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By Keith J. Myers, PhD, LPC, NCC

Daron (pseudonym) was 17 years old when her parents brought her to counseling. She didn’t want to be there; she was depressed. Her parents wanted her to stop being attracted to girls. The counselor obliged. Four years later, she sat across from me in my office, struggling to rebuild a sense of self that had been systematically dismantled, word by word, session by session.

I’ve been thinking about her a lot since the U.S. Supreme Court ruled 8-1 in Chiles v. Salazar that Colorado’s ban on conversion therapy for minors likely violates the First Amendment. And I’ve been thinking about what that ruling means for the rest of us, the counselors doing this work every day, trying to hold the line between clinical authority and client welfare.

Here’s the Supreme Court’s logic: Because conversion therapy involves talk, it is speech. And speech, the First Amendment tells us, cannot be so easily regulated by the government. Writing for the majority, Justice Neil Gorsuch concluded that Colorado’s ban amounted to government-enforced orthodoxy over professional expression. It’s a principle worth taking seriously. But it rests on an assumption that, as clinicians, we know isn’t true: that what happens between a licensed counselor and a minor client is simply a conversation.

It isn’t. And we know it isn’t because we’ve lived it.

Think about what a therapeutic relationship actually is. A client, often an adolescent, walks in already vulnerable, already in some degree of crisis. They invest an enormous amount of trust in us. We hold clinical authority, professional licensure and, in many cases, a level of perceived expertise that borders on unquestioned. When we speak in that room, we don’t speak the way a friend or a pastor speaks. We speak with the weight of a professional relationship behind every word. That weight is what makes counseling effective. It’s also what makes it possible to cause serious harm.

The clinical consensus on conversion therapy isn’t ambiguous. The American Psychological Association, ÀÖ²©´«Ã½, our organization, and American Academy of Pediatrics have all formally rejected it. The research consistently links it to higher rates of depression, anxiety and suicidal ideation in LGBTQ+ youth. This isn’t a values debate. It’s a clinical finding, and one that the ÀÖ²©´«Ã½Code of Ethics takes seriously.

Justice Ketanji Brown Jackson, the lone dissenter, put the concern plainly: For the first time, the Supreme Court has interpreted the First Amendment to permit a risk of therapeutic harm to children. She raised a question the majority didn’t adequately answer. If talk therapy is simply speech, what stops any licensed professional from invoking the First Amendment to say whatever they want to a client, regardless of the evidence base?

That question should matter to every counselor reading this, whether or not you ever work with LGBTQ+ youth. Because what the ruling actually does is expand counselors’ authority significantly, at the direct expense of state regulatory power over licensed professionals. The states that had conversion therapy bans drew a line between coercive practice and client-directed exploration. The Supreme Court has now said states cannot draw that line at all.

I want to be careful here because the case deserves nuance. The counselor at the center of it, Kaley Chiles, describes her approach as voluntary, faith-informed and client-driven. I take that seriously. A clinical and ethical distinction exists between a counselor who imposes change-oriented goals on a minor and one who, at a client’s explicit request, explores questions of identity through a spiritual lens. Those are not always the same thing. Our ethics code is actually well equipped to navigate that distinction. It centers client autonomy, informed consent and the counselor’s responsibility to avoid harm. The law, apparently, is not. But nuance is not the same as equivalence. Whatever her intentions, Chiles was operating from a framework the research has consistently shown to be ineffective and harmful. That is not a statement about faith. It is a clinical one.

So what does this mean for your practice?

First, it means the ethical burden on us increases. When the law removes a regulatory floor, professional ethics becomes the primary protection for clients. That’s always been true in principle. It’s more consequential now in practice. If you supervise counselors-in-training, this ruling is worth discussing explicitly. Talk through both the legal landscape and the ethical framework that still governs how we work, regardless of what the Supreme Court permits.

Second, it means we should be paying attention to how states respond. Some will do nothing. Others may try to craft narrower regulations that survive First Amendment scrutiny, focusing on coercion, minors’ consent or specific harmful techniques rather than broad content-based bans. Those efforts will need clinical voices behind them. That’s us.

Third, and maybe most important, it’s a reminder of what makes this work possible in the first place. Every client who has ever walked into my office and taken the risk of being honest did so because they trusted that I would not use the power of that room against them. That trust is not a legal standard. It is not a First Amendment question. It is the foundation of everything we do. The Supreme Court can redefine speech. It cannot redefine that.

Somewhere out there is another Daron, sitting in a waiting room, about to trust someone with everything. The law has decided what we are permitted to do. Our ethics still decide what we should do. The ruling changed what’s permitted. It didn’t change what’s right.