The Supreme Court ruled 8-1 that banning conversion therapy violates the First Amendment. More than 20 states have similar laws. They’re all in trouble.

Background

The Supreme Court sided 8-1 with therapist Kaley Chiles on Tuesday in Chiles v. Salazar, ruling that Colorado’s ban on conversion therapy for minors violates the First Amendment. The decision doesn’t overturn the law outright but requires lower courts to apply strict scrutiny—the highest bar for the state to clear—and strongly hints the ban will fail that test. More than 20 states have similar bans. Justice Ketanji Brown Jackson was the sole dissenter.

1. This Is About Free Speech, Not Therapy (Gorsuch, Chiles, Alliance Defending Freedom)

The government can’t tell a therapist what she’s allowed to say to a patient who came to her voluntarily. That’s viewpoint discrimination—and the First Amendment doesn’t allow it.

Gorsuch wrote that the First Amendment "stands as a shield against any effort to enforce orthodoxy in thought or speech." The Court found Colorado’s law regulates the content of what a therapist says and prescribes which views she can and can’t express—that’s viewpoint discrimination. Chiles isn’t doing shock therapy or aversion techniques. She offers talk therapy to clients who seek her out because their orientation or gender identity doesn’t align with their religious values.

Chiles describes her work as helping clients become "comfortable and at peace" with their body. Her patients come voluntarily, she says, precisely because their faith shapes how they understand their identity. Alliance Defending Freedom, the religious law group representing her, has won a string of similar cases at the Supreme Court in recent years.

Even the liberal justices mostly agreed. Sotomayor and Kagan joined the majority, making this 8-1 across ideological lines—not a typical left-right split. The ruling is narrow in form but sweeping in implication: if talk therapy is speech, then banning certain therapeutic viewpoints is censorship.

2. This Will Get Kids Killed (Trevor Project, APA, Medical Organizations)

Every major medical organization says conversion therapy is harmful and discredited. The Supreme Court just made it a constitutional right.

LGBTQ+ youth subjected to conversion therapy are more than twice as likely to attempt suicide. The Trevor Project called the ruling "a tragic step backward for our country that will put young lives at risk." The APA and every major medical organization consider conversion therapy a discredited practice—not evidence-based treatment—rooted in the belief that being LGBTQ+ is a mental illness.

The harm data is overwhelming. A 2020 study found youth whose parents attempted to change their orientation reported three times greater likelihood of depression and suicide attempts. The practice is associated with PTSD, anxiety, substance abuse, and lasting psychological damage. States passed these bans specifically because the evidence of harm was so clear.

The ruling effectively guts 20-plus state bans. Colorado is already exploring alternative legal strategies, including allowing civil lawsuits against providers. But the First Amendment shield Gorsuch created means any ban that targets what a therapist says—as opposed to physical practices—is now constitutionally suspect.

3. Jackson's Warning: This Goes Way Beyond Conversion Therapy (Justice Jackson)

If the government can’t regulate what a therapist says, it can’t regulate medical advice at all. This ruling breaks the entire framework for professional speech.

Jackson read her dissent from the bench—a signal she considers this among the Court’s worst decisions. She wrote that the ruling "misreads our precedents, is unprincipled and unworkable, and will eventually prove untenable." She was the only dissenter in an 8-1 ruling, breaking with Sotomayor and Kagan.

Her core argument: states have always regulated medical speech. Doctors can’t prescribe snake oil. Therapists can’t practice outside their training. States regulate what professionals say to patients every day. Jackson argues this ruling "threatens to impair States’ ability to regulate the provision of medical care in any respect."

She warned the Court is "blessing a risk of therapeutic harm to children." For the first time, the Supreme Court has used the First Amendment to limit a state’s ability to regulate medical providers who treat patients with speech. Jackson says the logic extends far beyond conversion therapy—any state regulation of professional advice is now vulnerable to a First Amendment challenge.

Where This Lands

The medical consensus is clear: conversion therapy is harmful and discredited. The legal consensus, as of today, is that banning it through licensing laws probably violates the First Amendment. On the other hand, Jackson’s warning about the ruling’s reach—that it undermines all state regulation of professional medical speech—may prove more consequential than the conversion therapy question itself. Where this lands depends on whether states find alternative legal frameworks to protect LGBTQ+ youth, and whether Jackson’s prediction holds: that this ruling is "unprincipled and unworkable" and the Court will eventually have to revisit it.

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