align with biological sex, sexual behavior or actual sexual orientation. While the Centre for Addiction and Mental Health and American Psychiatric Association state that sexual orientation is innate, continuous or fixed throughout their lives for some people, but is fluid or changes over time for others, the American Psychological Association distinguishes between sexual orientation (an innate attraction) and sexual orientation identity (which may change at any point in a person's life). Scientists and mental health professionals generally do not believe that sexual orientation is a choice. The American Psychological Association states that "sexual orientation is not a choice that can be changed at will, and that sexual orientation is most likely the result of a complex interaction of environmental, cognitive and biological factors...is shaped at an early age...[and evidence suggests] biological, including genetic or inborn hormonal factors, play a significant role in a person's sexuality." They say that "sexual orientation identity—not sexual orientation—appears to change via psychotherapy, support groups, and life events." The American Psychiatric Association says individuals may "become aware at different points in their lives that they are heterosexual, gay, lesbian, or bisexual" and "opposes any psychiatric treatment, such as 'reparative' or 'conversion' therapy, which is based upon the assumption that homosexuality per se is a mental disorder, or based upon a prior assumption that the patient should change his/her homosexual orientation". They do, however, encourage gay affirmative psychotherapy. In the first decade of the 2000s, psychologist Lisa M. Diamond studied 80 non-heterosexual women over several years. She found that in this group, changes in sexual identity were common, although they were typically between adjacent identity categories (such as 'lesbian' and 'bisexual'). Some change in self-reported sexual feeling occurred among many of the women, but it was small, only averaging about 1 point on the Kinsey scale on average. The range of these women's potential attractions was limited by their sexual orientations, but sexual fluidity permitted movement within that range. In her book Sexual Fluidity, which was awarded with the 2009 Lesbian, Gay, Bisexual, and Transgender Issues Distinguished Book Award by Division 44 of the American Psychological Association, Diamond speaks of female sexuality and trying to go beyond the language of "phases" and "denial", arguing that traditional labels for sexual desire are inadequate. For some of 100 non-heterosexual women she followed in her study over a period of 10 years, the word bisexual did not truly express the