Like slowing down to leer at a gruesome car accident, viewers seem fascinated with popular TV shows that take them inside hoarders' homes. We can't help but stare at those obsessed with hanging on to everything, decades-old paper napkins, opened cans of beans feasted upon by cockroaches, even bulky inflatable children's toys that have not held air since the Hindenburg disaster.

West Seattle professional organizer Karen Pfeiffer Bush helps hoarders unclutter their homes, inside and out. She works with therapists who assist hoarders with their underlying psychological problems that compel them to retain stuff they will never use that in some cases becomes a danger to themselves, and their kids, like out-dated foods, and heavy boxes stacked precariously to the ceiling.

She operates Housewarming Home Staging & Design, LLC, the parent company of her LifeSpace, Home Organization & Transition Support. Of course not all who confront clutter are hoarders. For example, she assists those with cluttered offices around tax time who simply want to get their hands on documents in a time efficient manor, seniors transitioning from their large house to a 400 square-foot assisted living space, and she sorts and "eliminates" as she stages homes for real estate sales.

Pfeiffer, who belongs to a national trade association for professional organizers, helped a Seattle hoarder get her act together for a recent episode of the TLC Discovery Channel's "Hoarding: Buried Alive". It initially aired Jan. 8, but is repeated, and will soon appear on the TLC website. The show covers similar ground as A&E's "Hoarders".

"I think that people are more aware of it now, partly because of the fact that there are these TV show," she said, adding that hoarders are becoming identified as having a specific psychological problem. "It used to be 'the crazy person who lived up the street with the haunted house filled with stuff'. That might have very well been a hoarder."

She helped Beacon Hill resident, Hsi Ming, for the broadcast. Ming appeared on the show and agreed to use her real name. She collected notebooks, many tooth brushes, and miscellaneous things. Her stuff spilled outside surrounding her house as well. Face masks had to be worn indoors at all times by Pfeiffer, her crew, and TV crew who wrestled for spots to place their camera tripods.

"Someone in her family submitted her to TLC," said Pfeiffer. "She obviously had to agree to it. The network pays for our services and some other services involved. She had been hoarding steadily for 15 years. They brought in a psycho-therapist to work with her as well. She seems to be doing better now but there is still a tremendous amount of more work to do. She wants to continue with me.

'She made humongous progress, and we filled two commercial-sized dumpsters. The greatest progress is that she accepted her condition for the first time in her life. To some extent, she seemed to accept her condition when she allowed the cameras to come in."

Pfeiffer said that hoarding can stem from a childhood trauma or loss, or it can be a form of Obsessive-Compulsive Disorder, or OCD, and that an organizer may completely clean a hoarder's home, and it will most likely become re-cluttered within a couple of months without psychological help on hand during the process. Her career places her in the homes of extreme hoarders about eight times a year, she said.

"Often times there is a compulsive shopping issue that goes along with hoarding," she said. "It is not uncommon to go into a (hoarder's) home and see rooms filled with unopened boxes of things they've ordered off of TV shopping networks. Vacuum cleaners, kitchen things, knives, slicers, dicers, blenders, irons, steamers. Another one is diet products, shakes, mixes, freeze-dried food associated with diet plans. Some (non-hoarders) have good have intentions, and order diet products that they may never get around to using, but hoarders are different in that they will continue to order diet items even though they haven't opened the first shipment.

"Every hoarder is different," she cautioned, suggesting it is difficult to generalize. "You don't know what's going on behind closed doors often. Somebody can appear completely normal and have a serious hoarding issue that others wouldn't know about. What always marvels me is that people who live like that at home can pull themselves together every day, take the extra effort to have yourself dressed and look presentable after having to overcome challenges in your home just to find a simple thing like a hair brush or make-up and then carry on normally without many people knowing.

"You'll see on these shows that sometimes they shut out people from their lives. I hear this from clients all the time. They say, 'My daughter hasn't been to my house in 10 years' even though she might live up the street. They're afraid of people finding out. They often experience a profound sense of shame when others learn of their hoarding issues."

Some may learn about a family member's hoarding problems through the legal system.

"Many who come to us are on the radar of the town or county because their house is close to being condemned, and then the family finds out and has us in as last ditch effort," she said.

"We can't fairly help someone in this situation unless they are an active participant," said Pfeiffer. "I will ask you, 'Are you OK with me getting rid of this napkin?' You get to be in control of everything we get rid of. We previously agree on rules, like anything we find hazardous to your health, like expired food or things with rodent damage we are 'allowed to' get rid of automatically."

Of course hoarders resist, she said, but having a third party work together avoids an emotional component that confronts hoarders when their family attempts to assist. Typically a hoarder's kid, parent, or sibling will say, "Just throw this garbage out. You don't need it anymore," which she said is ineffective.

Pfeiffer started with her home staging business for real estate, mostly vacant homes. But when the market changed, people lived in the homes that were on the market longer and her business transitioned to helping people sort and pack and reduce what they had in their homes. Then some with serious challenges of sorting and eliminating began coming to her.