Conversion therapy has been defined by the American Psychological Association as therapy aimed at changing sexual orientation, and by the American Psychiatric Association as "psychiatric treatment...which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation." Techniques that have been tried include behavior modification, aversion therapy, psychoanalysis, primal therapy, EMDR, and reparative therapy.   
- 1 History
- 2 Contemporary theories and techniques
- 3 Mainstream medical and scientific view in the U.S.
- 4 Legal status in the U.S.
- 5 Effectiveness
- 6 Political debate
- 7 World trends
- 8 References
- 9 External links
- 10 Discuss
In 1886 noted sexologist Richard von Krafft-Ebing listed homosexuality in his definitive work, Psychopathia Sexualis. Krafft-Ebing proposed that homosexuality was caused by either "congenital inversion" or an "acquired inversion".
In 1896 Sigmund Freud published Heredity and the Aetiology of the Neuroses, which contained his first ideas on psychoanalysis. Freud believed that all humans were innately bisexual. People could develop particular sexual orientations for numerous different reasons, including environmental factors interacting with biological sexual drives. Freud expressed serious doubts about the potential for therapeutic conversion. In a famous letter to a mother who had asked Freud to treat her son, he wrote:
|â€œ||By asking me if I can help [your son], you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted.||â€|
In that letter, he also stated that "homosexuality is assuredly no advantage but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness....".
Medical attempts to change homosexuality included surgical treatments such as hysterectomy, ovariectomy, clitoridectomy, castration, vasectomy, pudic nerve surgery, and lobotomy. Substance-based methods included hormone treatment, pharmacologic shock treatment, and treatment with sexual stimulants and sexual depressants. Other methods included aversion therapy, the reduction of aversion to heterosexuality, electroshock treatment, group therapy, hypnosis, and psychoanalysis.
During the three decades between Freud's death in 1939 and the Stonewall riots in 1969, conversion therapy received approval from most of the psychiatric establishment in the United States.  The 1952 first edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-I) classified homosexuality as a mental disorder. Prominent researchers arguing for therapeutic conversion included Edmund Bergler, Irving Bieber, Albert Ellis, Abram Kardiner, Lionel Ovesey, Sandor Rado, and Charles Socarides. Rado rejected Freud's theory of innate bisexuality. Rado argued instead that heterosexuality is nature's default setting and that homosexuality is caused by parental psychopathology. Socarides developed similar theories: Socarides regarded homosexuality as an illness arising from a conflict between the id and the ego usually arising from an early age in "a female-dominated environment wherein the father was absent, weak, detached or sadistic".
The conversion therapists rejected Freud's pessimism about therapy's ability to change sexual orientation. In 1962 Bieber et al published Homosexuality: A Psychoanalytic Study of Male Homosexuals, which concluded that "although this change may be more easily accomplished by some than by others, in our judgment a heterosexual shift is a possibility for all homosexuals who are strongly motivated to change." Homosexuality was assumed to be a psychopathology: Ellis found that "fixed homosexuals in our society are almost invariably neurotic or psychotic:... therefore, no so-called normal group of homosexuals is to be found anywhere."
Evelyn Hooker was a contrary voice when she published her 1957 paper "The Adjustment of the Male Overt Homosexual," which found that "homosexuals were not inherently abnormal and that there was no difference between homosexual and heterosexual men in terms of pathology." This paper subsequently became influential.
In 1966, psychologist Martin E.P. Seligman reported that using aversion therapy to change sexual orientation "worked surprisingly well," with up to 50% of men subjected to such therapy not acting on their homosexual urges. These results produced what Seligman described as "a great burst of enthusiasm about changing homosexuality [that] swept over the therapeutic community" after the results were reported in 1966. However, Seligman notes that the findings were later demonstrated to be flawed: most of the treated men who did stop having sex with men were actually bisexual. Among men who were primarily gay, aversion therapy was far less successful.
In 1969, the Stonewall riots increased the visibility of homosexuality in the United States. In 1970, Arthur Janov published The Primal Scream, which claimed that homosexuality was a neurosis that could be cured by a therapy involving screaming.  Janov's therapy became widely influential.  In 1973, after intense lobbying by gay groups, new scientific information from researchers like Evelyn Hooker and Alfred Kinsey, and dissension from the psychiatric ranks, the American Psychiatric Association declassified homosexuality as a mental disorder with a vote of 58% of the membership supporting the measure.
However, conversion therapy continued to be used. In 1992, the Phoenix Memorial Hospital in Phoenix, Arizona, was using these methods on children as young as 10. Aversion therapy is no longer sanctioned by the APA as a treatment for homosexuality.
Contemporary theories and techniques
In 1983 research psychologist Elizabeth Moberly coined the term reparative drive to refer to male homosexuality itself, interpreting men's sexual desires for other men as attempts to compensate for a lacked connection between father and son during childhood. She encouraged same-sex bonding with both mentors and peers as a way of stopping same-sex attraction. In 1991, Joseph Nicolosi published Reparative Therapy of Male Homosexuality: A New Clinical Approach.  This book introduced the term reparative therapy , which is sometimes used loosely as a synonym for conversion therapy in general.
Rather than promoting cures for homosexuality, reparative therapists tend to characterize themselves as offering "a possibility of change" for homosexuals who are unsatisfied with their sexual orientation. This therapeutic model often emphasizes minimizing the patient's homosexual desires, rather than eliminating them outright. Most mental health professionals today consider reparative therapy discredited, but some professionals still attempt it. Joseph Nicolosi, Charles Socarides, and Benjamin Kaufman founded the National Association for Research & Treatment of Homosexuality (NARTH) in 1992, a mental health organization opposed to the mainstream mental health view of homosexuality that is the most vocal advocate of reparative therapy. The American Psychoanalytic Association (APsaA) has spoken against NARTH, stating "that organization does not adhere to our policy of nondiscrimination and ... their activities are demeaning to our members who are gay and lesbian."
Nicolosi is today's leading representative of the view that same-sex desires are a form of arrested psychosexual development, resulting from "an incomplete bond and resultant identification with the same-sex parent, which is then symbolically repaired in psychotherapy". His corresponding psychoanalysis-based intervention plans involve conditioning a man to a traditional masculine gender role. He should "(1) participate in sports activities, (2) avoid activities considered of interest to homosexuals, such [as] art museums, opera, symphonies, (3) avoid women unless it is for romantic contact, (4) increase time spent with heterosexual men in order to learn to mimic heterosexual male ways of walking, talking, and interacting with other heterosexual men, (5) Attend church and join a men's church group, (6) attend reparative therapy group to discuss progress, or slips back into homosexuality, (7) become more assertive with women through flirting and dating, (8) begin heterosexual dating, (9) engage in heterosexual intercourse, (10) enter into heterosexual marriage, and (11) father children".
This anti-gay psychoanalytic approach toward homosexuality has been repudiated by the psychoanalytic mainstream and the theories that underlie it countered by analysts offering gay-affirmative approaches. Exodus International considers reparative therapy to be a useful tool, but not a necessary one.
Practitioners who view homosexuality as learned behavior may adopt behavioral modification techniques. These may include masturbatory reconditioning, visualization, and social skills training. The most radical involve electroconvulsive therapy, a form of aversion therapy. Documented cases include electric shocks being administered to patients' genitalia, "sometimes paired with disturbing images, including a bowl of feces and pictures of Kaposi's Sarcoma lesions". In another case plethysmography, which uses electric sensors attached to a person's genitals to measure sexual arousal, was used in conjunction with shock therapy to electrically shock the patient's penis when he became sexually aroused by same-sex images. 
Mainstream medical and scientific view in the U.S.
The medical and scientific consensus is that conversion therapy is potentially harmful, but that there is no scientifically adequate research demonstrating either its effectiveness or harmfulness. No mainstream medical organization endorses conversion therapy. Many organizations have expressed concerns over its practice. The American Psychological Association has affirmed several principles with regard to treatments to alter sexual orientation. A survey of the American Psychological Association rated reparative therapy as "certainly discredited", though the authors warn that the results should be interpreted carefully as an initial step, not a final word. The American Psychiatric Association noted in 1997 that "the ethics, efficacy, benefits, and potential for harm of therapies that seek to reduce or eliminate same-gender sexual orientation are under extensive debate in the professional literature and the popular media."
The ethics guidelines of the mental health establishment discourage, and sometimes prohibit, the practice of conversion therapy. The APA states that as a general principle, a therapist should not determine the goal of treatment. It also recommends that ethical practitioners refrain from attempts at conversion therapy until more research is available."
Mainstream health organizations critical of conversion therapy include the American Medical Association, American Psychiatric Association, the American Psychological Association, the American Counseling Association, the National Association of Social Workers, the American Academy of Pediatrics, the American Association of School Administrators, the American Federation of Teachers, the National Association of School Psychologists, the American Academy of Physician Assistants, and the National Education Association. According to Kenji Yoshino, conversion therapy based on psychoanalytic techniques has become a largely marginalized practice as a result of these views, and "the most high-profile contemporary purveyors of conversion therapy tend to be religious organizations." 
In 2007, the American Psychological Association convened a task force to evaluate its policies regarding reparative therapy; ex-gay organizations expressed concerns about the lack of representation of pro-reparative-therapy perspectives on the task force, while alleging that anti-reparative-therapy perspectives were amply represented.
The ethics guidelines of major U.S. mental health organizations vary from cautionary statements about the safety, effectiveness, and dangers of prejudice associated with conversion therapy (American Psychological Association) to recommending that ethical practitioners refrain from practicing conversion therapy (American Psychiatric Association) or refrain from referring patients to others who do (American Counseling Association). The organizations do, however, respect the client's right to self-determination.
In 1998, the American Psychiatric Association issued a statement opposing any treatment which is based upon the assumption that homosexuality is a mental disorder or that a person should change their orientation, but did not have a formal position on other treatments that attempt to change a person's sexual orientation. In 2000, they augmented that statement by saying that as a general principle, a therapist should not determine the goal of treatment, but recommends that ethical practitioners refrain from attempts to change ones' sexual orientation until more research is available.
The American Counseling Association has stated that they do not offer or condone any training to educate and prepare a counselor to practice conversion therapy. They strongly suggest counselors do not refer clients to a conversion therapist or to proceed cautiously once they know the counselor fully informs clients of the unproven nature of the treatment and the potential risks and takes steps to minimize harm to clients. However, "it is of primary importance to respect a client's autonomy to request a referral for a service not offered by a counselor." A counselor performing conversion therapy "must define the techniques/procedures as 'unproven' or 'developing' and explain the potential risks and ethical considerations of using such techniques/procedures and take steps to protect clients from possible harm." The counselor must also provide complete information about the treatment, offer referrals to gay-affirmative counselors, discuss the right of clients, understand the client's request within a cultural context, and only practice within their level of expertise.
The American Psychological Association "is concerned about [conversion] therapies and their potential harm to patients.... Any person who enters into therapy to deal with issues of sexual orientation has a right to expect that such therapy would take place in a professionally neutral environment absent of any social bias." The APA stated, with regard to conversion therapy,
|â€œ||...that psychologists do not knowingly participate in or condone unfair discriminatory practices... do not engage in unfair discrimination based on sexual orientation... respect the rights of individuals to privacy, confidentiality, self-determination and autonomy... , try to eliminate the effect on their work of biases based on [cultural, individual and role differences due to sexual orientation]... where differences of sexual orientation significantly affect psychologist's work concerning particular individuals or groups, psychologists obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals... do not make false or deceptive statements concerning the scientific or clinical basis for their services... obtain appropriate informed consent to therapy or related procedures which generally implies that the client or patient (1) has the capacity to consent, (2) has been informed of significant information concerning the procedure, (3) has freely and without undue influence expressed consent, and (4) consent has been appropriately documented... [and that] the American Psychological Association urges all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientation." (internal quotes, brackets, and ellipses omitted).||â€|
The American Psychiatric Association has stated that "anecdotal reports of 'cures' are counterbalanced by anecdotal claims of psychological harm." It further states that there are no scientifically rigorous outcome studies to determine the actual harm of conversion treatments. However, they have also stated that the "potential risks of 'reparative therapy' are great, including depression, anxiety, and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by a patient." In Nicolosi's survey, 7.1% of patients reported that they were worse after therapy than before. He concluded that "clients who have decided they wish to affirm a gay identity could feel shamed and emotionally hurt if therapists attempted to impose conversion therapy on them."
Mainstream medical bodies state that conversion therapy can be harmful because it may exploit guilt and anxiety, thereby damaging self-esteem and leading to depression and even suicide. Participants are at increased risk for guilt, depression, anxiety, confusion, self-blame, suicidal gestures, unprotected anal intercourse with untested partners, and heavy substance abuse.
Beyond harms caused to individual people, there is a broad concern in the mental health community that the advancement of conversion therapy itself causes social harm by disseminating inaccurate views about sexual orientation and the ability of gay and bisexual people to lead happy, healthy lives. The APA warns that the conversion therapy movement helps "create an environment in which prejudice and discrimination can flourish." Stephen Halpert says "To attempt to 'cure' is to reinforce bigotry."
The APA encourages and supports research to determine risks versus benefits.
Debate within professional literature
The APA has stated that the ethics, efficacy, benefits, and potential for harm of therapies that seek to reduce or eliminate same-gender sexual orientation are under extensive debate in the professional literature and the popular media. Those against conversion therapy focus on the potential for harm and the negative effects it has on gay rights. Those for conversion therapy focus on freedom of choice for the client and potential for success.
In the United States, conversion therapy is currently allowed, under the American Psychological Association's code of conduct which states: "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination." However, the code of conduct also states that "Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making."
Opponents of conversion therapy argue that clients who request it do so out of social pressure and internalized homophobia, pointing to evidence that rates of depression, anxiety, alcohol and drug abuse and suicidal feelings are roughly doubled in those who undergo conversion therapy.
Reasons why people seek to change sexual orientation
The American Psychological Association states that harassment and abuse, as well as pressure from family, peers, and religious groups ignorant about and prejudiced against homosexuality, may cause high levels of emotional stress for LGB people. These pressures may lead people to feel forced into attempting to change their sexual orientation. Other researchers have found that social pressure plays a key role in a person's desire to change his or her sexuality.
Reaction by conversion therapists
Conversion therapists generally respond to the mainstream medical view with three main points. First, they argue that the mainstream medical view (from the 1973 declassification of homosexuality as a mental disorder to the current opposition to conversion therapy) is the result of political beliefs and lobbying. Second, they argue that there is evidence that conversion therapy is effective. Third, they argue that people should be able to determine their own therapeutic goals.
Legal status in the U.S.
On multiple occasions teenagers have reportedly been forcibly treated by ex-gay organizations. A 2006 report outlined evidence that conversion therapy groups are increasingly focusing on children.  Several legal researchers have responded to these events by arguing that parents who force their children into aggressive conversion therapy programs are committing child abuse under various state statutes.
There have been few, if any, medical malpractice lawsuits filed on the basis of conversion therapy. Laura A. Gans suggested in an article published in The Boston University Public Interest Law Journal that this is because there is an "historic reluctance of consumers of mental health services to sue their care givers" and because of "the difficulty associated with establishing the elements of... causation and harm... given the intangible nature of psychological matters." Gans also suggested that a tort cause of action for intentional infliction of emotional distress might be sustainable against therapists who use conversion therapy on patients who specifically say that his or her anxiety does not arise from his or her sexuality.
In one of the few published U.S. cases dealing with conversion therapy, the Ninth Circuit addressed the topic in the context of an asylum application. A Russian citizen "had been apprehended by the Russian militia, registered at a clinic as a 'suspected lesbian,' and forced to undergo treatment for lesbianism, such as 'sedative drugs' and hypnosis.... The Ninth Circuit held that the conversion treatments to which Pitcherskaia had been subjected constituted mental and physical torture. The court rejected the argument that the treatments to which Pitcherskaia had been subjected did not constitute persecution because they had been intended to help her, not harm her.... The court stated that 'human rights laws cannot be sidestepped by simply couching actions that torture mentally or physically in benevolent terms such as "curing" or "treating" the victims.'" "
American medical organization have have expressed concerns over potential harms of attempts to change sexual orientation through therapy.  The director of the APA's LGBT Concerns Office stated: "I don't think that anyone disagrees with the idea that people can change because we know that straight people become gays and lesbians.... the issue is whether therapy changes sexual orientation, which is what many of these people claim." The American Psychiatric Association has stated "To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of "reparative" treatments," and supports research to further determines risks versus its benefits. Similarly, United States Surgeon General David Satcher issued a report stating that "there is no valid scientific evidence that sexual orientation can be changed".
Nicolosi states that when a man changes orientation, he "doesn't immediately walk down a street and get a sexual charge from looking at a woman. But he will begin to notice women. He will begin to feel a desire to get married and have a family." Nicolosi states a successful client may still have same-sex attractions, but adds "that sexual desire is greatly diminished." Other proponents of conversion therapy argue that it is possible for a person's sexual orientation to be changed.  Some research supports that contention, although such research differs regarding the likelihood of such change. However, Exodus International warns its members not to go to counselors who "glibly" claim that all attractions to the same gender can be eliminated; Exodus indicates that such statements may reflect the counselor's inexperience regarding conversion therapy. Evergreen International similarly warns its members that "therapy will likely not be a cure in the sense of erasing all homosexual feelings."
Studies on changing homosexuality
In 2000, the APA stated: "In the last four decades, 'reparative' therapists have not produced any rigorous scientific research to substantiate their claims of cure." It has called for more scientific research to determine the risks and benefits involved, and until such research is available, recommended that "ethical practitioners refrain from attempts to change individuals' sexual orientation." However, there is anecdotal evidence of effectiveness. Studies from the 1950s and 1980s generally reported rates of positive outcomes at about 30%, with more recent survey research generally consistent with the extant data. In a survey of 882 people who were undergoing therapy, attending ex-gay groups or ex-gay conferences, 22. 9% reported they had not undergone any changes, 42.7% reported some changes, and 34.3% reported much change in sexual orientation. As a group, they reported large reductions in homosexual thoughts and fantasies and improvements in their psychological, interpersonal, and spiritual well-being.
In 2001, Dr. Robert Spitzer, who was involved in the APA's declassification of homosexuality as a mental disorder, presented a paper on conversion therapy at the APA annual convention. He reported that 66% of the men and 44% of the women he sampled had achieved "good heterosexual functioning" through interventions. This paper was widely reported by proponents of conversion therapy as evidence of success of the therapy.
The APA immediately issued an official disavowal of the paper, noting that it had not been peer-reviewed and stating that "There is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one's sexual orientation." Two years later, Spitzer published the paper in the Archives of Sexual Behavior. The publication decision sparked controversy and one sponsoring member resigned in protest. The paper has been criticized on various grounds, including using non-random sampling and poor criteria for "success". Critics argue that it relied upon samples selected by conversion therapists themselves (86 participants were handpicked by ex-gay organizations), that proper random samplings were not used, that small samplings were used, that the subjects appeared to be ex-gay advocates who may have been biased in favor of conversion therapies, that 60% of the subjects had previously reported being bisexual, and that no follow-up study had been carried out to ascertain long-term conversion.
Spitzer himself played down the results of his own paper; upon being asked about the 200 patient sample after 16 months, and the percentage of people who might succeed, Spitzer said that it took almost a year and a half to only find 200 willing individuals, and therefore, the number of gay people who could successfully become heterosexual was likely to be "pretty low". He also conceded that the study's participants were "unusually religious."
A 2002 peer-reviewed study found that 88% of participants failed to achieve a sustained change in their sexual behavior and 3% reported changing their orientation to heterosexual. The remainder reported either losing all sexual drive or attempting to remain celibate, with no change in attraction. Some of the participants who failed felt a sense of shame and had gone through conversion therapy programs for many years. Others who failed believed that therapy was worthwhile and valuable. Of the 8 respondents (out of a sample of 202) who reported a change in sexual orientation, 7 worked as ex-gay counselors or group leaders.
Conversion therapy advocates point to non-peer-reviewed studies to show evidence of change, conducted either by NARTH or other professional therapists. For example, many groups point to "Ex-Gays? A Longitudinal Study of Religiously Mediated Change in Sexual Orientation", a book published by researchers Stanton Jones and Mark Yarhouse. The study showed that out of a sample size of 98 people who sought a change in their sexual orientation, 15% reported a change in orientation over a three year period. The American Psychological Association has refused to comment on the study.
Criticism of conversion therapists
Major medical organizations do not accept the anecdotal evidence offered by conversion therapists for reasons including:
- the results are not published in peer-reviewed journals, but tend to be released to the mass media and the Internet (see Science by press conference);
- random samples of subjects are not used and results are reliant upon the subjects' own self-reported outcomes or on the therapist's own evaluations which may be subject to social desirability bias;
- the evidence is gathered over short periods of time and there is little follow-up data to determine whether it was effective over the long-term;
- the evidence does not demonstrate a change in sexual orientation, but merely a reduction in same-sex behavior;
- the evidence does not take into consideration that subjects may be bisexual and may have simply been convinced to restrict their sexual activity to the opposite sex;
- conversion therapists falsely assume that homosexuality is a mental disorder;
- conversion therapists' research focuses on gay men almost exclusively and rarely includes lesbians.
Francis Mark Mondimore argued that the reason for the focus on gay men is more political than medical. In his view, conservative and rigidly defined gender roles are the core value system used by conversion therapists, and male sexuality, with its emphasis on masculine and patriarchal hierarchies, is seen as more important and valuable than female sexuality.
Conversion therapy has become highly politicized, and the ensuing debates "have obscured the scientific data by calling into question the motives and even the character of individuals on both sides of the issue." Some conservative Christian political and social lobbying groups such as Focus on the Family, the Family Research Council, and the American Family Association actively promote to their constituencies the accounts of change of conversion therapies.
Individuals who feel conversion therapy has been helpful have felt oppressed by LGBT activists opposed to conversion therapy.  They have protested the policies of the APA, stating that their views on issues such as the immutability of homosexuality have caused real harm to real people and patients. A. Dean Byrd commented "There exists a climate of prejudice in APA against clients -- often people of traditional values -- who wish to decrease their homosexual attractions and develop their heterosexual potential." In 2008, the organizers, including a gay psychiatrist, of an APA panel on the relationship between religion and homosexuality canceled the event after gay activists objected that "conversion therapists and their supporters on the religious right use these appearances as a public relations event to try and legitimize what they do."
Psychologist John Gonsiorek called the position espoused by the Christian right hypocritical. He wrote "some conservative Christian institutions actively foster social conditions to maximize distress for such clients about their sexual orientations, and these institutions simultaneously promote conversion therapy as the solution to this distress."
The development of theoretical models of sexual orientation in non-U.S. countries with established mental health professions often tracks the history within the U.S. (although often at a slower pace) as a shift from pathological to non-pathological conceptions of homosexuality.
The World Health Organization's ICD-10, which along with the DSM-IV is widely used internationally, states that "sexual orientation by itself is not to be regarded as a disorder". It lists ego-dystonic sexual orientation as a disorder instead, which it defines as occurring where "the gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it." The APA dropped ego-dystonic homosexuality from the DSM-IV in 1987 and opposes the diagnosis of either homosexuality or ego-dystonic homosexuality as any type of disorder.
Western psychiatry and psychology were imported during a "Westernization Movement" in the late 19th century. That homosexuality was a mental disorder thus became the prevailing view in China. These views lasted throughout the 1970s, despite changed theoretical models of sexuality orientation in the West, during a period when the Chinese government held a "closed-door" policy on information about human sexuality. After 1980, information became more available, and views began to change. In 2000 and under pressure from both the APAs and the ACA, the Chinese Classification of Mental Disorders (CCMD-III) declassified homosexuality, but added a diagnosis resembling ego-dystonic sexual orientation. Attempts at conversion therapy are rare in China.
In 2008 German Bundestag decided that conversion therapy is dangerous and does not help. 
In India, psychiatry and psychology scholars have "preserved an almost complete silence on the subject of homosexuality". Aversion therapy continues to be used.  One paper discusses behavior modification methods used to treat the sexual orientation of thirteen gay patients. They use the WHO classification of egodystonic sexual orientation, but the People's Union for Civil Liberties reports that doctors will often diagnosis the patient as egodystonic even if the patient really is egosyntonic.
In Norway the shift from a pathological to non-pathological view of homosexuality began in the 1970s, following the APA's declassification in 1973. In 2000, the General Assembly of the Norwegian Psychiatric Association overwhelmingly voted for the following position statement on conversion therapy: "Homosexuality is no disorder or illness, and can therefore not be subject to treatment. A treatment with the only aim of changing sexual orientation from homosexual to heterosexual must be regarded as ethical malpractice, and has no place in the health system." 
In the 1970s and 1980s, the South African Defence Force administered aversion therapy to people who were suspected of being gay. 
United Kingdom and Ireland
In 1952, the British government subjected Alan Turing to hormonal treatment after he was arrested for having sex with a man.
In 2007, the Royal College of Psychiatrists, the main professional organization of psychiatrists in the United Kingdom and Ireland, issued a report stating that: "Evidence shows that LGB people are open to seeking help for mental health problems. However, they may be misunderstood by therapists who regard their homosexuality as the root cause of any presenting problem such as depression or anxiety. Unfortunately, therapists who behave in this way are likely to cause considerable distress. A small minority of therapists will even go so far as to attempt to change their client's sexual orientation. This can be deeply damaging. Although there is now a number of therapists and organisation in the USA and in the UK that claim that therapy can help homosexuals to become heterosexual, there is no evidence that such change is possible." 
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies) (PDF). American Psychiatric Association (May 2000). Retrieved on 2007-08-28.
- ↑ 2.0 2.1 2.2 For a Better Understanding of Sexual Orientation and Homosexuality (PDF). American Psychological Association. Retrieved on 2008-02-14. â€œTo date, there has been no scientifically adequate research to show that therapy aimed at changing sexual orientation (sometimes called reparative or conversion therapy) is safe or effective.â€
- ↑ 3.0 3.1 Janov, Arthur. (1977). The Primal Scream. New York: Abacus. ISBN 0-349-11834-5.
- ↑ 4.0 4.1 Nicolosi, Joseph (1991). Reparative Therapy of Male Homosexuality: A New Clinical Approach. Northvale, NJ: J. Aronson. ISBN 0876685459.
- ↑ The Use of EMDR with Reparative Therapy
- ↑ 6.0 6.1 LeVay, Simon (1996). Queer Science: The Use and Abuse of Research Into Homosexuality. Cambridge, MA: MIT Press. ISBN 0262121999.
- ↑ Gay, Peter (1995). The Freud Reader. London: Vintage. ISBN 0099577119.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Yoshino, Kenji (2002-01). "Covering". Yale Law Journal 111 (4): 179 et seq..
- ↑ 9.0 9.1 9.2 Katz, Jonathan (1976). Gay American history: lesbians and gay men in the U.S.A.: a documentary anthology. New York: Crowell, 129. ISBN 0690005105.
- ↑ Daniel, F.E. (1893). "Castration of Sexual Perverts". Texas Medical Journal 9: 255â€“71.
- ↑ Talbot, E.S.; Ellis, Havelock (1896). "A Case of Developmental Degenerative Insanity, with Sexual Inversion, Melancholia, Following Removal of Testicles, Attempted Murder and Suicide". Journal of Mental Science 42: 341â€“44.
- ↑ (1929) "Results of Castration in Sexual Abnormalities". Urologic & Cutaneous Review 33: 351.
- ↑ ï»¿Sharp, Harry Clay. "The Sterilization of Degenerates". National Christian League for Promotion of Purity.
- ↑ (1904) "The Gentleman Degenerate. A Homosexualist's Self-Description and Self-Applied Title. Pudic Nerve Section Fails Therapeutically". Alienist & Neurologist 25: 68â€“70.
- ↑ Friedlander, Joseph; Banay, Ralph S. (1948). "Psychosis Following Lobotomy in a Case of Sexual Psychopathology; Report of a Case". Archives of Neurology & Psychiatry 59: 303â€“11, 315, 321.
- ↑ Rosenzweig, Saul; Hoskins, R.G. (1941). "A Note on the Ineffectualness of Sex-Hormone Medication in a Case of Pronounced Homosexuality". Psychosomatic Medicine 3: 87â€“89.
- ↑ Owensby, Newdigate M. (1940). "Homosexuality and Lesbianism Treated with Metrazol". Journal of Nervous & Mental Disease 92: 65â€“66.
- ↑ Cautela, Joseph R. (1967). "Covert Sensitization". Psychology Report 20: 464â€“65.
- ↑ 19.0 19.1 Rutner, Ivan T. (1970). "A Double-Barrel Approach to Modification of Homosexual Behavior". Psychology Report 26: 256â€“58. PMID 5486305.
- ↑ McConaghy, Nathaniel; Armstrong, Michael S.; Blaszczynsky, Alex (1981). "Controlled Comparison of Aversive Therapy and Covert Sensitization in Compulsive Homosexuality". Behavior Response & Therapy 19: 425. doi:10.1016/0005-7967(81)90132-7. PMID 7316919.
- ↑ Max, Louis William (1935). "Breaking Up a Homosexual Fixation by the Condition Reaction Technique: A Case Study". Psychology Bulletin 32: 734.
- ↑ Liebman, Samuel (1967). "Homosexuality, Transvestism, and Psychosis: Study of a Case Treated with Electroshock". Journal of Nervous & Mental Disease 99: 945â€“57.
- ↑ Duberman, Martin (1992). Cures: A Gay Man's Odyssey. New York: Plume, 93â€“115, 118-24. ISBN 0452267803.
- ↑ Harms, Ernest (1953). "Homo-Anonymous". Diseases and the Nervous System 14: 318,19. PMID 13095274.
- ↑ Hadden, Samuel B. (1957). "Attitudes Toward and Approaches to the Problem of Homosexuality". Pennsylvania Medical Journal 6: 1195,98. PMID 13465269.
- ↑ Smith, Alexander B.; Bassin, Alexander (1959). "Group Therapy with Homosexuals". Journal of Social Therapy 5: 227, 231,32.
- ↑ Quackenbos, John Duncan (1899). "Hypnotic Suggestion in the Treatment of Sexual Perversions and Moral Anaesthesia: A Personal Experience". Transactions of the New Hampshire Medical Society 108: 69, 72, 75, 78,80.
- ↑ Miller, Michael M. (1963). "Hypnotic-Aversion Treatment of Homosexuality". Journal of the National Medical Association 55: 411,13, 415. PMID 14049556.
- ↑ Brill, A.A. (1913). "The Conception of Homosexuality". JAMA 61: 335,40.
- ↑ Stekel, Wilhelm (1930). "Is Homosexuality Curable?". Psychoanalytic Review 17: 443, 447,48.
- ↑ Drescher, Jack (June 1998). "I'm Your Handyman: A History of Reparative Therapies". Journal of Homosexuality 36 (1): 19â€“42. doi:10.1300/J082v36n01_02.
- ↑ Rado, S. (1940), A critical examination of the concept of bisexuality. Psychosomatic Medicine, 2:459,467. Reprinted in: Sexual Inversion: The Multiple Roots of Homosexuality, ed. J. Marmor. New York: Basic Books, 1965, pp. 175,189.
- ↑ Socarides, Charles (1968). The Overt Homosexual. New York: Grune & Stratton. ISBN 080890437X.
- ↑ Irving Bieber, Homosexuality: A Psychoanalytic Study of Male Homosexuals, Basic Books Inc, 1962
- ↑ Hooker, Evelyn (March 1957). "The adjustment of the male overt homosexual". Journal of projective techniques 21 (1): 18â€“31. PMID 13417147.
- ↑ Kirby, Michael (December 2003). "The 1973 deletion of homosexuality as a psychiatric disorder: 30 years on". Australian & New Zealand Journal of Psychiatry 37 (6): 674,677. doi:10.1111/j.1440-1614.2003.01269.x. â€œOn the basis of excellent sampling and statistical methods, [Hooker] published her influential paper 'The Adjustment of the Male Overt Homosexual'... â€ , p. 675.
- ↑ 37.0 37.1 37.2 Seligman, Martin E.P. (1994). What You Can Change and What You Can't: The Complete Guide to Self Improvement. New York: Knopf, 156,157. ISBN 0-679-41024-4.
- ↑ Kovel, Joel (1991). A Complete Guide to Therapy: From Psychoanalysis to Behaviour Modification, p.188-198.
- ↑ Rosen, R. D. (1977). Psychobabble: Fast Talk and Quick Cure in the Era of Feeling, p.154-217.
- ↑ Pendergrast, Mark (1995). Victims of Memory: Incest Accusations and Shattered Lives, p.442-443.
- ↑ "An Instant Cure", Time, 1974-04-01. Retrieved on 2007-10-29.
- ↑ K.H.. "Panelists Recount Events Leading to Deleting Homosexuality As a Psychiatric Disorder From DSM", Psychiatric News. Retrieved on 2007-10-29.
- ↑ 43.0 43.1 43.2 Shidlo, Ariel; Schroeder, Michael; Drescher, Jack (2001). Sexual Conversion Therapy: Ethical, Clinical, and Research Perspectives. New York: Haworth Medical Press. ISBN 0789019108.
- ↑ Chenier, Elise (2004). "Aversion Therapy". glbtq: An Encyclopedia of Gay, Lesbian, Bisexual, Transgender, and Queer Culture. Ed. Summers, Claude J.. Chicago: glbtq, Inc.. Retrieved on 2007-08-28.
- ↑ Moberly, Elizabeth R. (1983). Psychogenesis: The Early Development of Gender Identity. London: Routledge & Kegan Paul Ltd.. ISBN 0710092717.
- ↑ 46.0 46.1 Moberly, Elizabeth R. (1983). Homosexuality: A new Christian ethic. Cambridge: James Clarke. ISBN 0227678508.
- ↑ GLAAD. GLAAD Media Reference Guide (PDF). Retrieved on September 2006.
- ↑ Crow, C.. "Irate reader's expert on gays has drawn fire from his peers", San Antonio Express-News, 2004-11-20.
- ↑ 49.0 49.1 49.2 49.3 Haldeman, Douglas C. (June 2002). "Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy". Professional Psychology: Research and Practice 33 (3): 260â€“264. doi:10.1037//0735-7028.33.3.260.
- ↑ 50.0 50.1 50.2 50.3 50.4 Bright, Chuck (December 2004). "Deconstructing Reparative Therapy: An Examination of the Processes Involved When Attempting to Change Sexual Orientation". Clinical Social Work Journal 32 (4): 471,481. doi:10.1007/s10615-004-0543-2.
- ↑ Isay, R.A. (1989), Being Homosexual: Gay Men and Their Development. New York: Farrar, Straus and Giroux.
- ↑ Domenici, T. & Lesser, R.C., eds. (1995), Disorienting Sexuality: Psychoanalytic Reappraisals of Sexual Identities. New York: Routledge.
- ↑ Drescher, J. (1998), Psychoanalytic Therapy and the Gay Man. Hillsdale, NJ: The Analytic Press.
- ↑ Exodus International Policy Statements. Exodus International. Retrieved on 2007-08-28.
- ↑ Smith, Glenn; Bartlett, Annie; King, Michael (January 2004). "Treatments of homosexuality in Britain since the 1950s -- An oral history: the experience of patients". BMJ 328: 427. doi:10.1136/bmj.37984.442419.EE. PMID 14751921.
- ↑ 56.0 56.1 56.2 56.3 56.4 56.5 Just the Facts About Sexual Orientation & Youth: A Primer for Principals, Educators and School Personnel. American Academy of Pediatrics, American Counseling Association, American Association of School Administrators, American Federation of Teachers, American Psychological Association, American School Health Association, The Interfaith Alliance, National Association of School Psychologists, National Association of Social Workers, National Education Association (1999). Retrieved on 2007-08-28.
- ↑ 57.0 57.1 H., K.. "APA Maintains Reparative Therapy Not Effective", Psychiatric News (news division of the American Psychiatric Association), 1999-01-15. Retrieved on 2007-08-28.
- ↑ 58.0 58.1 58.2 58.3 58.4 Resolution on Appropriate Therapeutic Responses to Sexual Orientation. American Psychological Association (1997-08-14). Retrieved on 2007-08-28.
- ↑ Norcross, John C.; Koocher, Gerald P.; Garofalo, Ariele (October 2006). "Discredited Psychological Treatments and Tests: A Delphi Poll". Professional Psychology: Research and Practice 37 (5): 512,522. doi:10.1037/0735-7028.37.5.515.
- ↑ See Conversion therapy#Ethics guidelines.
- ↑ American Medical Association policy regarding sexual orientation. American Medical Association (2007-07-11). Retrieved on 2007-07-30.
- ↑ (1993) "Homosexuality and Adolesence" (PDF). Pediatrics, Official Journal of the American Academy of Pediatrics 92: 631â€“634. Retrieved on 2007-08-28.
- ↑ Physician Assistants vote on retail clinics, reparative therapy. SpiritIndia.com. Retrieved on 2007-08-28.
- ↑ http://www.washingtontimes.com/news/2007/jul/11/gay-reparative-therapy-under-scrutiny/
- ↑ Whitman, Joy S.; Glosoff, Harriet L.; Kocet, Michael M.; Tarvydas, Vilia (2006-05-22). Ethical issues related to conversion or reparative therapy. American Counseling Association. Retrieved on 2007-08-28.
- ↑ 66.0 66.1 Nicolosi, Joseph; Byrd, A. Dean; Potts, Richard W. (June 2000). "Retrospective self-reports of changes in homosexual orientation: A consumer survey of conversion therapy clients" 86: 1071,1088. Psychological Reports.
- ↑ Luo, Michael. "Some Tormented by Homosexuality Look to a Controversial Therapy", The New York Times, 2007-02-12, p. 1. Retrieved on 2007-08-28.
- ↑ 68.0 68.1 68.2 Shidlo; Schroeder, Michael (2002). "Changing Sexual Orientation: A Consumers Report". Professional Psychology: Research and Practice 33 (3): 249â€“259. doi:10.1037//0735-7028.33.3.249.
- ↑ 365Gay.com Newscenter Staff. "APA Discredits 'Ex-Gay' Movement", 365Gay Newscenter, 2006-08-11. Retrieved on 2007-04-14.
- ↑ Halpert, Stephen C. (January 2000). ""If It Ain't Broke, Don't Fix It": Ethical Considerations Regarding Conversion Therapies". International Journal of Sexuality and Gender Studies 5 (1): 19â€“35. doi:10.1023/A:1010133501054.
- ↑ Ethical Principles of Psychologists and Code of Conduct. American Psychological Association (2003-06-01). Retrieved on 2007-08-28.
- ↑ Beckstead, A. Gay is not me: Seeking Congruence Through Sexual Reorientation Therapy. (Unpublished master's thesis, University of Utah, 1999).
- ↑ Rogers H., Wright; Cummings, Nicolas A. (2005). Destructive Trends in Mental Health. New York: Routledge. ISBN 0415950864.
- ↑ 74.0 74.1 See generally Yarhouse, Mark A.; Throckmorton, Warren (2002). "Ethical Issues in Attempts to Ban Reorientation Therapies" (PDF). Psychotherapy: Theory/Research/Practice/Training 39 (1): 66â€“75. doi:10.1037//0033-3188.8.131.52. Retrieved on 2007-08-28. â€œOne of the most frequently cited arguments in support of a client's right to choose change therapy is the freedom and self-determination of the client...â€
- ↑ ABOUT EX-GAY MINISTRIES By David Williams Accessed September 14, 2008
- ↑ Melzera, Eartha. "Tenn. opens new probe of a ex-gay facility: Experts say children should not be forced into counseling", Washington Blade, 2005-07-01. Retrieved on 2007-08-28.
- ↑ Williams, Alex. "Gay Teenager Stirs a Storm", New York Times, 2005-07-17. Retrieved on 2007-10-06.
- ↑ Popper, Ben. "Love in Court: Gay-to-straight ministry and the state go to court", Memphis Flyer, 2006-02-10. Retrieved on 2007-08-28.
- ↑ Tennessee closes down Christian ex-gay camp for treating mental illness without a license, WikiNews, 09-21-2005. Retrieved on 2007-02-08.
- ↑ Cianciotto, J.; Cahill, S. (2006). Youth in the crosshairs: the third wave of ex-gay activism (pdf). National Gay and Lesbian Task Force. Retrieved on 2007-08-29.
- ↑ Talbot, T. Reparative therapy for homosexual teens: the choice of the teen should be the only choice discussed, 27 J. Juv. L. 33. 2006.
- ↑ Cohan, J. Parental Duties and the Right of Homosexual Minors to Refuse "Reparative" Therapy, 11 Buff. Women's L.J. 67, 2002.
- ↑ 83.0 83.1 Gans, Laura A. (Winter 1999). "Inverts, Perverts, and Converts: Sexual Orientation Conversion Therapy and Liability". The Boston University Public Interest Law Journal 8.
- ↑ Bansal, Monisha. Psychologists Disagree Over Therapy for Homosexuals. Cybercast News Service. Retrieved on 2007-08-28.
- ↑ The Surgeon General's call to Action to Promote Sexual Health and Responsible Sexual Behavior", A Letter from the Surgeon General U.S. Department of Health and Human Services, 2001-07-09. Retrieved 2007-03-29.
- ↑ Yeoman, Barry. "Gay No More", Psychology Today, 1999-03/04, p. 5. Retrieved on 2007-08-28.
- ↑ http://www.nytimes.com/2007/02/12/nyregion/12group.html?pagewanted=print
- ↑ Can Some Gay Men and Lesbians Change Their Sexual Orientation? 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation (Archives of Sexual Behavior, October 2003, p.403-417) PMID 14567650
- ↑ http://www.upcsa.org.za/assembly_papers/Human_sexuality/Attempts%20to%20Modify%20Sexual%20Orientation.pdf
- ↑ How to Find the Right Counselor for You
- ↑ Therapy
- ↑ Spitzer, Robert L. (October 2003). "Can Some Gay Men and Lesbians Change Their Sexual Orientation? 200 Participants Reporting a Change from Homosexual to Heterosexual Orientation". Archives of Sexual Behavior 32 (5): 403,417. doi:10.1023/A:1025647527010. PMID 14567650.
- ↑ 93.0 93.1 93.2 93.3 93.4 Attempts To Change Sexual Orientation. University of California, Davis Department of Psychology. Retrieved on 2007-08-28.
- ↑ Robinson, B.A. (2006-06-04). Analysis of Dr. Spitzer's Study of Reparative Therapy. Ontario Consultants on Religious Tolerance. Retrieved on 2007-08-28.
- ↑ Draper, Electra. "Focus on Family: Sexual orientation can change", The Denver Post, 2007-09-18. Retrieved on 2007-10-29.
- ↑ Hall, Randy. "Changing Sexual Orientation Is Possible, New Research Says", CNS News, 2007-09-17. Retrieved on 2007-10-29.
- ↑ Sells, Heather. "Study Says Gays Can Change Orientation", Christian Broadcasting Network, 2008-02-23.
- ↑ Haldeman, Douglas (December 1999). "The Pseudo-science of Sexual Orientation Conversion Therapy" (PDF). The Policy Journal of the Institute for Gay and Lesbian Strategic Studies 4 (1): 1â€“4. Retrieved on 2007-08-28.
- ↑ Mondimore, Francis Mark (1996). A natural history of homosexuality. Baltimore: Johns Hopkins University Press. ISBN 0801853494.
- ↑ Bluely, Robert. "Documents Reveal San Francisco Mayor's Ties to Homosexual Activists", Cybercast News Service, 2004-07-21. Retrieved on 2007-11-01.
- ↑ "APA Convention Targeted for Protest; APA Focused More on Political Correctness Than Helping Patients, Group Says", U.S. Newswire, August 2006.
- ↑ "Homosexual change is focus of protest", Deseret News, 2006-08-12.
- ↑ Plowman, William. "Homosexuality Panel Squelched by Gay Activists", NPR, 2008-05-12.
- ↑ Robinson backs out of symposium on "ex-gays" - Washington Blade
- ↑ Gonsiorek, John (2004). "Reflections From the Conversion Therapy Battlefield" 32: 751. The Counseling Psychologist.
- ↑ See generally (2003) "Special Issue on the Mental Health Professions and Homosexuality". Journal of Gay & Lesbian Psychotherapy 7 (1/2). Haworth Medical Press. .
- ↑ 107.0 107.1 ICD-10, Chapter V: Mental and behavioural disorders: Disorders of adult personality and behaviour. World Health Organization (2007). Retrieved on 2007-08-28.
- ↑ APA Council of Representatives (1987-08-30). APA Policy Statement: Use of Diagnoses "Homosexuality" & "Ego-Dystonic Homosexuality". American Psychological Association. Retrieved on 2007-08-28.
- ↑ Wu, Jin (2003). "From Long Yang and Dui Shi to Tongzhi: Homosexuality in China". Journal of Gay & Lesbian Psychotherapy 7 (1/2): 117â€“143. Haworth Medical Press. doi:10.1300/J236v07n01_08.
- ↑ "Homosexuality Depathologized in China", Chinese Society for the Study of Sexual Minorities News Digest, 2001-03-05. Retrieved on 2007-08-28.
- ↑ [http://dip21.bundestag.de/dip21/btd/16/080/1608022.pdf German Bundestag:Antihomosexuelle Seminare und pseudowissenschaftliche Therapieangebote religiÃ¶ser Fundamentalisten (German)]
- ↑ Parekh, Suresh (2003). "Homosexuality in India: The Light at the End of the Tunnel". Journal of Gay & Lesbian Psychotherapy 7 (1/2): 153. Haworth Medical Press. doi:10.1300/J236v07n01_09.
- ↑ Chandran, Vinay (February 2006). Prayer, punishment or therapy? Being a homosexual in India. InfoChange News & Features. Retrieved on 2007-08-28. â€œWhile social attitudes are slowly changing [in India] and the anti-sodomy law is being challenged, mental health professionals in many places still offer therapy to homosexuals.â€
- ↑ Pradhan, P.V.; Ayyar, K.S.; Bagadia, V.N. (1982). "Homosexuality: Treatment by behaviour modification". Indian Journal of Psychiatry 24 (1): 80â€“83.
- ↑ Human rights violations against sexuality minorities in India (PDF). People's Union for Civil Liberties (February 2001).
- ↑ KjÃ¦r, Reider (2003). "Look to Norway? Gay Issues and Mental Health Across the Atlantic Ocean". Journal of Gay & Lesbian Psychotherapy 7 (1/2): 55â€“73. Haworth Medical Press. doi:10.1300/J236v07n01_05.
- ↑ Thinking Anglicans, 13 September 2008 | 
Pro-conversion therapy perspectives
- "Homosexuality & Hope Catholic Medical Association
- Christian Anthropology and Homosexuality
- Evergreen International
- Exodus International a Christian ex-gay organization
- National Association for Research & Therapy of Homosexuality
- People Can Change
- International Healing Foundation
Mainstream scientific community perspectives
- American Academy Of Paediatrics ("Therapy directed specifically at changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation.")
- American Counseling Association ("Research does not support conversion therapy as an effective treatment modality.... There is potential for harm when clients participate in conversion therapy.")
- American Psychiatric Association ("In the last four decades, 'reparative' therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm.")
- American Psychological Association ("Mental health professional organizations call on their members to respect a personâ€™s (clientâ€™s) right to self determination")
- Joint coalition of health organizations ("[H]ealth and mental health professional organizations do not support efforts to change young people's sexual orientation through 'reparative therapy' and have raised serious concerns about its potential to do harm.)
- World Health Organization (Those with an egodystonic sexual orientation "may seek treatment in order to change it".)
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