The U.S Supreme Court has ruled against states’ ability to ban licensed mental health providers from providing conversion therapy on the grounds that it violates free speech.
In a twist of fate, national LGBTQ+ advocates and law experts say the decision proves Texas can’t ban gender affirming care from the therapy room, but local mental health providers are pessimistic.
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Last month, an 8-1 court sided with Kaley Chiles, a licensed professional Christian counselor in Colorado Springs, who argued her state’s ban on conversion therapy, a controversial treatment aimed at changing a LGBTQ+ minor’s sexual orientation or gender identity, violated her right to free speech. The justices ruled the Colorado law censors the speech of mental health providers and that the First Amendment prohibits states from limiting the topics licensed therapists can discuss with their clients.
LGBTQ+ advocates and legal experts say this ruling means any treatment that licensed mental health providers in Texas give to clients that affirms their gender identities is constitutionally protected free speech. The high court’s decision runs counter to Texas Attorney General Ken Paxton’s recent opinion that licensed Texas therapists can’t provide gender-affirming care to LGBTQ+ youth clients, advocates and experts say.
“If the Supreme Court sets this precedent that what happens in a therapist’s office is sort of per se protected First Amendment speech, then I think we have to take them at their word and say, ‘Okay, well then that applies to all regardless of ideological implications,’” said Shawn Meerkamper, a managing attorney for the California-based Transgender Law Center.
Texas mental health providers say in theory, the Supreme Court’s ruling should protect gender-affirming therapy for LGBTQ+ people, too, but gender-affirming care providers don’t trust Republican lawmakers and the conservative Supreme Court to apply free speech principles equally. They fear the state will investigate and villainize licensed therapists who provide gender-affirming care while allowing conversion therapy to proliferate without fear of regulations. Texas has 104 conversion therapy providers, the second highest number in the country, according to the Trevor Project, the largest suicide and crisis prevention organization for LGBTQ youth.
While the state hasn’t made any attempts to ban conversion therapy, which all major health associations in the country, including the American Medical Association, American Academy of Child and Adolescent Psychiatry and American Psychiatric Association, have panned as harmful, Texas has blocked gender-affirming care, which those same groups have supported as evidence-based care.
Gender-affirming health care is a range of services that help align a person’s physical and mental characteristics with their preferred gender identity.
“If speech in the therapy room is completely unregulated and states are not allowed to step in, then where does it stop? If a therapist is a white nationalist, are they allowed to say certain things in that room about other races? Where is the limit?” said Johnathan Gooch, deputy director for public affairs for Equality Texas.
Can the ruling help LGBTQ+ therapy?
Chiles, with support from President Donald Trump’s administration, argued a ban on conversion therapy is an unfair restriction on faith-based practices in mental health.
She said allowing states to ban conversion therapy permits interfering in all conversations between providers and their clients, including, for example, prohibiting doctors from discussing birth control or counselors from encouraging or discouraging divorce.
Various religious organizations, such as the Catholic Medical Association, applauded the Supreme Court’s decision siding with Chiles, saying it allows for the “free exchange of ideas” in mental health.
Steven D. Schwinn, a professor of law at the University of Illinois Chicago Law School, who has analyzed Supreme Court decisions over the past few years, said the ruling on conversion therapy is the latest example of the country’s highest court using the First Amendment to push a conservative policy.
“The Court has recently championed religious freedom under the guise of free speech,” he said.
Meerkamper said the silver lining of the Supreme Court’s decision is that it takes away from states like Texas the ability to ban LGBTQ+-friendly treatments, such as gender-affirming care, because free speech protections apply across the board.
“If the act of therapy and engaging in therapy is considered free speech, then it’s certainly hard to see how a prohibition on conversion therapy survives,” they said. “But on the other side of the coin is that if that doesn’t survive, then how can prohibitions on gender-affirming health care services survive?”
Mental health professionals who provide gender-affirming care defend their field as legitimate health care that helps a population vulnerable to some of the most serious mental illnesses. Providers often help diagnose and recommend treatment to adults and minors with gender dysphoria, a psychological diagnosis widely accepted in the medical and mental health communities for someone whose gender identity doesn’t match their gender assigned at birth. The treatment can include depression and anxiety, assessments for readiness for hormone therapy or surgeries, and support for families.
“We do not pass judgment and that we provide care that is evidence-based and ethical, and we try to reduce harm,” said Michael Lesher, director of the Texas Society for Sexual, Affectional, Intersex, and Gender Expansive Identities. “We are supposed to provide client-centered care that’s not coercing our clients into anything that is going to be harmful to them.”
Gender affirming care providers in Texas say that while the Supreme Court has ruled to protect conversion therapy, history proves it won’t do the same for LGBTQ+ treatments.
The Supreme Court ruled last year that states have a right to ban gender-affirming medical care for minors, like puberty blockers and hormones, because the state has a right to protect children, despite multiple medical studies citing its usefulness. Texas banned gender-affirming care for minors in 2023.
“As an affirming therapist in this state, I work to undo the harm conversion therapy perpetrates every single day. So with this ruling? I’m worried we’ll see an increase in the availability of conversion therapy, and I’m worried about the precedent it sets going forward,” said Abi Smith, a licensed professional counselor for Southlake-based AltNarratives LLC.
Conversion therapy proliferation
When Guy Felder came out in the 1990s as a member of the LGBTQ+ community, his parents promptly placed him in a conversion therapy program. The unlicensed counselor often told his parents and members of his religious community about their sessions, and the entire experience, which lasted a year until he turned 18, did permanent damage to the relationship with his family.
“The theory in conversion therapy is that the cause of homosexuality is a dysfunctional relationship with a parental figure. They kept telling my dad he was in some way responsible for me living my life as a gay man,” said Felder, who is now a Houston-based licensed professional counselor associate, providing LGBTQ+ mental health treatment.
Conversion therapy attempts to change an individual’s sexual orientation or gender to heterosexual or cisgender norms. The most common way to achieve this is through talk therapy, but some extreme methods include shame-based practices, religious-based treatments, and aversion therapy.
Twenty seven states have laws that either restrict or prohibit licensed professionals from practicing conversion therapy on minors, but Texas isn’t one of them. The Trevor Project identified more than 1,320 conversion therapy providers across 48 states, with Pennsylvania having the most.
“A lot of them went underground, but they never went away,” Felder said about the recent restrictions on conversion therapies.
The Texas Tribune contacted multiple conversion therapists in Texas to discuss their reactions to the recent Supreme Court ruling, but they did not respond.
LGBTQ+ advocates are concerned that with Texas already not regulating conversion therapy, the recent ruling by the Supreme Court will turn the state into a breeding ground for this kind of treatment.
“Around 15% of LGBTQ+ youth, according to the Trevor Project, cited fear of conversion therapy as a reason not to seek out mental health support,” said Rox Sayde, community support and operations manager for Equality Texas, adding that many conversion therapists in Texas hide under the guise of LGBTQ+ friendly care.
By protecting conversion therapy, the Supreme Court ruling delegitimizes therapy as a valid medical treatment, according to some mental health providers.
Justice Ketanji Brown Jackson, the lone dissenting voice, wrote that the decision made by her fellow justices “opens a dangerous can of worms” because it will impair the state’s ability to regulate the mental health profession.
Studies have shown that conversion therapy can cause harm — and if a state can’t regulate it, what therapy can the state regulate, LGBTQ advocates question.
“My take on the ruling is that it fundamentally misunderstands what therapy is,” Gooch said. “Words, in this case, are a tool that is used to treat a patient, which is a different type of relationship. The court is now saying speaking to a client is essentially the same as someone just giving their gut instinct reaction to a friend seeking advice.”
For mental health support for LGBTQ youth, call the Trevor Project’s 24/7 toll-free support line at 866-488-7386. For trans peer support, call the Trans Lifeline at 877-565-8860. You can also reach a trained crisis counselor through the Suicide and Crisis Lifeline by calling or texting 988.
Disclosure: Equality Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.