Geralin Thomas, Phyliss and Dr. Pfeffer; Geralin Thomas, inset Geralin Thomas, Phyliss and Dr. Pfeffer; Geralin Thomas, inset

The question for any show that purports to help distressed and/or disordered people is straightforward: How much is it actually helping? A&E's Hoarders, which returns for its fourth season Monday at 9/8c, is no exception. To help sort it out, we spoke to Geralin Thomas, a certified professional organizer specializing in chronic disorganization. She's appeared on roughly 20 episodes throughout Hoarders' run. Like the show she's on, Thomas "tends to gravitate to helping people with mental health challenges and physical health challenges get organized." By phone, Thomas told us about the effect that working with challenged people has on her, whether the TV production helps or hurts the organizing process and how the show's exposure of hoarding has helped people pinpoint their own problems.

VIDEO exclusive: "Doll surgery" on Hoarders season premiere

Is it tough on a human level to deal with people who are disordered? Does it ever freak you out?
Geralin Thomas: I don't think I've ever been freaked out by anything. The word that always springs to mind especially with every disorder I'm unfamiliar with and am collaborating with a therapist on — that's part of the way I work, I'm almost always working in tandem with a therapist and a client — is "fascinating." It's interesting to me how fragile mental health can be and how it affects everyday lives. I think most of the people in this field are compassionate and we want to do our best just to help people maintain a nice, healthy lifestyle.

What is it about your personality that got you into this line of work?
Thomas: New organizers want to know if this is a skill you can learn or are born with and I always tell them that it's probably 50/50. I come from really organized parents. Less is more and everything was neat and tidy. My parents were very methodical.  My brother is an engineer, and my sister runs a housecleaning business, so they are very organized. For me, it's genetic, but a great deal of organizers came about it because they had to. They had some personal struggle in their life, they learned from it, and then they wanted to transfer that skill to their clients.

It sounds like organizers are on the opposite side of the same coin as hoarders: hoarding is generally tied to something innate that is often exacerbated by a tragic event.
Thomas: Absolutely. I know of one client that I worked with who's a hoarder, has two homes completely stuffed, her car — everything about her life is out of control as far as acquiring stuff. Her brother is exactly the opposite. He has next to nothing in his home. He sleeps on a futon on the floor because he doesn't want sheets or a mattress and he rolls it up and tucks it away in the morning.

What's been the biggest challenge for you when attempting to help someone get organized?
Thomas: It's almost always the same issue: trust. It's about: Is this person going to let me into their life enough to trust me and a therapist? The other challenge, of course, is financial. It's very time-consuming. On TV, it's done in two days but in real life, it can take months and sometimes years. It's a very slow process. It adds up.

Watch Hoarders videos

In addition to time, do you lose anything in the way your work must be translated for television?
Thomas: No. I think the show does an excellent job of not ever faking what's going on. They've never said, "Do this," or, "See if you can manipulate the story." It's very much, "Walk in, Geralin, do what you do." And what happens happens. If nothing gets straightened up or thrown away, there's no producer breathing down your neck. And that's how it is in real life. If I go to someone's home and there's 100 percent resistance, no glimmer of hope, I usually tell the person, "I don't feel like you need to keep spending your money on me," or, "Get more therapy and then call me back."

Was there a learning curve as far as the production process went?
Thomas: Yeah. It was an adjustment to get used to the cameras being there. But here's something good about doing this on TV: the lighting is 100 times better than in a regular hoarded home. They have to bring in lights to illuminate for the cameras. A lot of times, I'm in homes with dim lighting or no electricity. Light bulbs haven't been replaced. It's usually a darker environment. I love having the lights. We can really see what's going on. On camera, it can be a little bit different in the sense that I feel like it's my responsibility to help the person with the hoarding disorder forget they're being filmed. It's about telling them to talk to me and the therapist in an open, honest way, and remind them ... that they don't [have] to answer something if they aren't comfortable, especially if they don't want the world to know it.

I don't think Hoarders is much of a target for criticism, but I imagine you've heard at least some of the same things that have been thrown at shows about helping the disordered and troubled: It's exploitative, for example.
Thomas: I think everyone has a different spin and is entitled to that. One of the criticisms is: Are we rushing them too much? My answer to that is: We don't impose these crises. Nothing is fabricated in terms of the show. If Child Services is coming July 5, we're not making that up. They need to fish or cut bait in order to get that house cleaned up. There are many reasons why people need to hustle if they can.

Catch up on today's news

You did mention that you're doing what you'd normally do in months or years in days. What's the trade-off there? How can you pack that much work into that short amount of time?
Thomas: In off-camera work, the person can usually only go financially for two to three hours maximum. If there's ADHD involved, it's only one hour. When someone else is footing the bill ... and don't forget that there's thousands of dollars [spent] because there's a team of organizers, a therapist and a huge Got Junk? team with their trucks. I try calling the person well in advance and starting these conversations [early], so by the time I arrive, there have been several phone conversations prepping these people on what's going to happen. I try to be as thorough as possible and manage their expectations before we arrive.

So you're able to compress the work into a brief period of time?
Thomas: Yes. And once they're in motion, they tend to stay in motion. So, if we can get them motivated and are up and running by 11:30ish, I know it's going to be a good, productive day.

Do you find yourself getting emotionally involved with these people?
Thomas: Sometimes I do. My heart breaks for them. When you're having this conversation with somebody and they're depending on you and trusting you to help them through this, but they cannot, due to some deficit in the way their brain is functioning, they cannot make a decision between a plastic Big Gulp cup or custody of their own child, I'm a mom, so I look at that and think, "Oh, wow." It's just devastating.

Hoarders' rat-filled season finale

Do you keep in touch with any of them?
Thomas: I do! Almost all of them.

Is there any other added benefit to this show in the bigger picture, in your experience?
Thomas: It's brought [hoarding] out of the closet for so many people. One of the best things about having this show air is that now when hoarders call me to come help them, people will say, "I'm not as bad as Jim, who was featured last night, but I'm more like Bonnie." They have a gauge now. I don't want to say this normalizes, but it helps them feel less alone. The other thing is, people tell me all the time, "I didn't know who to call. I knew there was something wrong, but I didn't know who to reach out to. And now I do."