Content warning: Discussions of youth suicide and self-harm
“The tragedy isn’t just that conversion therapy doesn’t work, it’s that it teaches you to hate the very parts of yourself that make you whole,” wrote Timothy Schraeder Rodriguez, a conversion therapy survivor and author, in his recent novel.
Conversion therapy is a pseudoscientific practice that aims to change a person’s sexual orientation, gender identity, or gender expression through emotional or physical therapy, in order to make people conform to heterosexual or cisgender norms. Schraeder Rodriguez recently published the book “Conversion Therapy Dropout,” which details his experience growing up in evangelical Christianity, participating in megachurches, and enduring years of unsuccessful conversion therapy. He is not alone in his conversion therapy being unsuccessful; in fact, the American Psychological Association (APA) specifically distinguishes between evidence-based therapy and conversion “therapy” practices. The latter of these will be referred to as “sexual orientation and gender identity change efforts” (SOGICE) for the duration of this article because of their unscientific nature.
On March 31, the Supreme Court of the United States (SCOTUS) ruled 8-1 in favor of the plaintiff in Chiles v. Salazar, a landmark case that challenged the constitutionality of Colorado’s Minor Conversion Therapy Law (MCTL). The MCTL prohibited licensed mental health professionals from practicing SOGICE on minors. Unlicensed, religion-based providers are not prohibited or restricted from practicing SOGICE. Kaley Chiles, a licensed mental health counselor, deemed the law a violation of her First Amendment rights, arguing that the MCTL was an unconstitutional restriction on her private speech with her clients. Chiles claimed that she provided SOGICE only when asked. However, minors are unable to consent to such treatments, because SOGICE is not a recognized or credible mental health practice.
A significant component of the opinion of the court was that, by only offering exclusively speech-based SOGICE, Chiles does not “engage in any coercive or aversive practices. … All Ms. Chiles offers is talk therapy.” While the majority of SOGICE in the United States has moved away from the directly physically violent “aversive” practices of the past, the talk “therapy” offered by counselors like Chiles still has significant negative impacts. There are concerns that Chiles’ claims erase the intrinsic harm of any type of SOGICE — talk or physical, consenting or unconsenting. “No person [who] is claiming to struggle with quote-unquote attraction is getting electroshocked by a therapist,” says Jonathan Di Carlo, a U.S. queer legal historian and course instructor at the University of Toronto. “That’s just not happening, but by creating this false semantic distinction, the court is able to pretend [that] they care about [preventing] harmful conversion therapy practices, while also enabling the bulk of conversion therapy practices.”
Evidence has consistently shown that SOGICE is pseudoscientific and ineffective. Queerness is not a flaw or moral failure, and it cannot be “fixed” through willpower or any form of SOGICE. SOGICE institutions assert that a person’s sexuality can be forcefully made heterosexual or cisgender through external efforts, such as talk therapy or electroshock therapy. This notion is unsupported by science; rather, research has consistently shown SOGICE’s devastating effects on physical, mental, and emotional health. A study led by Stanford Medicine researchers found that SOGICE “is linked to greater symptoms of depression, post-traumatic stress disorder, and suicidality,” a finding corroborated by multiple other studies. SOGICE has led to significant and lifelong negative effects for many survivors. According to Statista, 27% of LGBTQ+ youth who have endured SOGICE had attempted suicide in the past 12 months, at the time of the study’s publication in 2023. This is compared to an already-elevated rate of 9% for LGBTQ+ youth who have not endured SOGICE, far higher than that of non-LGBTQ+ youth.
Additionally, the Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People found that 5% of LGBTQ+ youth reported experiencing SOGICE, and another 10% have been threatened with it. The percentage of LGBTQ+ youth who have endured SOGICE that have attempted suicide in the year prior — 27% — is the same for youth who have been threatened with SOGICE. If existing state-specific bans on SOGICE are challenged and overruled — due to the outcome of Chiles v. Salazar — not only will the number of LGBTQ+ youth who are subjected to it increase, but so will the number that are threatened with it, potentially more drastically. This has the potential to cause a significant increase in suicide rates of queer youth, even those that are not directly subjected to SOGICE. Another study by the Trevor Project estimates that in 2021, over 500,000 LGBTQ+ youth were at risk of being subjected to SOGICE — a number that has likely increased since due to the outcome of Chiles v. Salazar.
SOGICE has damaging and lasting effects, particularly for minors. The United Nations has said that SOGICE “may amount to torture,” and, as stated by Victor Madrigal-Borloz, a UN expert on sexual orientation and gender identity, it causes “long-lasting psychological and physical damage.” Di Carlo adds that, “Minors are especially vulnerable to conversion therapy because they’re … still developing physiologically and emotionally, so they are more susceptible to being pressured by … societal forces within their lives.”
In an amicus brief — a legal document submitted for consideration by parties with a strong interest, but not direct involvement, in a case — for the Chiles v. Salazar lawsuit, multiple survivors of SOGICE reported being encouraged to harm themselves by their mental health providers. One amici recounted, “‘[A]lmost everyone’ in group sessions participated in the recommended self-harm and self-mutilation punishments,” and stated that “Nothing in my life has been as defining or traumatic.” Many other amici recounted beginning self-harm shortly after starting SOGICE, likely due to the traumatic nature of the experience.
The APA has also filed numerous amicus briefs supporting SOGICE bans in the past, and filed a joint amicus brief with thirteen other mental and medical health organizations for Chiles v. Salazar, urging the Supreme Court to uphold the MCTL.
Chiles was represented by a lawyer from the Alliance Defending Freedom (ADF), a Christian conservative legal organization “committed to protecting religious freedom, free speech, the sanctity of life, marriage and family, and parental rights.” In the past, the ADF has represented a plethora of Plaintiffs in anti-abortion and anti-LGBTQ cases, and has been categorized as an anti-LGBTQ hate group by the Southern Poverty Law Center. A 2025 article by the Guardian found the work of multiple scholars cited by the ADF in the Chiles v. Salazar decision was “profoundly misrepresented” in the case files.
The ADF claims that “in more than twenty states, government officials have created policies designed to silence counselors like Kaley Chiles” and argues that the lawsuit is necessary because “[Chiles] is a committed Christian who seeks to live out her faith in every aspect of her life, including her work.” However, all pre-existing SOGICE bans in the United States have applied only to licensed mental health professionals like Chiles, meaning that SOGICE that takes place in alternate contexts — such as religious environments — has always been fully permitted by the law. If Chiles was not a therapist, she would be legally permitted to practice SOGICE. Religion-based SOGICE is surprisingly prevalent even in liberal areas; several Christian SOGICE organizations — with youth programs — exist within the Portland area.
The majority Supreme Court ultimately ruled in favor of Chiles, reasoning that because the MCTL permits LGBTQ+-affirming therapy but forbids SOGICE, it is, in fact, an unconstitutional viewpoint-based restriction, and unfairly limited Chiles’ speech. Chiles did not respond to a request for comment.
“[The ruling] subjects laws like [the MCTL] to strict scrutiny, which is a higher standard [than the typical rational-basis scrutiny], and which is very ironic for this court,” adds Di Carlo. Previously, Chiles’ request for a preliminary injunction — moving to continue her SOGICE practices during the lawsuit — was denied by two lower circuit courts. These judges reasoned that the MCTL was best interpreted as a regulation of professional conduct, and therefore did not require strict First Amendment scrutiny. In the final Supreme Court decision, these two rulings were overturned. Essentially, it challenged the MCTL’s right to enact a content-based regulation of therapists’ speech and required a heightened level of scrutiny to be applied to all laws similar to it.
The legal precedent established by National Institute of Family and Life Advocates (NIFLA) v. Becerra was a key contributor to the Plaintiff’s case. The case filed by NIFLA overturned a California act that required certain notices that included information about family planning, contraception, and abortion to be posted at “crisis pregnancy centers” — typically religiously-backed, pro-life nonmedical facilities — and, more significantly to Chiles v. Salazar, outlined guidelines for distinguishing between the levels of First Amendment scrutiny required for different circumstances. In the NIFLA case, the ruling asserted that content-based limitations on professional speech could lead to the government working to silence certain ideas rather than promoting valid regulatory practices. This precedent led the Supreme Court to determine that Chiles’ SOGICE practices should be protected by the First Amendment. In her 35-page dissenting opinion, Supreme Court Justice Ketanji Brown Jackson counters this interpretation, arguing that the precedent established by NIFLA v. Becerra would instead support the restriction of Chiles’ speech within a professional therapy context.
“[T]he notice requirement in NIFLA v. Becerra was not ‘tied to a procedure at all’ and was therefore meaningfully different [from Chiles v. Salazar]: That law restricted ‘speech as speech,’” wrote Jackson. Talk therapy is a recognized form of professional medical care and is subject to federal regulation. Because of this, Jackson argues that as a licensed mental health counselor, Chiles is not exempt from this regulation.
She elaborates that establishing any standard of care must involve regulating the conduct of the relevant care providers. “A State can permissibly ‘prohibi[t] the administration of specific drugs for particular medical uses’ but not for others,” wrote Jackson, “So, too, may it prohibit a doctor from encouraging a patient to commit suicide, … or a dietician from telling an anorexic patient to eat less.”
Jackson concludes her dissent by warning of the implications of the Chiles v. Salazar decision. She writes, “Providers who offer ‘cruel’ speech-only therapies or who use speech to (intentionally or incompetently) harm the welfare of patients, for example, can now assert a First Amendment right to carry on, regardless of these standards.” She asserts that the ruling to uphold Chiles’ argument undermines the foundation of the standard of care by potentially “ushering in an era of unprofessional and unsafe medical care administered by effectively unsupervised healthcare providers.” As Jackson discusses, this ruling could affect practices beyond SOGICE, as it implies that any talk-only healthcare provider could justify potential malpractice by claiming a First Amendment violation if the government tries to regulate their professional conduct.
The Chiles v. Salazar decision has also been criticized by many because it treats LGBTQ-affirming therapy and SOGICE as being equal practices that merely correspond with different opinions or viewpoints, ignoring that SOGICE is widely renounced by medical organizations as ineffective, harmful, and pseudoscientific, while affirming therapy is widely supported.
It is also important to note that all of these bans apply to minors only; licensed therapists are permitted to practice SOGICE on consenting adults in all 50 states. What makes the Chiles v. Salazar decision so significant is that it challenges the constitutionality of SOGICE bans that protect minors and brings them under strict scrutiny. In addition to the legal scrutiny that existing laws will now face, Di Carlo says he thinks the “more harmful part of the decision is that it will … have a chilling effect on other states, [preventing them] from bringing any kind of conversion therapy [ban] into litigation.” He explains that, in the process of introducing any new law or bill, states must take into consideration the potential expenses incurred from fighting lawsuits or constitutional challenges.
According to Axios Denver, only 24 states currently have bans on SOGICE for minors, while five have partial bans, 18 have no bans at all, and four states prohibit enacting bans. This ruling affects everyone, even those in states that currently have bans on SOGICE. At a time when the LGBTQ+ community is facing increased restrictions on their lives and attacks on their identities — from “don’t say gay” laws to bathroom bills —, this ruling sets a precedent that has reinforced many fears of these communities. In June 2023, the Human Rights Campaign (HRC) declared a state of emergency for LGBTQ+ people in America, for the first time in the organization’s history.
Following the appointment of Justice Amy Coney Barrett to fill former Justice Ruth Bader Ginsburg’s former spot, the Supreme Court now holds a conservative supermajority. According to the Gay and Lesbian Alliance Against Defamation , Justice Barrett has direct ties to the ADF and has been paid by them at least five times to speak at their Christian summer fellowship.
In 2025 alone, 616 anti-LGBTQ+ bills were created or introduced in the United States. Of those, 344 advanced or were passed. With the exception of Vermont, every state had at least one anti-LGBTQ+ bill introduced. The Chiles v. Salazar decision represents another manifestation of what the Human Rights Campaign describes as the Trump administration’s “persistent attacks on the LGBTQ+ community.” It is another step in the attempted erasure of queer history in the United States — removing memorials, banning books, and revising historical data — through the legal justification of SOGICE. The Supreme Court enabling a scientifically discredited practice specifically targeting queer youth sets a precedent that has the potential to cause significant harm to an already vulnerable population.
