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Conversion therapy is the pseudoscientific practice of attempting to change an individual's sexual orientation from homosexual or bisexual to heterosexual or their gender identity from transgender to cisgender using psychological, physical, or spiritual interventions. There is no reliable evidence that sexual orientation or gender identity can be changed, and medical institutions warn that conversion therapy practices are ineffective and potentially harmful. Medical, scientific, and government organizations in the United States and the United Kingdom have expressed concern over the validity, efficacy and ethics of conversion therapy. Various jurisdictions around the world have passed laws against conversion therapy. The American Psychiatric Association (APA) encourages legislation which would prohibit psychiatric treatment "based on the a priori assumption that diverse sexual orientations and gender identities are mentally ill and should change" and describes attempts to change a person's sexual orientation by practitioners as unethical. In 2015, the American Psychological Association and the Substance Abuse and Mental Health Services Administration collaborated on a report stating "conversion therapy—efforts to change an individual’s sexual orientation, gender identity, or gender expression—is a practice that is not supported by credible evidence and has been disavowed by behavioral health experts and associations. Conversion therapy perpetuates outdated views of gender roles and identities as well as the negative stereotype that being a sexual or gender minority or identifying as LGBTQ is an abnormal aspect of human development. Most importantly, it may put young people at risk of serious harm."Contemporary clinical techniques used in the United States have been limited to counseling, visualization, social skills training, psychoanalytic therapy, and spiritual interventions such as "prayer and group support and pressure", though there are some reports of aversive treatments through unlicensed practice as late as the early 2000s, sometimes with residential structure. The term reparative therapy has been used as a synonym for conversion therapy in general, but it has been argued that, strictly speaking, it refers to a specific kind of therapy associated with the psychologists Elizabeth Moberly and Joseph Nicolosi. Techniques that were used in the past in the United States and Western Europe have included ice-pick lobotomies; chemical castration with hormonal treatment; aversive treatments, such as "the application of electric shock to the hands and/or genitals"; "nausea-inducing drugs ... administered simultaneously with the presentation of homoerotic stimuli"; and masturbatory reconditioning.