Speech or conduct? “Conversion therapy” bans

The Supreme Court’s 8–1 ruling in Chiles v. Salazar will have far-reaching implications for the well-being of LGBTQ+ youth, the field of psychology, and regulatory mental health practice. In a March 31 decision, authored by Justice Neil Gorsuch, the court held that Colorado’s law prohibiting licensed mental health professionals from engaging in “conversion therapy” with minors must be reviewed under strict scrutiny, as the law was found to regulate speech in violation of the First Amendment.

Conversion therapy, also known as sexual orientation and gender identity change efforts (SOGICE), refers to practices seeking to change an individual’s sexual orientation or gender identity based on the belief that being lesbian, gay, bisexual, transgender, or queer is a mental illness or sinful, and therefore can be changed (Haldeman, D. C., Journal of Gay and Lesbian Psychotherapy, Vol. 5, 2002opens in new window). Studies have revealed conversion therapy fails to change sexual orientation or gender identity while producing a host of serious negative outcomes, including depression, anxiety, adverse physical health outcomes, self-hatred, isolation, and suicidality (Davison, G. C., & Walden, K. R., Annual Review of Clinical Psychology, Vol. 20, 2024opens in new window; Gibb, J. K., et al., JAMA Network Open, Vol. 8, No. 5, 2025opens in new window). LGBTQ+ youth are particularly vulnerable, as youth who undergo SOGICE are more than twice as likely to attempt suicide compared with those who do not (Green, A. E., et al., American Journal of Public Health, Vol. 110, No. 8, 2020). These are not side effects of well-intentioned but flawed treatment—they are the predictable consequences of a practice rooted in pathologizing identity.

To date, numerous professional organizations, including APA, the American Medical Association, the American Psychiatric Association, and the American Academy of Pediatrics (AAP), have condemned SOGICE as both ineffective and harmful. Over the years, APA divisions, including Division 44 (Society for the Psychology of Sexual Orientation and Gender Diversity), have made position statements and resolutions regarding the use of appropriate, affirmative therapeutic responses (APA, 1997; 2009opens in new window; 2024; Flinn, R. E., Journal of Counseling Psychology, Vol. 72, No. 5, 2025opens in new window; SAMHSA, 2015). The court did not question the well-established scientific consensus that conversion therapy is harmful; however, it noted the core issue for debate was whether the state may restrict one viewpoint in favor of another.

The Chiles ruling raises serious concerns beyond SOGICE. By classifying therapy as protected speech, the court has called into question states’ broader authority to enforce evidence-based standards of care for any health profession that delivers services through verbal communication. Justice Ketanji Brown Jackson was the lone dissenter, arguing that states have long held authority to regulate the practice of medicine and psychology, including talk therapy. As APA CEO Arthur C. Evans Jr. noted in response to the ruling, the unresolved question of whether states can regulate what licensed mental health professionals say to patients will determine not only the fate of conversion therapy bans but the ability of licensing boards to protect consumers across the mental health professions.

Ultimately, APA’s Ethical Principles of Psychologists and Code of Conduct (2017) are clear: Psychologists are obligated to avoid harm and respect the dignity and rights of those they serve. Conversion therapy violates each of these principles as it pathologizes identity and operates outside the bounds of empirically supported practice. The Chiles ruling does not change the ethical obligations of mental health professionals; it makes advocacy for those obligations more urgent than ever. Psychologists, licensing boards, and professional organizations must continue to engage in evidence-driven practices, train future practitioners in affirmative approaches, and advocate for legislative protections for LGBTQ+ youth.