The Supreme Court ruled Tuesday that states do not have the authority to ban licensed therapists from subjecting LGBTQ children to a scientifically discredited practice that every major medical association in the country calls harmful, ineffective, and a form of child abuse.
In an 8-1 decision, the justices sided with a Christian counselor in Colorado who argued that her right to free speech under the First Amendment allows her to counsel minors who want to “reduce or eliminate unwanted sexual attractions.” The ruling effectively dismantles laws in more than 20 states that had prohibited licensed professionals from attempting to change the sexual orientation or gender identity of young people.
The practice known as conversion therapy has been linked to suicide attempts at rates nearly twice those of peers who never underwent it. A study published this year by the American Medical Association found that 42% of those subjected to the practice attempted suicide, compared with 5% of those who were not. The United Nations has called it torture.
None of that mattered to the majority.
Justice Neil Gorsuch, writing for the court, said Colorado’s 2019 law violated the First Amendment because it “censors speech based on viewpoint.” The state, Gorsuch wrote, cannot “enforce orthodoxy in thought or speech.”
Only Justice Ketanji Brown Jackson dissented. She read her opinion from the bench, a rare public display of disagreement that signaled the gravity of what she called a “dangerous can of worms.” States, she warned, will now find themselves hamstrung when trying to regulate medical care, whether it involves a therapist telling a 13-year-old that God made him wrong or a doctor giving fraudulent medical advice.
“This decision might make speech-only therapies and other medical treatments involving practitioner speech effectively unregulatable,” Jackson wrote. She accused her colleagues of making “this momentous decision without adequately grappling with the potential long-term and disastrous implications.”
The case began in 2022 when Kaley Chiles, an evangelical Christian therapist in Colorado Springs, sued the state over a law that prohibited her from helping young patients who, she said, wanted to live in accordance with their faith. Chiles said she did not seek to “cure” clients of same-sex attractions but rather to help those who came to her with what she called “unwanted” feelings.
Colorado’s law carried fines of up to $5,000 per violation and the potential loss of a counselor’s license. It included an exemption for religious ministry. No one had ever been penalized under it.
Chiles was represented by the Alliance Defending Freedom, the same conservative legal organization that successfully argued before the same court in 2023 that a Colorado web designer had a First Amendment right to refuse to create wedding websites for same-sex couples. The Trump administration backed Chiles in court.
The ruling lands at the intersection of two competing principles that have divided the court for years: the government’s long-established authority to regulate the conduct of licensed professionals and the First Amendment’s protection of speech.
Colorado argued that it was not censoring ideas but regulating medical practice, something states have done since the nation’s founding. A therapist’s advice to a patient, the state contended, is not abstract political speech but professional conduct subject to standards designed to protect the public from harm.
The majority disagreed. Gorsuch wrote that the law “trains directly on the content of her speech and permits her to express some viewpoints but not others.”
Justice Elena Kagan, joined by Justice Sonia Sotomayor, filed a concurring opinion that appeared intended to limit the reach of the decision. Kagan wrote that the law was unconstitutional because it suppressed “one side of a debate while aiding the other.”
But the debate in question, as the scientific record makes clear, is not a genuine debate at all. It is a collision between evidence and belief.
The term “conversion therapy” itself is a misnomer, according to medical professionals who have spent decades trying to erase it from practice. There is no therapy in conversion therapy. There is only a collection of interventions—talk therapy, aversion techniques, electric shocks, induced nausea, hypnosis, and in the darker chapters of its history, chemical castration and lobotomy—all built on the foundational lie that something is broken in a child who is gay or transgender.
The practice is rooted in the belief that LGBTQ people are somehow inferior, morally or physically, and must be fixed. The Pan American Health Organization declared in 2012 that conversion therapy had no medical justification and represented a severe threat to health and human rights. The World Psychiatric Association said in 2016 that “there is no sound scientific evidence that innate sexual orientation can be changed.”
The Williams Institute at UCLA estimates that as of 2019, about 700,000 LGBTQ adults in the United States had undergone conversion therapy. About half received it as adolescents.
What those numbers do not capture is the aftermath. The depression. The post-traumatic stress. The indelible scars on body and mind from being told by a trusted authority figure that who you are is a sin to be corrected. The children who were shackled, beaten, deprived of food, subjected to exorcisms. The ones who did not survive.
The court’s decision does not only affect Colorado. It casts doubt on similar laws in nearly 30 states, many of which were passed over the past decade as evidence mounted that the practice caused lasting psychological harm. In one stroke, the court has told those states that their efforts to protect children from what the UN calls torture may be unconstitutional.
Jaymes Black, CEO of the Trevor Project, which provides suicide prevention services to LGBTQ youth, said in a statement that the ruling “will put young lives at risk.”
“These efforts, no matter what proponents call them, no matter what any court says, are still proven to cause lasting psychological harm,” Black said.
Chiles, the therapist who brought the case, hailed the decision. In a statement, she said she had turned away families whose children were struggling with sexual identity because she feared running afoul of the law. “Counselors walking alongside these young people shouldn’t be limited to promoting state-approved goals like gender transition,” she said.
There is no evidence that Chiles, or any therapist practicing conversion therapy, is being asked to promote gender transition. The Colorado law she challenged did not require any therapist to affirm a child’s gender identity. It simply prohibited licensed professionals from using their credentials to tell a child that their fundamental identity is a problem to be solved.
The decision is the latest in a string of rulings in which the court’s conservative majority has expanded religious liberty claims while narrowing protections for LGBTQ people. In 2022, the court allowed a high school football coach to pray at the 50-yard line after games. In 2023, it ruled for the web designer in Colorado who did not want to work with same-sex couples. Last term, it upheld a Tennessee law banning certain gender-affirming medical treatments for transgender minors.
Now, it has ruled that a state cannot stop a licensed professional from using speech to try to change who a child is.
Colorado Attorney General Phil Weiser warned last year that a ruling against his state would open a “dangerous Pandora’s box” that could extend far beyond conversion therapy. If states cannot regulate speech by licensed professionals, he argued, then they cannot regulate lawyers giving bad legal advice or financial advisers making fraudulent claims.
The court did not address that broader question directly. It sent the case back to the lower courts to determine whether Colorado’s law meets a strict legal standard that few laws survive.
But the message was clear. A state can no longer tell a licensed therapist that they cannot counsel a child to suppress who they are, even when the evidence shows that such fraudulent counseling leaves lasting scars.
A state can no longer protect citizens from torture, even when the consensus of medical science is unanimous, or when children die as a result.
The First Amendment, Gorsuch wrote, “stands as a shield against any effort to enforce orthodoxy in thought or speech in this country.”
On Tuesday, that shield protected a form of speech that, by every credible measure, has done nothing but harm. The children the shield was meant to protect were left on the other side of it, exposed.