
世俗心理治療對LGBTQ、性行為、其他道德問題的態度
張逸萍
如果你想學煮一碗廣東雲吞麵,大概不會找一個四川酸辣麵師傅,因為口味可能大有不同。是嗎?同樣的,如果你需要在思想、行為、情緒上得到指導,你是否會物色一位道德價值觀和你相同的輔導員呢?至少是一個你能相信他的觀點的人。對嗎?
所以,在你考慮物色輔導員之前,第一件事,就是要考慮﹕世俗心理治療的道德價值觀適合作為一個基督徒的你嗎?
我曾經在自己的網站上討論過這個問題﹕「心理學家的上帝觀、道德觀、冥想觀、性愛婚姻觀」和「心理學和性革命」。為了進一步研究這個問題,我在7/9/26,詢問了Google
的
AI 摘要(AI
Overview)和ChatGPT
的研究(前者有注腳)。所得結果如下﹕
(一)心理治療師對LGBTQ的態度
我首先詢問了它們對LGBTQ(lesbian,
gay, bisexual, transgender, queer or questioning, intersex, asexual,即“女同性戀、男同性戀、雙性戀、跨性別、酷兒或性取向待定者、雙性戀人、無性戀者”)的態度。事實上,“台灣輔導與諮商學會”在網上已經標明他們的責任之一是,「加強本會對多元性別及性傾向認同者……人權之尊重。」[1]
A﹕Google
AI
摘要回答﹕
現代心理治療師普遍對LGBTQ+族群持正面肯定的態度,但他們的臨床準備和專業知識仍有顯著不足。儘管美國心理學會(American
Psychological Association (APA))等主要專業組織明確反對將性少眾病理化,但這種支持的實際落實情況會因培訓、地域和潛在偏見而有所不同。[2]
大規模系統性回顧表明,絕大多數心理健康從業者明確認可,支持
LGBTQ+
的權利。[3]
現代心理學的主流框架是
LGBTQ+
肯定療法。這種方法積極肯定少數群體的身份,而不是僅僅容忍或忽視它們。[4]
20
世紀 70
年代,重要的心理學協會瓦解了歷史上將同性戀視為一種疾病。現代理論認同“少數群體壓力理論”——而不是身分本身——才是
LGBTQ+
群體焦慮和憂鬱加劇的根本原因。[5]
B﹕CHATGPT
回答﹕
心理治療師對
LGBTQ+
人群的態度,在過去數十年間有很大的轉變。今天,大多數主流心理治療專業組織認為,LGBTQ+
身份是人類性取向與性別表達的正常差異,而不是心理疾病。主流心理健康專業組織(如American
Psychological Association、American
Psychiatric Association
、National
Association of Social Workers
、American
Counseling Association)的共識:
LGBTQ+
身份不應被視為需要「治療」或「改變」的障礙。 治療師應提供尊重、不歧視的心理服務。
治療師應協助來訪者按照自己的價值觀和身份生活,而不是強迫他們符合社會傳統期待。不過,不同治療師之間仍存在不同看法,尤其是在某些宗教背景或保守信仰傳統中的治療師。
ChatGPT另報導了基督教輔導(Christian
Counseling)界對
LGBTQ+
的看法。一些基督教輔導者:完全認同同性關係及跨性別身份; 認為 LGBTQ+
身份可以與基督信仰相容。 另一些基督教輔導者:例如:Association
of Certified Biblical Counselors(ACBC)以及Christian
Counseling & Educational Foundation(CCEF)通常強調:人的核心身份應建立在基督裡,而不是建立在性取向或性別身份上;以憐憫和尊重陪伴人;
同時維持傳統基督教對性倫理的理解。
注﹕〔1963年,美國精神病學協會(American
Psychiatric Association,簡稱APA)以同性戀為疾病。
1971年,投票決定以同性戀為正常。
1994年,APA甚至宣佈,他們不贊成改變同性戀者的生活方式。
〕
(二)心理治療師對婚前婚外性行為和同居的態度
一般基督徒大概對LGBTQ的意見是站在聖經一邊,沒有太多讓步和相量的餘地。但是婚前和婚外性行為,同居呢?恐怕一些基督徒在這類行為比較寬鬆。所以我又請教了Google和ChatGPT。
A﹕Google
AI
摘要回答﹕
現代心理治療師通常對婚前性行為和同居持較為寬容和認可的態度,將其視為正常的成長階段。然而,他們對婚外性行為(不忠)的態度仍以限制和謹慎為主,主要關注信任破裂、創傷和欺騙等臨床風險。[6]
現代治療界不採用僵化的道德準則,而是透過知情同意、關係穩定性和心理困擾等框架來評估這些行為。[7]
(1)婚前性行為
臨床醫師將婚前性行為視為人類發展的一個標準要素,而不是行為問題。治療師對婚前性行為的主要關注點不是行為本身,而是性健康、情緒安全、個人界線以及與客戶內在價值觀的一致性。[8]
限制性態度通常只出現在高度專業化的宗教或信仰諮商機構中,在這些機構中,實務工作者在特定的神學架構下運作。[9]
(2)同居
治療師普遍接受同居作為實用、健康的伴侶測試彼此是否合適的方法,然後再做出長期承諾或結婚。[10]
治療師會關注那些僅僅出於經濟或生活方便而「順其自然」地住在一起的伴侶,以及那些明確、有意地「決定」同居的伴侶,因為後者與更高的長期關係滿意度密切相關。治療師很少從道德角度勸阻同居,而是專注於幫助伴侶解決溝通、家務分工和財務界線等問題。[11]
(3)婚外性行為(不忠)
婚外性行為由於可能擾亂心理健康,因此在臨床上受到高度謹慎對待。
[12]
治療師將未經同意的婚外性行為(出軌)視為對伴侶關係依附安全感的深刻破壞。婚外情的發現往往會在被背叛的一方引發類似創傷後壓力症候群(PTSD)的症狀,治療師必須對其進行系統性的治療。[13]
即使面對婚外性行為的欺騙,倫理準則也要求治療師避免羞辱不忠的來訪者。相反,婚姻和家庭治療師會專注於系統性原因——例如情感忽視、溝通不良或衝動控制問題——以幫助夫妻安全地和解或徹底分手。[14]
至於雙方同意的非一夫一妻制/多伴侶關係:現代治療師越來越多地接受培訓,以肯定多伴侶關係或開放式婚姻結構,前提是所有參與者都明確同意這種安排,並建立了清晰、透明的界限。
[15]
B﹕CHATGPT
回答﹕
過去數十年的研究顯示,北美和西歐大多數持牌心理治療師對成年人自願的性行為採取不加批判、以案主為中心(client-centered)的態度,包括婚外情、同居及婚前性行為。然而,他們的觀點仍會因理論取向、個人價值觀、宗教信仰及專業倫理而有所不同。
(1)婚外性行為
大多數心理治療師不會把通姦本身視為精神疾病,也不認為它本質上屬於心理病態。相反,他們通常會探討以下問題:婚外情為何會發生?婚姻中有哪些未被滿足的需要或關係因素?當事人現在希望怎樣做?如何把對自己及他人的傷害減至最低?
(2)同居
大多數心理治療師把同居視為一種正常的親密關係選擇,而不是心理問題。
(3)婚前性行為
在世俗心理治療領域,大多數心理治療師普遍認為,成年人之間在雙方自願下發生婚前性行為,是成人發展中的正常現象,而非心理異常。
(三)心理治療師對說謊的態度
我們不能要求世俗心理治療員的道德價值觀點和聖經完全吻合,也相信他們絕不會贊成他們的當事人進行違反當地法律的事情,例如謀殺、搶劫、暴力、販毒等。但是,那些一般人都認為雖不犯法,但仍是不道德的事情,心理治療怎麼看呢?現在以撒謊為例,讓我們的AI工具去研究。
A﹕Google
AI
摘要回答﹕
現代心理治療師並不將說謊視為道德缺陷,而是將其視為具有不同法律、倫理和臨床規範的複雜行為標誌。治療師對說謊持不批判的態度,以理解其潛在的心理功能。[16]治療師區分正常的社交謊言、適應性謊言(例如,為了保護自己免受虐待而撒謊)和病態謊言。後者被視為潛在疾病(例如邊緣型人格障礙、反社會型人格障礙或自戀型人格障礙)的潛在症狀。[17]
說謊是一個需要了解的臨床症狀。治療師不會監督患者是否說真話;相反,他們會將欺騙行為視為臨床數據的一部分。[18]
臨床醫師會探究患者說謊的原因。說謊通常被認為是一種適應不良的應對機制,其驅動因素包括害怕被拒絕、羞恥感、創傷或自我保護的需要。[19]
B﹕CHATGPT
回答﹕
世俗心理治療通常不會先從道德角度判定說謊本身就是錯誤或罪惡。相反,治療師通常會問:為什麼這個人要說謊?這個謊言對他有什麼作用?它滿足了什麼情感需要?說謊如何影響他的心理健康和人際關係?說謊常被視為一種適應(Coping)策略。因此,心理治療的重點通常是理解,而不是定罪。
總體而言,大多數心理治療師並不贊成說謊,但他們通常將說謊視為一種需要理解和改變的行為,而不是本質上具有道德罪責的行為。他們更關心的是當事人為什麼會說謊,以及如何幫助他建立更健康、更真誠的生活方式。
相比之下,聖經輔導(Biblical
Counseling)則認為,說謊既是道德問題,也是屬靈問題。聖經輔導同樣會探討說謊背後的動機,但最終會把問題放在聖經的框架下,強調罪、悔改、赦免,以及因基督而來的生命更新。
(四)心理治療師對道德的一般態度
最後,我讓這些AI
工具總論一下世俗心理治療對道德的一般觀點。
A﹕Google
AI
摘要回答﹕
心理治療師通常將道德評論與臨床治療分開,並保持不批判的立場,優先考慮來訪者的自主性。佛洛伊德(Freud)認為,過度活躍的超我所驅動的嚴苛道德說教會,導致心理痛苦,因此現代心理治療強調減輕有害的道德壓力。[20]
大多數主流心理治療師都秉持著一個「無批判」的信念。就是說,他們避免對客戶做出道德評判。[21]
治療師的目標是幫助客戶發現和澄清自己的內在價值觀,而不是將外在道德標準強加給他們。[22]
從業者普遍認為,過度、僵化的道德壓力會對心理造成損害,並加劇憂鬱和焦慮等問題。
[23]
保持中立立場可確保安全的環境,讓客戶感到足夠安全,可以揭露弱點而不用擔心被拒絕。
[24]
B﹕CHATGPT
回答﹕
有關心理治療師對道德的一般態度,北美、歐洲和澳洲的研究顯示出相當一致的趨勢。雖然每位治療師的觀點都可能不同,但現代主流心理治療已逐漸不再把治療師視為道德權威。相反,治療師通常被鼓勵協助當事人釐清並實踐他們自己的價值觀,前提是這些價值觀不會對自己或他人造成嚴重傷害。治療師一般採取“價值中立”(Value-Neutral)的立場,強調“不帶批判的接納”(nonjudgmental
acceptance),而不是告訴當事人什麼是道德上的對或錯。
整體而言,現代主流心理治療師對道德的態度:道德價值應由當事人自己決定,而不是由治療師決定;心理治療的目標是促進個人成長與心理健康,而不是提供一套普世性的道德規範;當行為涉及重大傷害、虐待或剝削時,治療師通常會明確介入並提出挑戰。
ChatGPT也報導基督教輔導與聖經輔導則不同,它們通常認為道德的最終權威來自聖經,而非當事人自行建構的價值觀。基督教輔導通常會把聖經的道德教導整合到治療中。聖經輔導明確以聖經作為道德的客觀標準。
研究後的感觸
搜集了這些資料之後,我有一點感觸。
首先,崇尚心理學的基督徒從前很喜歡說,心理學是上帝的“普通啟示”,後來他們明白“普通啟示”不是這個意思(請參考﹕「心理學絕對不是上帝的普通啟示」),於是他們又改口說,心理學是上帝的“普通恩典”。但是神賜下的“普通恩典”是支持LGBTQ和婚前婚外性行為的嗎?是道德中立,持無批判態度的嗎?
其次,如果世俗心理治療是道德中立,不批判的,只支持當事人的價值觀;另一方面,即使ChatGPT也指出,窄義的聖經輔導,會遵循聖經原則來輔導。難怪有誤會聖經輔導的話,如“什麼都是罪”或者“傷害案主”。誰喜歡別人指出自己的錯處?
那麼讓我們回到文首的問題﹕如果你需要在思想、行為、情緒上得到指導,你是否會物色一位道德價值觀和你相同的輔導員呢?也許更應該問,你是否會物色一位道德價值觀和上帝相同的輔導員呢?
「凡聽見我這話就去行的,好比一個聰明人,把房子蓋在磐石上。雨淋,水沖,風吹,撞著那房子,房子總不倒塌。因為根基立在磐石上。」(太
7:24-25)
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Therapy Trainings, Nov 2024 (https://www.therapytrainings.com/pages/blog/sex-therapy-principles-techniques-and-ethical-considerations).,Robert
Athanasiou & Richard Sarkin, “Premarital sexual behavior
and postmarital adjustment,” Springer Nature Link
(https://link.springer.com/article/10.1007/BF01541486).,Chelsea
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Life," Phases of the Mind Therapy (https://www.phasesofthemindtherapy.com/blog/types-of-sex-therapy).,Lauren
M Walker, "Back to the Basics: Origins of Sex Therapy, Sexual
Disorder and Therapeutic Techniques,"
Research Gate,
January 2012 (https://www.researchgate.net/publication/310812007_Back_to_the_Basics_Origins_of_Sex_Therapy_Sexual_Disorder_and_Therapeutic_Techniques
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Allison Claire Rayburn, “The relationship between premarital
sexual behaviors and the state of the marriage,”
Louisiana State University LSU Scholarly Repository , 2007 (https://repository.lsu.edu/cgi/viewcontent.cgi?article=3206&context=gradschool_theses)。[10]
Ibid.。[11]
Alicia Moore, “An Examination of Counselors' and Therapists'
Attitudes Toward Marriage,” Walden University Scholar
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).,“Marital Problems,”
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Psychology Exposed, “The Psychology of Marital Affairs: What
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G Humphrey, "Extramarital affairs: clinical approaches in
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Psychology Exposed, “The Psychology of Marital Affairs: What
Drives Infidelity?,” youtube.,Wes
White Counseling, “Why Do People Cheat? | The Psychology of
Cheating Explained by a Couples Therapist,” youtube (https://www.youtube.com/watch?v=zRUX2K17AgQ).,Lawrence
Josephs, “Does Sexual Betrayal Cause PTSD?”
Psychology Today,
July 2018 (https://www.psychologytoday.com/us/blog/between-the-sheets/201807/does-sexual-betrayal-cause-ptsd).。[14]
D H Sprenkle
and D L Weis ,
“Extramarital sexuality: implications for marital therapists”.,F
G Humphrey, “Extramarital affairs: clinical approaches in
marital therapy,”,Wes
White Counseling , “Why Do People Cheat? | The Psychology of
Cheating Explained by a Couples Therapist,” Youtube.。[15]
Tara Baluck , “Assessing therapists’ attitudes toward
consensually non-monogamous clients,”
Eastern
Michigan University Master Thesis, 2020 (https://commons.emich.edu/cgi/viewcontent.cgi?article=2388&context=theses).,Adam
Herbert, “Psychotherapists’ Attitudes Toward Polyamory and
Responses to Polyamorous Clients: An Exploratory Study,”
RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY Dissertation,
(https://rucore.libraries.rutgers.edu/rutgers-lib/64794/PDF/1/play/
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“The Psychology of Marital Affairs: What Drives Infidelity? ,”
youtube.。[16]
Don Grubin, “Commentary: Getting at the Truth about Pathological
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the Law (https://jaapl.org/content/33/3/350).,“Confidentiality
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Christian L. Hart, “Can Pathological Liars Be Cured?”
Psychology Today, April 8, 2023 (
https://www.psychologytoday.com/us/blog/the-nature-of-deception/202304/can-pathological-liars-be-cured).,Kathleen
Doheny and Markham Heid, “Compulsive Versus Pathological Lying:
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Everyday
Health, Dec 2023 (
https://www.everydayhealth.com/emotional-health/truth-behind-pathological-compulsive-liars/
).,Kristina Robb-Dover,
“Pathological Lying Can Occur with These Mental Disorders,”
FHE Health, June 25, 26 (https://fherehab.com/learning/pathological-lying-disorders).,Palo
Alto University, “Pseudologia Fantastica: Layers of Deceit,” (https://paloaltou.edu/resources/business-of-practice-blog/pseudologia-fantastica-layers-of-deceit
).,“A Practical Guide on
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Dec 23 (https://therapy-central.com/2023/12/02/a-practical-guide-on-how-to-start-telling-the-trut
h-and-stop-lying/ ).。[18]
Caitlin Harper , “Is It Okay to Lie to My Therapist?,” (https://mywellbeing.com/therapy-101/is-it-okay-to-lie-to-my-therapist
).。[19]
Regain Editorial Team, “Married To A Compulsive Liar: Treatment
For Families And Couples,” Regain affection, April 7th,
2026 (https://www.regain.us/advice/infidelity/am-i-married-to-a-compulsive-liar-treatment-for-families-and-couples/).,“Can
a Compulsive Liar Change?,” Bayside Psychotherapy (https://www.baysidepsychotherapy.com.au/compulsive-lying-therapy/?srsltid=AfmBOopC3u_i8UF62m3uHUHX5SCYIRm_PxpkkyU5vFJqNFoT-5jn0KbM).,Roberta
Satow , “Adults Who Lie,” Psychology Today, May 24, 2020
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lying feels like the only option you have,” Hope Therapy &
Counseling (https://www.hopefulminds.co.uk/conditions/mythomania/).,Deborah
Quinn, “Pathological Liar: 11+ Signs & Solutions of Habitual
Lying,” Sandstone Care (
https://www.sandstonecare.com/blog/pathological-liar/
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Kirill Kryuchkov, "Psychotherapy as an applied ethics: case of
Client-Centered Psychotherapy,"
ReserachGate (https://www.researchgate.net/publication/330658105_Psychotherapy_as_an_applied_ethics_case_of_Client-Centered_Psychotherapy).,Jeffrey
E. Barnett, “Being an Ethical Psychotherapist,”
Society for
the Advancement of Psychotherapy, April 30,20178 (https://societyforpsychotherapy.org/being-ethical-psychotherapist-5-steps/).,Robert T. Fancher, "Talk Therapy’s Moral Morass,"
Quillette, Aug 23 (https://quillette.com/2023/08/17/talk-therapys-moral-morass/).,Richard
G. T. Gipps, “Psychotherapy as Ethics,”
MDPI, April 2023 (https://www.mdpi.com/2409-9287/8/2/42).,Peter
Levine, “Morality in Psychotherapy,” (https://peterlevine.ws/?p=12541).
。[21]
Robert T. Fancher, "Talk Therapy’s Moral Morass,"。[22]
Ibid.。[23]
Richard G. T. Gipps, “Psychotherapy as Ethics.”,Peter
Levine, “Morality in Psychotherapy,”
,Constantin
Patrascu, “What Your Therapist Knows But
Won’t Tell You About Morality: Your Conscience Is Making You
Sick,” Medium, July 2006 (https://medium.com/@constantinpatrascu/what-your-therapist-knows-but-wont-tell-you-about-morality-your-conscience-is-making-you-sick-190bce64ca46
).。[24]
Dr. Kyler Shumway, “Good Therapist vs. Great Therapist – What
Makes a Therapist Great?” Deep Eddy Therapy (
https://deepeddypsychotherapy.com/a-good-therapist-vs-a-great-therapist/).,“Neutrality
is not complicity – it’s clinical integrity,”The British
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Bay, " Politics in the Therapy Office," Bay Mental Health LLC,
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).。