Public Offers Diagnosis of ‘First Patient’

The lines light up every night on “Dr. Judy’s Love Phones,” a two-hour syndicated radio show broadcast five nights a week and featuring clinical psychologist Judy Kuriansky’s advice on sex and relationships.

Usually, callers waiting patiently behind those blinking green lights want only to talk about themselves. Not this week. They just want to talk about President Clinton and Monica S. Lewinsky--what they did and why.

“The president has become a lightning rod for every other person’s problems,” Kuriansky said Monday. “He has become Every Man.”

Since the graphic details of Clinton’s relationship with Lewinsky became public Friday in independent counsel Kenenth W. Starr’s report to the House, everyone from pop psychologists and practicing clinicians to social drinkers at local bars and callers to radio talk shows have been dissecting the nation’s First Patient and his Young Paramour.

Was he a predator or compulsive sex addict who couldn’t help himself? Was she a seductress--or victim? Is he to blame? Is she? And what do the details of their relationship, sexual and otherwise, reveal about the two participants--and about the rest of us?

This may be the president of the United States on the other side of the lens, but his story is touching Americans on a very personal level.

And the fact that Clinton is president has triggered an avalanche of opinions--informed and otherwise. Experts who specialize in the psychological problems related to sexual conduct note patterns of compulsive behavior in this case. Insisting that it is dangerous to “diagnose” from afar, they nevertheless point out the underpinnings of familiar behavior: a man who is powerful and charismatic with a history of serial affairs, who has a sense of “entitlement,” who engages in denial about what he is doing, who constantly tries to stop but cannot, who takes risks in pursuing the affair despite the potential for catastrophic consequences.

Psychologist Al Cooper, clinical director of the San Jose Marital and Sexuality Centre in San Jose, estimates that 7% to 10% of Americans engage in some form of sexual compulsion, which he said includes five phases: denial, attempts to stop, inordinate planning, great risk and a compulsion to repeat the behavior.

For her part, Kuriansky--a New York therapist whose show airs between 10 p.m. and midnight and claims several million listeners--described both Clinton and Lewinsky as “classic textbook cases.”

“She [Lewinsky] is an extremely common example of a very insecure and desperate young lady who has a history of feeling rejected by male figures and is desperate to be accepted by strong male authority,” she said.

Giving Clinton a peek at her thong underwear, grabbing at his crotch while on a receiving line, giving but not receiving pleasure--Lewinsky, said Kuriansky, “has a very shaky self-esteem.”

And that, she said, is why the former White House intern lashes out at her prince charming, calling him “the creep.”

“She tells her friends about it--to reinforce its reality, because she is so lost in fantasy--and then she develops this tremendous anger toward the man for not fulfilling her fantasy--and she is once again the victim,” Kuriansky said.

As for Clinton, said the radio host, he is “a thrill personality,” a man who puts himself in “dangerous situations.”

“This was not a relationship of equality,” Kuriansky said.

“His holding off comes from an element of self control, a way of keeping apart from her--and, most importantly--it’s a part of himself denying the act as a true sex act. It’s an affirmation that this was not a real sexual encounter--’you don’t have all of me and I have not really engaged in this act.’ ”

Some professionals think that Clinton’s conduct constitutes sex addiction, which is not the same as having an affair.

“You feel like your need for sexual pleasure is your greatest need and you proceed to get that need met--even when it can ruin your life,” said Aline Zoldbrod, a Boston-based psychologist and author of the book, “Sex Smart: How Your Childhood Shaped Your Sexual Life and What to Do About It.”

Others avoid the term sex addiction, preferring to talk of the various motivations for sex.

Dr. Thomas Nagy, a clinical assistant professor at Stanford University’s department of psychiatry and behavioral science, said that sex represents different things to different people. “Some use it as an antidepressant--as an upper to improve a low mood. Some use it as a way of managing stress. Some use it as self-validation--they are growing older, feeling not desirable, to reinforce themselves. Some use it to punish a spouse, although there is not evidence of that here. And their motivation could be none of those things.”

White House Press Secretary Mike McCurry has been most emphatic that Clinton is not seeking therapy--only spiritual counseling from a minister, not a therapist. Perhaps fearing the political stigma of psychological treatment, Clinton is not under therapy. And, McCurry said, he will not seek it.

“I’ve talked to his physician. He’s not under any medical treatment for anything involving a mental condition,” McCurry said.

Therapy for sexually compulsive behavior typically involves individual counseling and often group therapy, said Cooper of the San Jose center. Sometimes in severe cases, drugs are prescribed, such as selective seratonin uptake inhibitors, which can suppress sexual drives.

Group therapy is important because members “can confront each other” in ways an individual therapist cannot, according to Cooper. Such settings also “create a social norm that allows a participant to change his behavior,” he added. Zoldbrod said it was most important to “keep track of the underlying feelings” associated with the behavior, which usually involve “feelings of deprivation and sadness.”