APA指南 | 性少数倾向不是心理疾病，试图改变性倾向会造成伤害
2021年，美国心理学会第44分会发布了《美国心理学会性少数者的心理实践指南》。指南由美国心理学会性倾向和性别身份多元委员会共同发起美国心理学会性少数者心理实践专案组，结合当下的理论发展与临床实践，修订了于2020年发布的《女同性恋、男同性恋和双性恋来访者的心理工作指南》，并由美国心理学会代表委员会批准了最终版本。该指南以性少数压力模型、多元交织性理论和肯定性咨询法作为理论基础，内容涉及心理咨询、心理学研究和心理学教育，为心理学从业者提供了16条工作指南。
该指南能够指导心理学从业者对性少数来访者开展友善心理咨询工作。因此，小悟生心理主动联系了美国心理学会，并且获得了授权，将其翻译为中文，以期帮助更多国内的心理咨询师更深入地、系统地了解与性少数来访者工作的相关规范。
未来的几个月内，我们计划将指南中的部分内容制作成推送进行连载，今天的内容是该系列推送的第四篇，选自指南「基本知识与意识」部分的「指南四：心理学从业者应理解，性少数倾向不是心理疾病，而试图改变性倾向会造成伤害。」
关注小悟生心理，后台回复「APA指南」即可获得中文版全文。
01
基本原理
性少数倾向是人类的性(sexuality)的正常类别(APA, 2009a; APA, 2009b)。没有科学依据支持性少数倾向有心理性的病理学起源(Blanchard, 2018; Breedlove, 2017; LeVay, 2016; Swift-Gallant 等, 2019; Xu等, 2020)，同样，科学也不支持具有多元性倾向的人存在固有的精神疾病倾向(Gonsiorek & Weinrich, 1991)。相反，性少数人群和异性恋人群在健康方面的任何显著差异都源于性少数人群遭受的压力(Feinstein, 2019; Hsich & Ruther, 2016; Katz-Wise等, 2017; Mereish & Poteat, 2015; Meyer, 2003; Michaels 等, 2019; Moscardini等, 2018; Pachankis & Branstrom, 2018; Roi 等, 2019)。
早期文献将性少数倾向归类为“可治愈”的精神疾病，但现在这些文献被认为在方法论上是不可靠的：它们的研究方法有严重缺陷、术语定义不明确、参与者分类不准确、群体比较不恰当、抽样程序不一致且存在偏见、忽视混杂的社会因素、结果测量方式有问题、对性(sexuality)的定义不统一，还存在统计错误(APA, 2009a)。比如一项曾被广泛引用、现在已被驳斥的研究，就认为性倾向可以被改变(Spitzer, 2003)。该研究的作者后来发表了致歉声明，承认主流学界对于这项研究的批评是正确的且有根据的(Becker, 2012; Drescher, 2016; Spitzer, 2012)。
虽然“性少数倾向是人类的性(sexuality)的正常类别”已经是公认的观念，但改变性少数倾向的尝试仍然存在，这被称为扭转性倾向的尝试(sexual orientationchange efforts, SOCE)。这些努力曾被称为“修复性治疗”或“扭转治疗”(APA, 2009a; Drescher等, 2016)，但是SOCE是一个更加准确的描述。
研究表明，对性少数者进行SOCE，不仅是无效的，还会造成实质性伤害。造成伤害的部分原因在于，SOCE增加了性少数者的压力，给了性少数者虚假的希望以及只会失败的治疗，这种失败最终被SOCE使用者内化(APA, 2009a)。有记录的SOCE负面结果包括认同混乱、焦虑、愤怒、情感麻木、解离(disassociation)、抑郁、自杀倾向(即自杀想法和自杀企图)、回避亲密关系、孤立、性别角色冲突、性功能障碍、高危行为(如使用药物、无保护性行为)、家庭关系恶化、自我价值感下降、生活满意度降低、失去信仰、经济损失，以及认同冲突与发展的延迟解决(APA, 2009a; Bradshaw等, 2015; Dehlin等, 2015; Fjelstrom, 2013; Haldeman, 2002; Ryan等, 2018; Shidlo & Schroeder, 2002; Weiss等, 2010)。与没有经历SOCE的性少数同龄人相比，遭受过SOCE的性少数者产生自杀意念和企图自杀的可能性是前者的两倍(Blosnich等, 2020)。SOCE的存在本身也会导致伤害，因为SOCE会强化偏见(Begelman, 1975)，阻碍人们接受更安全、有效的方法，以减轻与TA们性少数倾向有关的痛苦(Beckstead & morrow, 2004)。文献报告的SOCE的益处(比如找到社群，Flentje等, 2014)都不是普遍的，都可以通过更加安全、科学且不试图改变性倾向的方法实现(APA, 2009a; 2009b)。声称SOCE成功的人，倾向于描述TA们感知到性吸引力后采取的行动如何（或是否）变化，而不是TA们的性少数倾向本身的变化，辨明这一点十分重要(Beckstead, 2003; Beckstead & Morrow, 2004)。经历过SOCE的性少数来访者往往是被误导了，并不了解性倾向的本质，也不清楚性少数人群的正常生活经历(Schroeder & Shidlo, 2002; Shidlo & Gonsiorek, 2017)。另外值得注意的是，很多经历过SOCE的来访者，尤其是性少数青少年，按照美国心理学会(APA)的《对性倾向的适当治疗回应》政策(APA's policy on ApproporiateTherapeutic Responses to SexualOrientation)中所描述的SOCE程序的充分知情同意标准，TA们在接受SOCE前没有充分知情同意(APA, 2009a)。
鉴于这些严重的伦理问题，主要的健康专业协会大都认定SOCE是有害的，并发表声明谴责SOCE的做法，包括美国心理协会(2009a)、美国精神病学协会、美国儿童和青少年精神病学学会、美国医学会、美国儿科学会、美国儿童和青少年精神病学学会、世界卫生组织、美国学校顾问协会、婚姻和家庭治疗协会、美国医师学会、美国咨询协会、美国精神分析协会和全国社会工作者协会等。此外，美国20个州和哥伦比亚特区(截至2020年8月31日)已立法禁止有执照的精神卫生专业人员对未成年人使用SOCE (Movement Advancement Project, 2020)。但是，这些法律并不限制宗教服务提供者。结论是明确的，SOCE危害心理健康。心理学从业者不应参与其中。
国际上 SOCE的情况也令人担忧。19世纪和20世纪的英国殖民统治，传播并植入了基督教原教旨主义关于性(sexuality)的态度。殖民统治带来的宗教制度，仍然影响着许多后殖民国家当今关于性少数群体的社会和文化叙事(Barrows & Chia, 2016)。因此，殖民输入的异性恋霸权和恐同观念，被重新归为本土固有的(Danil, 2020)。由于殖民统治的历史,当下在世界许多地区，包括非洲、中东、东欧、加勒比海、大洋洲和亚洲地区，非异性恋性行为仍然是非法的，在某些地区甚至会被判处死刑, SOCE则被错误地宣传为治疗方法(Bailey 等, 2016)。英国殖民遗留的问题到今天仍然突出，遗留的殖民时代刑法仍然将性少数的性(sexuality)定为犯罪，并影响全世界对性(sexuality)的态度和对性倾向改变的做法(Danil, 2020)。02
应用
《APA道德准则》(APA Ethics Code)(APA，2017a)和APA《对性倾向的适当治疗回应》(APA 's policy on Appropriate Therapeutic Responses to Sexual Orientation) 中的政策，明确规定了心理学从业者应确保未成年来访者的知情同意(APA, 2009a, 2017)。知情同意程序应包括：讨论SOCE实证证据的缺乏，对来访者的潜在风险(APA, 2009a)，并提供关于性倾向的准确的、肯定性的信息。心理学从业者应仔细询问来访者因性少数倾向而苦恼的原因。此外，心理学从业者应与性少数来访者讨论治疗方案、理论基础、合理的疗效和替代性治疗方案。
排版：Tommie
封面图：《被抹去的男孩》参考文献：
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