性傾向轉換療法的有效性——學術研究怎麼說？

譯自康乃爾大學《What we know》計劃專文

本文翻譯自康乃爾大學的《What we know》計劃中（現已轉移至社會不平等研究中心），針對性傾向轉換療法的學術研究回顧專文：

What does the scholarly research say about whether conversion therapy can alter sexual orientation…

以下，正文開始。

在針對「性傾向轉換療法是否能在無害的前提下產生效果」的主題中，我們找到了47個符合《What we know》計劃中挑選標準且通過同儕審查的學術研究。

其中有13個是第一手研究（ primary research）。而在這13個第一手研究中，有12個作出了轉換療法無效／有害的結論，並發現轉換療法與抑鬱、自殺意念、焦慮、自我孤立以及親密能力的降低有關。只有1個研究作出了轉換療法可能成功的結論——雖然只佔其研究樣本中的極少數，並且這份研究有著方法學上的限制：這份研究的樣本皆使用自承報告且自承有虔誠的宗教信仰，這可能導致了偏頗與不可信的研究結果。

剩下的34個研究並未做出「轉換療法有效」的實證結論，但或許對於臨床工作者如何面對LGB族群個案的議題上，可以提供有用的觀點。

在轉換療法的研究中，普遍有著無法客觀評斷性傾向的限制。所有我們選擇的47個研究中，皆依賴自承報告。而那些非常渴望改變性傾向以至於尋求「治療」的人，可能會在回報他們自身性吸引的時候有所偏頗。大部分的研究皆缺乏控制組，並且沒有使用全國性的隨機樣本。

有許多贊同轉換療法的研究者，並非真正評估了性傾向的轉變或是生理反應，而是以樣本的行為作為改變的指標——而這並不符合性傾向真實的定義標準。許多宣稱自己性傾向從同性戀轉換回異性戀的樣本，其實能被更精準地以「雙性戀」描述，但沒有被如此紀錄下來。

而有許多研究僅只收取了有宗教背景的樣本，因此這些研究的結論比起「性傾向真正被改變」，更多的是反映了樣本的宗教認同。有些研究者成功抑制了受試者對於同性的性興奮反應——這通常使用了某些技巧，但這些被抑制的興奮反應，並無法轉換與增加到對於異性的性興奮反應，也無法增加受試者與異性維持穩定且彼此滿足關係的能力。

雖然有著這些限制，但不代表針對轉換療法的研究無法提供任何資訊。

在我們選擇的研究中，部分針對臨床工作者較有興趣的研究報告有著某些倫理議題上的討論，例如如何處遇對自己性傾向不滿意的個案。除此之外，直接檢視這些研究報告，也能幫助觀看這篇文章的人去判斷「性傾向可被改變」的論點有多少說服力。

然而，在回顧了這些研究之後，我們認為並沒有關鍵性的證據可證明性傾向能透過醫療處遇來轉變。許多這些所謂的「轉變」，比較像是「信仰療法」。同時也有許多有力的證據指出，試圖改變一個人的性傾向是非常危險且有害的。

綜上所述，許多心理學家與精神醫師在研究過轉換療法，或是研究如何治療對於自己性傾向有所掙扎的個案後，皆產生了壓倒性的共識：醫療處遇並無法改變一個人的性傾向。這個共識也受到相關領域中許多專業組織的聲援，例如美國心理學會（APA）。

12個認為轉換療法無效／有害的學術研究

1. Beckstead, A. L., & Morrow, S. L. (2004). Mormon clients’ experiences of conversion therapy: The need for a new treatment approach. The Counseling Psychologist, 32(5), 651–690.
2. Borowich, A. (2008). Failed reparative therapy of orthodox Jewish homosexuals.Journal of Gay & Lesbian Mental Health, 12(3), 167–177.
3. Dehlin, J. P., Galliher, R. V., Bradshaw, W. S., Hyde, D. C., & Crowell, K. A. (2014). Sexual orientation change efforts among current or former LDS church members. Journal of Counseling Psychology. Advance online publication.
4. Fjelstrom, J. (2013). Sexual orientation change efforts and the search for authenticity. Journal of Homosexuality, 60(6), 801–827.
5. Flentje, A., Heck, N. C., & Cochran, B. N. (2013). Sexual reorientation therapy interventions: perspectives of ex-ex-gay individuals. Journal of Gay & Lesbian Mental Health, 17(3), 256–277.
6. Haldeman, D. C. (2001). Therapeutic antidotes: Helping gay and bisexual men recover from conversion therapy. Journal of Gay and Lesbian Psychotherapy, 5(3/4), 117–130.
7. Jones, M., Botsko, M., & Gorman, B. (2003). Predictors of psychotherapeutic benefit of lesbian, gay, and bisexual clients: the effects of sexual orientation matching and other factors. Psychotherapy: Theory, Research, Practice, Training, 40(4), 289–301.
8. Maccio, E. (2011). Self-reported sexual orientation and identity before and after sexual reorientation therapy. Journal of Gay & Lesbian Mental Health, 15(3), 242–259.
9. Schroeder, M., & Shidlo, A. (2002). Ethical issues in sexual orientation conversion therapies: An empirical study of consumers. Journal of Gay and Lesbian Psychotherapy, 5(3/4), 131–166.
10. Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumer’s report. Professional Psychology: Research and Practice, 33(3), 249–259.
11. Smith, G., Bartlett, A. & King, M. (2004). Treatments of homosexuality in Britain since 1950 — an oral history: The experience of patients. British Medical Journal, 328(7437), 427–429.
12. Weiss, E. M., Morehouse, J., Yeager, T., & Berry, T. (2010). A qualitative study of ex-g

1個認為轉換療法有效的研究

1. Nicolosi, J., Byrd, A. D., & Potts, R. W. (2000). Retrospective self-reports of changes in homosexual orientation: A consumer survey of conversion therapy clients. Psychological Reports, 86, 1071–1088.

34個並未作出結論但對於面對LGB個案的臨床工作者可能有用的研究

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4. Cramer, R. J., Golom, F. D., LoPresto, C. T., & Kirkley, S. M. (2008). Weighing the evidence: Empirical assessment and ethical implications of conversion therapy. Ethics and Behavior, 18(1), 93–114.
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6. Drescher, J. (1998). I’m your handyman: A history of reparative therapies. Journal of Homosexuality, 36(1), 19–42.
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21. Morrow, S. L., & Beckstead, A. L. (2004). Conversion therapies for same-sex attracted clients in religious conflict: Context, predisposing factors, experiences, and implications for therapy. The Counseling Psychologist, 32, 641–650.
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