I Underwent “Conversion Therapy” as a Child. As a Psychiatrist, I Know How Professionally Derelict It Is. |
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At first glance, Chiles v. Salazar, argued before the Supreme Court in October and still awaiting a decision, appears to ask a narrow legal question: Can a state prevent licensed therapists from engaging in treatments, often called “talk therapy,” aimed at changing a person’s sexual orientation or gender identity? At direct stake is whether the state may protect children from licensed adults who use the authority of therapy to offer “identity-changing” treatment that medicine itself has deemed fraudulent.
But as both a psychiatrist and someone who has endured that so-called conversion therapy, I know that the question actually cuts to the heart of what constitutes true mental health treatment and which professional standards must govern it. “Conversion therapy” has nothing to do with treating a patient, but rather with using the authority of therapy to target vulnerable people and persuade them to undergo a practice built on the false promise that their identity can be changed—an intervention that medicine has shown to be ineffective at best and deeply harmful at worst.
During oral arguments, attorney James Campbell told the court that this case is about “speech between a licensed professional and a minor.” This framing obscures the power imbalance between children seeking care and adults licensed to treat them. It’s also the faulty logic at the center of this case. Holders of this viewpoint argue that regulating therapy risks governmental overreach into private belief and expression. That concern deserves consideration—until it collides with the reality of how licensed treatment actually functions.
In the 2018 case NIFLA v. Becerra, the court, in an opinion authored by Justice Clarence Thomas, reaffirmed that states may regulate professional conduct—even when that conduct consists primarily of speech—when necessary to prevent fraud or harm.
Nearly two decades ago, I sat across from a licensed professional counselor who told me we could reduce my then “unwanted same-sex attraction” through talk therapy. There were no electric shocks, no aversive treatments, only words. But those words taught me to hate myself in a voice that sounded like my own.
In therapy, words aren’t casual “First Amendment–protected” conversation. They are the therapeutic intervention itself. When a licensed clinician delivers words as treatment, that speech becomes professional conduct subject to the same standards as any other medical intervention. And when that treatment is based on deception, as in the case of “conversion therapy,” it becomes fraud.
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Professional treatment requires professional standards. If you are a medical professional, you cannot make false promises to clients. For example, you could not tell a patient with cancer that drinking a glass of green tea every day for a year would cure them. The same principle applies here.
The American Psychological Association, American Medical Association, and American Academy of Child and Adolescent Psychiatry have all condemned conversion practices as dangerous and unsupported by evidence. These practices fail the basic standards required of any legitimate treatment. The data are unequivocal: People subjected to these practices face sharply higher rates of depression, anxiety, and suicide attempts.
It would be just as unethical for a therapist to use treatment to pressure someone into being LGBTQ+ as it is to use treatment to coerce someone out of being such an identity. Our professional obligation is not persuasion. Healing requires professional standards, not ideology. Professional ethics demand that licensed care be grounded in evidence, autonomy, and nonmaleficence. When a therapist treats a client’s identity as a disorder that needs to be fixed, they violate every one of those principles. The right to speak freely ends where the duty to do no harm begins.
Colorado’s law does not ban opinions about sexuality or faith. It regulates a fraudulent practice offered under a license of trust. The First Amendment protects the right to speak freely; it does not protect the right to inflict harm or sell false hope with a government-issued license. If the court accepts the “speech” narrative, it risks undermining decades of precedent recognizing the state’s authority to regulate professional misconduct.
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What the Supreme Court decides in Chiles v. Salazar will echo far beyond this case. At its heart is a question of integrity, whether treatment that harms can hide behind the First Amendment simply because it’s delivered through talk therapy. Upholding these bans would affirm that professional standards and evidence-based practices still govern licensed treatment. Striking them down would send a very different message: that deception and abuse can be shielded by the First Amendment when delivered through the power of a professional license.
The court’s decision will not just define what therapy is. It will define whether professional treatment standards apply equally to all forms of medical intervention, including talk therapy. As a psychiatrist today, I am entrusted with the same authority that once harmed me. I know how powerful words can be when delivered under the authority of a license. That authority must be used to heal—not to legitimize practices that medicine itself has rejected.
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Gay Conversion Therapy