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A More Effective Way to Get Through to Charlie Sheen and Other Addicts

I would ask Charlie what he values most. I suspect it's his kids, and his career. Then I would work backwards from these things to what he is doing and where he is headed.
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I did one of those stints as a talking head Saturday on ABC's "Good Morning America," commenting briefly on Charlie Sheen. You can't say much in 10 seconds, but I like to think I did a good job countering Deni Carise, who called Charlie a textbook case of addict denial "on steroids."

There is a lot to critique in Charlie's recent performances, but I don't find the critical approach Ms. Carise advanced to be good therapy.

Instead, I spoke of building bridges in creating a therapeutic alliance with someone like Charlie. This involves reflecting off of his comments to show that I am on his side, while shifting his focus to how he might help himself. (This approach is called "motivational interviewing.")

Here are the things they left out from my interview (which I taped the evening before with Jeremy Hubbard), all based on comments Charlie himself made:

Charlie said he could clean up himself (which Ms. Carise mocked). I would say, "I agree, Charlie. You're the only one who can do this -- I'm here as your consultant and helper to allow you to steer yourself free."

Charlie expressed his distaste for AA and for those trying to force him to return to 12-step therapy ("AA Nazis," he called them). I said, "AA isn't especially effective -- even Dr. Drew has admitted this! But then people say, 'He needs to get with the program.' In response, I say, 'Why force someone to undergo a treatment he rejects and has repeatedly failed at? Not everyone responds well to admitting their powerlessness and making amends to God. Why not work with his actual view of things and attitudes?"

Charlie's rants have not been productive -- or healthy. Evidence: the termination of his show for the rest of the year, and perhaps forever. Beyond this, they seem remarkably -- almost delusionally -- self-inflated and condescending towards others. In one oft-quoted outburst, Charlie gave advice to Lindsay Lohan: "Work on your impulse control. Just try to think things through a little bit before you do them."

This is yet another statement Charlie made that has been used to mock him. But I told Mr. Hubbard I would build from it this way: "Let's reflect on your advice to Lindsay. How do you see what you said reflected in your own life?"

To further build a therapeutic alliance, I would select positive things Charlie has also said, such as:

People need to understand how supremely grateful I am that somebody stepped in here. Basically, Viacom showed up at my house and said, 'Dude, dude, it's getting really obvious and we're really worried about you... We care about your health.' They came in and man to man said, 'We have to shut it down.' This was the only person in my life with the power to do this.

This statement sounds very different from his more recent tirades, suggesting there is another side to Charlie, and showing how this process has been spiraling downward. I would take Charlie back to this place in his mind to reflect on why he felt the offer of help was beneficial, how it showed that the people he was working with are concerned about him, what the implications of this concern should be -- that is, how he might further respond positively to it, both in his own life and in dealing with his colleagues on "Two and a Half Men."

Finally, I told Mr. Hubbard (which likewise didn't make it into my brief screen appearance), "I would ask Charlie what he values most. I suspect it's his kids and his career. Then I would work backwards from these things to what he is doing and where he is headed."

This is the opposite of the traditional treatment approach, represented by Ms. Carise, which instead attacks people who are already in pain and drowning.