It starts with one box.

Because that box is handy, you stack another one on top of it. The magazines land there, then the mail. Some letters spill to the floor, hidden by a shopping bag set down, just for the moment, because you had other things on your mind.

That bag ends up behind other bags. Every day, there's mail. Fabric and patterns for a sewing project overwhelm the dining room table. You know this isn't right, but where to start? Next weekend's chores turn into next month's, and then a year has passed. Floors and tabletops and shelves disappear beneath every good intention. What was once a cluttered nest has hatched into an overwhelming albatross. Yet you need these things, all of them -- for your hobbies, for the dog, for the future.

That box is in here someplace.

Jeanne Leier's hoarding began in grief. Her fiancé, a man she'd dated for 12 years, supporting him through medical school, was called up to active duty in Iraq as a doctor in the Army Reserve. He was killed. She fell apart.

That was four years ago. She abandoned a side business making gourmet dog biscuits, leaving the baking and packaging materials in her kitchen. Depressed, Leier craved beauty and began buying bundles of dried and silk flowers to make wreaths and swags to sell at craft shows.

Then her old dog, Dudley Do-right, died. She'd had him for years, choosing his name because "he came into my life after an abusive marriage," said Leier, who's 48. "So when he died, I said that's it, I'm done."

Each morning, she'd go to her job at a medical devices company, but came home to her apartment in Little Canada unable to cope, or to make a decision. She'd shop, returning with a black sweater that joined other black sweaters that were such good buys. The boxes, bags, sweaters, and mail advanced around her, providing a peculiar security blanket. "Everything really kind of started so slowly that I can't even tell you exactly when it got away from me," she said.

When a new computer was delivered, the box was left in her front hall so that she had to step around it to reach the living room. There it remained, unopened, slowly disappearing under coats and bags and mail. That was two years ago.

"If my story helps someone else realize that they're not bad, or dirty, or stupid -- any of the negative words that are attributed to this -- then it's worth it," Leier said. "The best way to deal with my problem is to help someone else."

• • •

"This is hard work," said Nikki Havens. "We don't sugarcoat it."

Havens, 31, owns Seriously Organized and is one of the few professional organizers in the Twin Cities who tackle hoarder homes. Because of an earlier career in social services, she understands that negative behaviors often are the result of psychological disorders that can be treated. Hoarders account for about 30 percent of her business.

She comes across as a force to be reckoned with -- which is the whole idea. "The deal is, when I go into a home, clients have tried to manage their stuff and where has it gotten them?" she said. "If they hire me and they're not willing to listen to me, we're not going to make any headway and all that's going to happen is that the client is going to lose a bunch of money.

"I have a very strict program that clients have to adhere to. I'm not going to come in and organize 3,000 T-shirts."

Seriously Organized charges $50 an hour for the actual organizing after an initial consultation. Final costs depend on how much work must be done, how many organizing units must be bought. Most hoarding jobs run into the thousands of dollars, but Havens said that clients find that their daily expenses go down as a result. They shop less because they know what they own, and find troves of everything from medications to paper towels. Their finances are organized, eliminating overdraft fees or interest charges. They might find thousands of dollars in uncashed checks.

Before Havens takes on hoarding clients, they enter counseling to get at the issues driving their behavior. "We need to make sure not to pretend that I'm a therapist, and not to promise self-help," said Havens, who's also president of the Minnesota chapter of the National Society of Professional Organizers. She said that the vast majority of hoarders backslide if their homes are merely cleaned "because companies treat the clutter, and the clutter is not the problem."

The heart of the work is answering the six "Go" questions: Do I need this item? Do I use this item? Does this item work? Does this item fit into my plan? Do I want to continue to have to organize, clear, maintain and manage this item? Do I really want this item?

A "no" to any of those questions means "go."

• • •

What prompted Leier to take action was, oddly enough, a trip to the dentist, where her blood pressure was found to be dangerously high. "It was a wakeup call," she said. "I decided to stop trying to control the things I can't control, and control the things I can control. Hopefully, if I can change these things, the other parts of my life will follow."

Havens and Leier first met two months ago to develop a plan. "This way, Jeanne had time to process what we talked about," Havens said. "If I came into an alcoholic's house and dumped out all their vodka and liquor and drove away, would that person come back to the house and no longer be an alcoholic? Absolutely not."

The plan worked around a three-stage process of sorting by room, item and purpose. Leier then decided what would be saved, donated, sold or purged. Havens likened each room to a 5-pound sack of potatoes.

"I have a client on one side with 30 pounds of potatoes on the floor, and I'm 2 feet away with an empty 5-pound potato sack," Havens said. "I work with her on priorities: What are the first potatoes that go in? The second potatoes? Once my bag has 5 pounds in it, I need to hold the client accountable because we're out of room.

"It's not about the potatoes -- her possessions. It's about math, plain and simple. This is the space we have."

• • •

There may be 10 million hoarders nationwide, probably more, said Renae Reinardy, a psychologist at the Lakeside Center For Behavioral Change in Minnetonka, who is among the few who specialize in hoarding disorders. Hoarding was barely discussed a dozen years ago, she said, but the behavior has become more visible since a TV show, "Hoarders," began airing on the A&E network. Reinardy, who took part in four episodes, said it's been renewed for a second season, and she knows of two similar shows in the works.

Hoarding is difficult to classify. "Right now, people see it under obsessive-compulsive personality disorder, but it doesn't really belong there because only 30 percent of hoarders have OCD," she said. "Hoarding is really its own thing," usually prompted by brain injury, personal trauma, depression or dementia. "Sometimes life just hits you too hard all at once."

The most successful treatment appears to be cognitive behavioral treatment, which involves identifying, challenging and replacing patterns of thinking, Reinardy said. "We talk about why they acquire. A lot of it is slowing them down. They start to function on autopilot, so I have to challenge their thinking, help them look at those toxic thoughts." For many, she added, hoarding comes from an avoidance of decision-making, and a fear of making the wrong choice.

• • •

The work is physically grueling. The organizers did 45 loads of clothes at a coin laundry and had Leier make decisions on the spot, returning with only one-third of her wardrobe. Every item in the home was sorted into cardboard boxes, each box labeled with a colorful sticky note.

For the client, the grueling work is emotional because it represents parting with what they own, and what they're convinced they still need. One day, Leier worked with Andria Berke, going through each box of materials for candle-making, stained glass, needlepoint, quilting, wreath-making, knitting, cross stitch. There were decorations for every holiday. "What about this?" Berke asked, holding up a card of snarled embroidery floss.

"If that was for 'The Last Supper,' that's done," Leier said.

Toss.

Berke grabbed a box of markers and quickly swiped one across a piece of paper, to no effect.

Toss.

A huge bag of dried eucalyptus was deemed enough for however many projects Leier could imagine making. Yet when the next box held three more bunches, Leier tried to argue them into the bag. Berke stood firm.

Leier pulled out four small plush bears. "I need these for a project," she said, then almost visibly shook herself. "No; donate two, keep two."

"Good call," Berke said, then sighed, glancing at the three cardboard boxes of ribbon against the wall.

• • •

"Wow."

It was a small word for a big finish, but about the only one that Leier could muster Wednesday as she saw, for the first time, her finished apartment. "It's beautiful," she said, looking across the expanse of freshly cleaned carpet that she hadn't seen in years. "Wow."

Havens walked Leier through the corner unit with her computer; the office supplies were organized in labeled plastic tubs. The hall closet had areas for coats, crafts and housekeeping. New shelving gave her bedroom closet a sense of logic.

Already, Leier can't wait to have the neighbors stop by. "My biggest fear was that I would find that others were so repulsed by what I had let happen. So it was a bit scary, but then change is always a bit scary -- but almost always well worth any fear that comes with it. I will finally have the space to enjoy life once again.

"I only wish I would have done this years ago. But no looking back."

Kim Ode • 612-673-7185