience I would argue that if a person faces eviction it's more important to do what I can to make the process go faster and make sure my client understand that she's in danger of losing her housing if she doesn't take action. Truthfully, though, my one experience with hoarding was fairly easy to tackle compared to most of the situations I saw on Hoarders. One reason was because it was a studio apartment but another was that the client I worked with was open and very cooperative. That made a huge difference.