Yesterday, by a rare vote of 8-1, the Supreme Court struck down Colorado’s ban on “conversion therapy” for minors (we’re talking about a ban on speech, not medical procedures). Judge Ketanji Brown Jackson dissented, breaking from her two liberal colleagues.
The background: in 2019, Colorado passed a bill banning “conversion therapy for a minor” (HB19-1129), which you can see here. it defined “conversion therapy” this way:
(5.5) (a) “CONVERSION THERAPY” MEANS ANY PRACTICE OR TREATMENT BY A LICENSED PHYSICIAN SPECIALIZING IN THE PRACTICE OF PSYCHIATRY THAT ATTEMPTS OR PURPORTS TO CHANGE AN INDIVIDUAL’S SEXUAL ORIENTATION OR GENDER IDENTITY, INCLUDING EFFORTS TO CHANGE BEHAVIORS OR GENDER EXPRESSIONS OR TO ELIMINATE OR REDUCE SEXUAL OR ROMANTIC ATTRACTION OR FEELINGS TOWARD INDIVIDUALS OF THE SAME SEX.
(b) “CONVERSION THERAPY” DOES NOT INCLUDE PRACTICES OR TREATMENTS THAT PROVIDE:
(I) ACCEPTANCE, SUPPORT, AND UNDERSTANDING FOR THE FACILITATION OF AN INDIVIDUAL’S COPING, SOCIAL SUPPORT, AND IDENTITY EXPLORATION AND DEVELOPMENT, INCLUDING SEXUAL ORIENTATION-NEUTRAL INTERVENTIONS TO PREVENT OR ADDRESS UNLAWFUL CONDUCT OR UNSAFE SEXUAL PRACTICES, AS LONG AS THE COUNSELING DOES NOT SEEK TO CHANGE SEXUAL ORIENTATION OR GENDER IDENTITY; OR
(II) ASSISTANCE TO A PERSON UNDERGOING GENDER TRANSITION.
This is aimed only at minors—people under 18. Conversion therapy was not characterized as a criminal offense, but as a violation of professional discipline—a form of “unprofessional conduct” that could be punished by licensing boards, including suspension of licenses and fines.
Note that although we hear a lot about the law banning “affirmative therapy,” most of us see that as a kind of therapy that urges children who are gender dysphoric to alter their gender or their sex. But the law as written also bans “gay conversion therapy”: attempts, once in vogue when homosexuality was seen as a mental illness, to prevent people from being gay—to keep them “straight.” There are laws in 27 states and the District of Colombia, as shown in the map below from the Measurement Advancement Project, prohibiting this kind of therapy.
As the SCOTUS blog reports (as does the Supreme Court’s decision, linked below), the ban was challenged by a therapist who wanted to help her clients transition the way they wanted:
The Supreme Court on Tuesday sent a challenge to Colorado’s ban on “conversion therapy” – treatment intended to change a client’s sexual orientation or gender identity – for young people back to the lower courts for them to apply a new standard. By a vote of 8-1, the justices agreed with Kaley Chiles, the licensed counselor challenging the law, that the ban discriminates against her based on the views that she expresses in her talk therapy. A federal appeals court, Justice Neil Gorsuch wrote for the majority, should have applied a more stringent standard of review, known as strict scrutiny, to determine whether the law violates the First Amendment as applied to Chiles.
But the Supreme Court also strongly hinted that the ban would fail that test. In his 23-page opinion, Gorsuch stressed that in cases like Chiles’, Colorado’s ban “censors speech based on viewpoint.” Because the First Amendment “reflects … a judgment that every American possesses an inalienable right to think and speak freely, and a faith in the free marketplace of ideas as the best means for discovering truth,” Gorsuch continued, “any law that suppresses speech based on viewpoint represents an ‘egregious’ assault on both of those commitments.”
Justice Ketanji Brown Jackson was the lone dissenter. She argued that the majority’s opinion “could be ushering in an era of unprofessional and unsafe medical care administered by effectively unsupervised healthcare providers.”
Chiles went to federal court in Colorado to challenge the constitutionality of the 2019 law and block Colorado from enforcing it against her. She contended that she did not attempt to “convert” her clients. Instead, she said, she merely tried to help them “with their stated desires and objectives in counseling, which sometimes includes clients seeking to reduce or eliminate unwanted sexual attractions, change sexual behaviors, or grow in the experience of harmony with one’s physical body.”
A divided panel of the U.S. Court of Appeals for the 10th Circuit allowed the state to continue to enforce the law. The majority concluded that the conversion therapy ban simply regulated conduct – a licensed mental health professional’s treatment of a client – that also happened to involve speech. Therefore, the court of appeals concluded, it would review the ban using the least stringent test for constitutional challenges, known as the “rational basis” test – a relatively low bar, the court of appeals said, that the ban passed.
Chiles came to the Supreme Court in 2024, asking the justices to weigh in. On Tuesday, they reversed the 10th Circuit’s ruling and sent the case back to the lower courts for another look.
Curiously, Chiles apparently wasn’t trying to force her clients to adopt one course of action over another, but to achieve the course of action they wanted:
[Chiles] contended that she did not attempt to “convert” her clients. Instead, she said, she merely tried to help them “with their stated desires and objectives in counseling, which sometimes includes clients seeking to reduce or eliminate unwanted sexual attractions, change sexual behaviors, or grow in the experience of harmony with one’s physical body.”
The issue here is that it’s still “affirmative” in that Chiles went along with what their (minor) patients wanted rather than examining what they wanted.
The grounds for the decision were narrow: banning conversion therapy violated the First Amendment’s provision for freedom of speech (my bold below):
Gorsuch characterized the question before the justices as “a narrow one”: whether Colorado’s ban on conversion therapy violates the First Amendment as applied to the talk therapy that Chiles provides, and in particular whether the 10th Circuit was correct in applying “rational basis review” to the ban.
The Supreme Court, Gorsuch observed, “has long held that laws regulating speech based on its subject matter or ‘communicative content’ are ‘presumptively unconstitutional’” and therefore trigger strict scrutiny, which requires the government to show that a restriction on speech is narrowly tailored to serve a compelling government interest. “Under that test,” Gorsuch added, “it is ‘“rare that a regulation . . . will ever be permissible.”’”
The court has also acknowledged, Gorsuch continued, “the even greater dangers associated with regulations that discriminate based on the speaker’s point of view. When the government seeks not just to restrict speech based on its subject matter, but also seeks to dictate what particular ‘opinion or perspective’ individuals may express on that subject, ‘the violation of the First Amendment is all the more blatant,’” Gorsuch stressed. “’Viewpoint discrimination,’” Gorsuch said, “represents ‘an egregious form’ of content regulation, and governments in this country must nearly always ‘abstain’ from it.”
“Applying these principles,” Gorsuch continued, “we conclude that the courts below failed to apply sufficiently rigorous First Amendment scrutiny in this case.” First and foremost, Gorsuch wrote, although “the First Amendment protects many and varied forms of expression, the spoken word is perhaps the quintessential form of protected speech. And that is exactly the kind of expression in which Ms. Chiles seeks to engage.”
. . . The majority rejected the state’s contention that the conversion therapy ban targets conduct or medical treatments, rather than speech, and therefore should be subject to a more deferential standard of review. Although the ban “may address conduct—such as aversive physical interventions” – Gorsuch wrote, Chiles “seeks to engage only in speech, and as applied to her the law regulates what she may say,” as well as “what views she may and may not express.” “Colorado,” Gorsuch concluded, “does not regulate speech incident to conduct; it regulates ‘speech as speech.’”
Note as well that Colorado’s ban wasn’t fully negated, nor were similar bans throughout the U.S.. Rather, the case was sent back to the lower courts for reevaluation on these grounds (from Grok, with sources); the applicable appellate courts must:
- Apply strict scrutiny (the most demanding level of First Amendment review) to the law as it applies to Chiles’s talk therapy. Under this standard, Colorado bears the burden of proving that the restriction on Chiles’s speech is narrowly tailored to serve compelling state interests.
- Reconsider the case in light of the Court’s determination that the law engages in viewpoint discrimination (banning one set of views on sexual orientation/gender identity while expressly permitting the opposing “affirmative” views, such as acceptance, support, identity exploration, or assistance with gender transition).
The Court’s opinion, concurrences, and Justice Jackson’s dissent can be found by clicking on the screenshot below:
I’ll be brief here (I hope): the Court screwed up big time here, failing to recognize, as Justice Jackson said in her 35-page dissent (which she read from the bench in toto), that in the case of therapy, medical or psychological, talk is more than just speech, it’s treatment. From her dissent:
No one directly disputes that Colorado has the power to regulate the medical treatments that state-licensed professionals provide to patients. Nor is it asserted that, when doing so, a State always runs afoul of the Constitution. So, in my view, it cannot also be the case that Colorado’s decision to restrict a dangerous therapy modality that, incidentally, involves provider speech is presumptively unconstitutional. In concluding otherwise, the Court’s opinion misreads our precedents, is unprincipled and unworkable, and will eventually prove untenable for those who rely upon the long-recognized responsibility of States to regulate the medical profession for the protection of public health.
Remember that medical therapy uses speech as well. Any doctor who simply told a patient to go home and drink vinegar with herbs to treat their cancer would be guilty of professional misconduct. Note that here the doctor doesn’t do anything, but could still be punished for malpractice. The doctor must adhere to reasonable and accepted forms of treatment, and that includes treatments suggested only through speech.
Brown notes that conversion therapy is “dangerous,” and nearly everyone would agree with that vis-à-vis gay conversion therapy. It’s long been recognized by therapists and their organizations that trying to force someone out of becoming gay, instead of simply talking over the issue, is acting unethically and, insofar as this causes stress and may change someone’s life in a negative way, i.e. causing harm.
We’re beginning to recognize that the same holds for “affirmative therapy” as well. If it works, affirmative therapy puts young people on a one-way treadmill leading to to puberty blockers, then to adult hormones, and perhaps to surgery. Britain’s Cass Review, as well as studies in Scandinavian countries, have already recognized that “affirmative therapy” that leads to blockers and hormones is of unproven efficacy and could be dangerous over the long term. Insofar as talk therapy promotes these actions, then, it too is dangerous—much like telling someone they should take vinegar for cancer. It seems only rational that when a minor has a psychological problem around gender or sexuality, the therapist should be giving objective treatment—helping the patient sort out their feelings—and not imposing some outside ideology on the therapy. For outside ideology is exactly what is polluting “conversion therapy”: you shouldn’t be gay on the one hand, and on the other your gender dysphoria should be roundly affirmed (e.g., you feel like a girl inhabiting a boy’s body, and thus should go that route) rather than examined.
Perhaps when this case is remanded to lower courts, they will clarify these issues, notably that talk therapy is equivalent to action. But surely the Supreme Court could have said that, and, as far as I can see, they messed up big time. I’m especially disappointed that the other two liberal justices, Kagan and Sotomayor, deemed the Colorado law a case of “viewpoint discrimination.” It may have been that way for legislators, but the law as written doesn’t deal with motivations. It is trying to prevent harm to minors.
I disagree strongly with the Court’s decision, while at the same time remembering that the law it banned is aimed at minors, not adults.










