Hoarding rarely starts as an easily recognizable problem from the outset.
It sneaks up on people item and half finished sort out, or project at a time, and slowly changing abilities to let go, or stay in control, piece by piece. Life and health and time, change, and the once easy enough to tackle pile of boxes becomes something difficult to manage or fit into living. The partner piles more things on top of them, herding the individuals problem items, until it becomes their pile/s.
Emotional transference onto objects can be instant, or build slowly, and is sometimes more obvious, but not always. Often the joy at the acquisition stage, is appreciated and often joined in with by the partner. It's bringing joy to both, and only later does that wain in the face of the results.
Partners living with it, have usually attempted to counteract the effects of it, before some sort of balance of resigned acceptance / pay off / ignoring / depression evolves.
From what I've seen, changing tolerance of both living conditions and MH conditions sneak up on the partners quietly, creating a combination of acceptance, and very frequently getting the partners own 'questionable' or 'I'm doing this for me, regardless of cost' behaviors, effectively 'tolerated' as a pay off, before often depression sets in.
Generally the people on TV shows, are very extreme examples of people with hoarding disorder, just as the difference between people appearing on 'my 600lb life' and the majority of people not on TV battling weight issues.
Some periods of time, individuals and their families, are headed in the right directions, some periods, plateauing, or headed in the wrong direction.
The effects of most people's hoarding is kept in check at varying levels, by themselves and those they live with, and the need to have some level of functioning home, to some degree, just as most people's weight gain problems are kept under enough control to not render them unable to move around any more.
But there are also feeders, of both the overweight, and those with HD.
With HD it is possible to be a 'feeder' and exacerbate unaware, and unintentionally.
With actual hoarding disorder as opposed to many things that can mimic it,
forcible throwing away just breaks the relationship, and whatever trust may have been built, and deepens the urge and sub conscious dependence on possessions to give meaning, memory, joy, and a sense of self to life, instead of human relationships.
Most people with the disorder know that once the stuff is gone, the relationship also goes, unless they can religiously keep up whatever useful function they're currently providing. The partner needs them to be well, and they aren't.
Ending up without possessions or people is often a silent fear going on for those trying to reduce.
As for those therapists who can just be magicked up to fix or cure HD, as oppose to reinforcing the idea that it is a horribly impossible difficult disorder to treat; please, please, can we have a list of these unicorns?
General therapists are at their best for those with no idea why they do what they do, but it takes actual and it seems very rare, skills, when it comes to those who recognize they've transferred onto objects.
One of the things that can prevent a diagnosis of HD, is being self aware, which is actually shocking when you think about it.
HD is almost always a maladaptive sub conscious response to hidden internal pain and damage, that builds and builds, as the individual try's consciously or sub consciously to suppress what's going on inside.
The 'stuff' is the external growing symptom forcing a spotlight onto the internal disorder, and as with all symptoms, the warning that this person is not actually ok, even though they're doing an otherwise good job of seeming 'normal.'
Putting up with the 'stuff' can be a partners acceptance that they can't help their partner, but don't want to harm them further. Generally there are pay offs going on somewhere in these situations.
As with all disorders, trying to tackle unpleasant or annoying symptoms without tackling what they are symptoms of, doesn't work. It just helps lock the person back in with their internal disorders, so they can carry on being useful for those around them, while not being a nuisance to them with their problems.