The Supreme Court Said Therapy Is Speech. That Changes Everything.
The big picture: The Supreme Court ruled 8-1 that Colorado’s ban on conversion therapy for minors violates the First Amendment because it “censors speech.” This wasn’t the usual ideological split — Kagan and Sotomayor sided with the majority on narrower grounds. The sole dissenter, Justice Ketanji Brown Jackson, warned the ruling could be “catastrophic” for states’ ability to regulate any medical care involving speech.
Why it matters: This directly undermines conversion therapy bans in nearly half of all states. BUT the broader impact may be even larger: if therapy delivered through speech is constitutionally protected expression, the same logic applies to any licensed professional giving medical advice. Jackson warned the decision “might make speech-only therapies and other medical treatments involving practitioner speech effectively unregulatable.”
The law: Colorado banned licensed professionals from attempting to change the sexual orientation or gender identity of minors in 2019. Almost half of all states have similar bans. Major medical organizations have discredited the practice. Studies link it to depression, PTSD, and suicide. No one was ever actually disciplined under Colorado’s law.
The challenge: Evangelical therapist Kaley Chiles sued in 2022, arguing the law prevented her from offering voluntary faith-based counseling to religious minors. She said she wasn’t trying to “cure” anyone but to help patients “live consistently with their faith.” Colorado argued the law already exempted religious ministries entirely and only applied to licensed medical professionals. Two lower courts sided with Colorado.
The ruling: 8-1 against Colorado. Gorsuch wrote that while Colorado “may regard its policy as essential to public health and safety,” the law “censors speech.” Kagan and Sotomayor concurred on narrower grounds, arguing the law regulated viewpoints on one side of the debate but not the other.
The dissent: Jackson alone. She wrote the decision “opens a dangerous can of worms” that “threatens to impair states’ ability to regulate the provision of medical care in any respect.” She warned it could make “speech-only therapies and other medical treatments involving practitioner speech effectively unregulatable” and “ultimately risks grave harm to Americans’ health and wellbeing.”
The ripple effect: If therapy-as-speech is constitutionally protected, the same logic applies to any medical professional giving advice through words. A doctor recommending a dangerous treatment. A counselor using a discredited method. A therapist giving advice that causes harm. States’ ability to regulate any of that just got significantly harder to defend.
AND this was 8-1, not 6-3. There’s almost no path to reversing it through the Court anytime soon. The precedent is set.
The bottom line: Conversion therapy was the case. Medical regulation is what actually got gutted. Nearly half of all states now have bans that are constitutionally vulnerable. AND every state that tries to regulate any kind of medical care delivered through speech now has to contend with a precedent that says that speech is protected by the First Amendment. Jackson called it catastrophic. She was the only one. That should scare you regardless of where you stand on conversion therapy.
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