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Types of Therapies to Avoid

Conversion therapy encompasses a range of practices aimed at changing an individual’s sexual orientation or gender identity to align with heterosexual and cisgender norms. These therapies often attempt to change their name to avoid detection and confuse LGBTQ+ individuals when first seeking out help. They are widely discredited and condemned by medical and psychological organizations due to their harmful effects. It frequently changes names to avoid detection. Here’s what you need to know to recognize and avoid them:

Recognizing and Avoiding Harmful Therapy

• Look Out For:
• Any therapy or counseling that seeks to change your sexual orientation or gender identity.
• Programs that pathologize LGBTQ+ identities or view them as disorders.
• Religious-based counseling that aims to “correct” your identity through prayer or spiritual guidance.
• Any therapeutic approach that imposes heteronormative or cisgender standards on you.

Unfortunately, conversion therapy is still practiced in Oregon. While it is illegal to perform this dangerous, abusive, and harmful therapy on minors, it remains legal for therapists to practice it on adults. https://oregon.public.law/statutes/ors_675.850

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Undermining the Concept of Sexual Consent and Bodily Autonomy

Coercion and Lack of Voluntary Participation: Individuals subjected to conversion therapy do not consent to it voluntarily. They are coerced by family members, religious leaders, or societal pressures with the risk of being ostracized if they do not participate. True consent must be given freely, without any form of coercion or manipulation, which is never the case in conversion therapy contexts.

Psychological Manipulation: Conversion therapy techniques often involve psychological manipulation, such as guilt-tripping, emotional blackmail, and intense scrutiny of personal thoughts and feelings. This manipulation distorts the individual’s sense of self and can make them feel compelled to conform to the expectations of the therapist/authority figure, rather than acting according to their own desires and identities.

Violation of Bodily Autonomy: Conversion therapy can include invasive and harmful practices such as aversion therapy and behavioral modification. These practices violate the individual’s bodily autonomy, as they are forced to endure psychological harm against their will.

Denial of True Identity: By attempting to change an individual’s sexual orientation or gender identity, conversion therapy denies the validity and authenticity of the individual’s true self. This denial is a profound violation of personal integrity and self-determination, which are core components of consent.

Long-Term Psychological Harm: The long-term psychological harm caused by conversion therapy further undermines the concept of consent. Individuals who undergo conversion therapy often suffer from depression, anxiety, PTSD, and other mental health issues. This harm reflects the profound breach of trust and violation of personal autonomy inherent in these practices.

On average it takes 10 years to come out after conversion therapy, if they make it. (Risk)

Dangers of Dis-affirming/Conversion Therapy

Psychological Harm: Conversion therapy leads to increased feelings of shame, depression, anxiety, and suicidal ideation. The harmful effects on mental health are profound and long-lasting, often leaving individuals with severe psychological trauma.

Erosion of Self-Determination: This practice undermines the autonomy and self-determination of individuals. By imposing an external agenda on their identities, conversion therapy denies people the right to explore and affirm their true selves.

Violation of Ethical Standards: Conversion therapy violates the ethical standards of psychology and medicine. Professional organizations globally condemn these practices as they contravene principles of doing no harm and respecting patient autonomy.

Legal and Social Consequences: The perpetuation of conversion therapy reinforces societal prejudices and can lead to systemic discrimination and violence against LGBTQ+ individuals. It legitimizes harmful stereotypes and contributes to a culture of intolerance and exclusion.

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Conversion Therapy: Different Labels, Same Unethical, Baseless Practice

Conversion therapy refers to a set of practices that share a common treatment objective: to change, suppress, or discourage a person’s sexual orientation or gender identity. While these practices have been described using different labels over time—ranging from “reparative” therapy to “gender-exploratory” counseling—the core premise has remained consistent. The individual’s identity is treated as a problem to be corrected rather than a characteristic to be supported.

Early forms of conversion therapy relied on overtly coercive or punitive methods, including aversion techniques and institutional confinement. These methods are now widely discredited and abandoned. In response, contemporary conversion practices have shifted toward approaches framed as counseling, exploration, family intervention, or religious guidance. This shift reflects a change in presentation, not in purpose or effect. Despite this rebranding, there is no credible evidence that talk-based or religious conversion efforts produce durable change, and these practices are associated with psychological harm (American Psychological Association, 2009; Shidlo & Schroeder, 2002).

A further practical concern is that these services are routinely delivered as fee-based care. Clients and families are charged for repeated sessions, prolonged “evaluation,” or extended treatment plans despite the absence of evidence that identity-change goals are achievable. In effect, individuals are billed for an intervention that does not work and that carries well-documented risks of harm, compounding psychological injury with financial exploitation (American Psychological Association, 2009).

Exploratory and Delay-Based Counseling

Practices sometimes described as “gender-exploratory therapy” are often presented as neutral inquiry. In practice, they operate from the assumption that a transgender identity results from confusion, trauma, or psychological dysfunction. Clinicians may subject clients to prolonged evaluation, repeated questioning, and indefinite delays in access to medically indicated care. The functional goal is not exploration, but deterrence—prolonging distress in the hope that the client will abandon their identity. There is no evidence that this approach improves mental health outcomes, and exposure to gender identity change efforts is associated with increased psychological distress and suicide attempts (Turban et al., 2020; American Psychological Association, 2021).

Behavioral and Cognitive Approaches

Some conversion practices adapt mainstream therapeutic modalities—such as behavioral therapy or cognitive-behavioral therapy—to discourage gender-nonconforming thoughts or behaviors. These approaches may reward conformity or frame identity-related thoughts as distortions to be corrected. Although delivered through speech, the treatment objective is behavioral and identity suppression. Such practices have not demonstrated efficacy and are associated with elevated risks of depression, anxiety, and suicidality, particularly among youth and young adults (Green et al., 2020; American Psychological Association, 2009).

Religious and Faith-Based Interventions

Religious conversion efforts frame gender identity as a moral failing, spiritual problem, or test of faith. Techniques may include prayer, fasting, pastoral counseling, or repeated moral instruction. These practices often rely on fear of rejection by family, community, or faith institutions. Research indicates that religious framing does not reduce harm; adverse mental health outcomes are observed regardless of whether conversion efforts are delivered by a licensed clinician or a religious authority (Turban et al., 2020; Beckstead & Morrow, 2004).

Family-Directed Conversion Efforts

Family-based conversion practices involve coordinated pressure by parents or caregivers to enforce conformity with cisgender norms. Acceptance, support, and belonging may be made conditional on change. Because minors are dependent on their families, these interventions raise significant concerns regarding coercion and undue influence, even when nominal consent is claimed. Parent-initiated conversion efforts have been linked to worse mental health outcomes in adulthood, including higher rates of depression and suicidality (Ryan et al., 2020; American Academy of Child & Adolescent Psychiatry).

Residential Programs and Camps

Some conversion practices occur in residential settings or camps that isolate individuals from supportive environments. These programs enforce rigid schedules, prescribed gender roles, and constant supervision. The controlled environment intensifies coercive dynamics and increases the risk of psychological harm. These programs frequently involve substantial fees, further compounding harm with economic burden (Government Equalities Office, 2021).

Common Characteristics Across Methods

Despite differences in form, conversion practices share three defining features:

1. A pathologizing premise that treats sexual orientation or gender identity as a disorder or defect
2. A coercive context, particularly for minors, involving authority, dependency, or conditional acceptance
3. A lack of credible evidence of benefit, alongside consistent evidence of psychological harm

Across studies and professional reviews, the evidence shows that these practices fail to produce lasting change and are associated with increased psychological distress and suicidality, especially among youth (American Psychological Association, 2009; Green et al., 2020; Turban et al., 2020).

Regulatory Implications

State regulation of conversion therapy does not prohibit belief, prayer, or private speech. It governs licensed professional conduct within healthcare settings. When speech is used as the mechanism of treatment, it may be regulated where the treatment objective is harmful, unsupported by evidence, and inconsistent with professional standards of care. This authority is routinely exercised in other areas of licensed healthcare and has been repeatedly upheld by courts.

The professional consensus rejecting conversion therapy reflects established evidence and ethical obligations, not ideological preference. Regulation is justified by the state’s interest in protecting minors and enforcing evidence-based standards within licensed healthcare—particularly where an intervention is marketed and billed as treatment despite lacking efficacy and carrying well-documented risks of harm.

American Medical Association. (n.d.). Issue brief: Sexual orientation and gender identity change efforts (so-called “conversion therapy”). (ama-assn.org)

Pickup v. Brown, 740 F.3d 1208 (9th Cir. 2014). (Ninth Circuit Court of Appeals)

Tingley v. Ferguson, 47 F.4th 1055 (9th Cir. 2022), cert. denied, 144 S. Ct. 33 (2023). (Ninth Circuit Court of Appeals)

American Psychological Association. (2009). Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (American Psychological Association)

• Pickup v. Brown, 740 F.3d 1208 (9th Cir. 2014). (Ninth Circuit Court of Appeals)
• Tingley v. Ferguson, 47 F.4th 1055 (9th Cir. 2022), cert. denied, 144 S. Ct. 33 (2023). (Ninth Circuit Court of Appeals)
• American Psychological Association. (2009). Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. (American Psychological Association)
• American Medical Association. (n.d.). Issue brief: Sexual orientation and gender identity change efforts (so-called “conversion therapy”). (ama-assn.org)

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Chilies V. Salazar Supreme Court CAse

Chiles v. Salazar is pending before the U.S. Supreme Court (after oral argument on October 7, 2025). Oral Argument Link The plaintiff—a licensed counselor who frames her practice as religiously motivated—argues that Colorado’s ban on “conversion therapy” for minors is viewpoint discrimination because it prohibits counseling that aims to change or suppress a minor’s sexual orientation or gender identity and has a “chilling effect” on her speech in her practice of therapy. Supreme Court Her counsel also contends that the research base on conversion therapy is “overbroad,” claiming studies often group together multiple methods and emphasize outcomes and harms rather than isolating narrowly framed, “talk-based” or “prayer-based” approaches.

Historically, efforts to change sexual orientation or gender identity—especially when pursued as a treatment goal—have shown poor efficacy and are widely described as psychologically harmful, which is one reason rigorous prospective trials are rare: designing controlled studies would raise serious ethical concerns about coercion, undue influence, and predictable harm—concerns that institutional ethics review processes typically treat as disqualifying. American Psychological Association In practice, when minors and their parents both “consent” to change-oriented counseling, consent often exists inside a high-pressure environment: parental authority, community expectations, internal conflict, indoctrination, shame, and implicit or explicit threats of rejection or exclusion. As a result, much of the empirical literature relies on retrospective (“post hoc”) reports from people who experienced or survived these interventions, rather than experimental designs that would be unethical to run.

The justices emphasized that states have broad authority to regulate licensed healthcare, including therapeutic practices delivered through speech. They drew an analogy to a nutritionist: if a licensed professional advised a client to follow a regimen that is widely recognized as unhealthy—such as eating McDonald’s hamburgers every day—the state could intervene to protect the public. In the same way, they suggested that a state may restrict licensed counseling that presents a client’s sexual orientation or gender identity as something that should be changed, or that can be “fixed,” when that practice is deemed medically unsound and potentially harmful.

Why “Talk-Based” or “Prayer-Based” Conversion Therapy Is Still Harmful—and Why It Is Regulated

A common claim raised in legal challenges to bans on conversion therapy is that existing research unfairly groups together all methods—particularly discredited aversive techniques—with so-called “talk-based” or “prayer-based” approaches. Proponents argue that because these methods involve speech rather than physical coercion, they should be protected as free expression or religious counseling. This framing misrepresents both the evidence and the ethical foundations of professional healthcare regulation.

First, there is no credible evidence that any form of conversion therapy—whether framed as psychotherapy, pastoral counseling, or prayer—successfully changes a person’s sexual orientation or core gender identity. While early, extreme methods such as electroshock or forced institutionalization are now widely condemned, later iterations that relied on counseling, shame-based narratives, or religious pressure have demonstrated the same fundamental failure: they do not produce durable “change,” and they are associated with psychological harm (American Psychological Association, 2009; Shidlo & Schroeder, 2002).

Because it would be unethical to assign minors to interventions that presume their identities are disordered, the strongest available evidence comes from observational and retrospective studies of people who were exposed to these practices. These studies consistently report increased depression, anxiety, internalized stigma, and suicidality—outcomes that appear across methods, not only aversive ones.

The absence of randomized controlled trials isolating “prayer-only” or “talk-only” approaches is not a weakness of the evidence base; it is a reflection of modern research ethics. Institutional review boards generally prohibit studies that would knowingly expose participants—especially minors—to interventions that are coercive, stigmatizing, or likely to cause harm. As a result, the literature relies on survivor reports and population-based surveys that document real-world experiences. These data are sufficient for professional consensus when the pattern of harm is consistent, the mechanism is well understood, and no countervailing evidence of benefit exists.

This is why every major U.S. healthcare and mental health organization opposes conversion therapy in all its forms. Groups such as the American Psychological Association, the American Academy of Pediatrics, the American Medical Association, the American Counseling Association, and the American Academy of Child and Adolescent Psychiatry have independently reviewed the evidence and reached the same conclusion: conversion therapy lacks scientific validity, conflicts with professional ethics, and poses a risk to patient well-being. These organizations do not object merely because the practice is religiously motivated; they object because it violates core principles of healthcare, including nonmaleficence, beneficence, and respect for patient autonomy.

The ethical concerns are particularly acute when minors are involved. Even when a child appears to “consent” alongside their parents, that consent occurs within an environment shaped by adult authority, community pressure, fear of rejection, internalized shame, and—often—explicit or implicit threats of exclusion from family or faith communities. In such contexts, change-oriented counseling exerts undue influence by positioning acceptance and belonging as contingent on suppressing or rejecting one’s identity. From a clinical ethics standpoint, this is not neutral exploration; it is coercion.

For this reason, state bans on conversion therapy are not restrictions on free speech in the ordinary sense. States are not prohibiting people from holding religious beliefs, praying, or discussing moral values. Instead, they are regulating licensed healthcare practice. When an individual chooses to practice under a professional license, they agree to abide by evidence-based standards of care. Just as a state may discipline a licensed nutritionist for advising a client to follow a diet known to cause harm, it may restrict licensed therapists from promoting interventions that are medically unsound and psychologically damaging—even when those interventions are delivered through words.

In short, opposition to conversion therapy is not ideological censorship. It is a reflection of settled professional judgment, grounded in decades of clinical evidence and ethical analysis. Rebranding these practices as “talk-based,” “values-based,” or “prayer-based” does not alter their underlying premise—that LGBTQ+ identities are problems to be corrected—nor does it eliminate the documented harms that follow from that premise. States regulate these practices because protecting children from harm is a legitimate and necessary function of healthcare oversight, not because they seek to police belief or silence speech.

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References

American Psychological Association. (2009). Report of the APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation. American Psychological Association. https://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864. https://doi.org/10.1037/a0039906

American Psychological Association. (2021). Resolution on gender identity change efforts (GICE). American Psychological Association. https://www.apa.org/about/policy/resolution-gender-identity-change-efforts.pdf

Beckstead, A. L., & Morrow, S. L. (2004). Mormon clients’ experiences of conversion therapy: The need for a new treatment approach. The Counseling Psychologist, 32(5), 651–690. https://doi.org/10.1177/0011000004267555

Dehlin, J. P., Galliher, R. V., Bradshaw, W. S., Hyde, D. C., & Crowell, K. A. (2015). Sexual orientation change efforts among current or former LDS church members. Journal of Counseling Psychology, 62(2), 95–105. https://doi.org/10.1037/cou0000011

Goodyear, T., Delgado-Ron, J. A., Ashley, F., Knight, R., & Salway, T. (2023). Sexual orientation and gender identity and expression change efforts and suicidality: Evidence, challenges, and future research directions. LGBT Health, 10(5), 339–343. https://doi.org/10.1089/lgbt.2022.0359

Green, A. E., Price-Feeney, M., Dorison, S., & Pick, C. J. (2020). Self-reported conversion efforts and suicidality among U.S. LGBTQ youths and young adults, 2018. American Journal of Public Health, 110(8), 1221–1227. https://doi.org/10.2105/AJPH.2020.305701

Government Equalities Office. (2021). Conversion therapy: An evidence assessment and qualitative study. UK Government. https://www.gov.uk/government/publications/conversion-therapy-an-evidence-assessment

Kinitz, D. J., Goodyear, T., Dromer, E., Salway, T., Ferlatte, O., Knight, R., & Hawkins, B. W. (2022). “Conversion therapy” experiences in their social contexts: A qualitative study of sexual orientation and gender identity and expression change efforts in Canada. The Canadian Journal of Psychiatry, 67(6), 441–451. https://doi.org/10.1177/07067437211030498

Power, J., Jones, T. W., Gurtler, P., et al. (2025). Religion and transgender experiences of belonging: The impact of conversion practices on trans survivors. International Journal of Transgender Health. https://doi.org/10.1080/26895269.2025.2498757

Ryan, C., Toomey, R. B., Diaz, R. M., & Russell, S. T. (2020). Parent-initiated sexual orientation change efforts with LGBT adolescents: Implications for young adult mental health and adjustment. Journal of Homosexuality, 67(2), 159–173. https://doi.org/10.1080/00918369.2018.1538407

Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumer’s report. Professional Psychology: Research and Practice, 33(3), 249–259. https://doi.org/10.1037/0735-7028.33.3.249

Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2020). Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry, 77(1), 68–76. https://doi.org/10.1001/jamapsychiatry.2019.2285

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Judicial Findings on Conversion Therapy Bans

Professional Regulation, Consent, and the Role of Social Coercion

Core Legal Finding Across Courts

Courts repeatedly recognize that states may regulate licensed mental-health professionals to prohibit conversion therapy for minors, because such bans regulate professional conduct within a licensing system, even when the conduct is carried out through speech. Where courts uphold these laws, they rely heavily on medical evidence of harm, professional consensus, and the inability of minors to provide meaningful consent under coercive conditions.

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I. Regulation of Conversion Therapy as Professional Conduct

Pickup v. Brown

Ninth Circuit — California SB 1172

• The Ninth Circuit upheld California’s ban on conversion therapy for minors, holding that the law regulates professional conduct, not protected speech.
• The court rejected First Amendment, vagueness, overbreadth, and parental-rights challenges.
• Key holding: Speech used as part of medical or therapeutic treatment may be regulated as conduct when delivered by licensed professionals.

Primary source:
Ninth Circuit opinion (Pickup v. Brown), available via the Ninth Circuit’s opinions archive
https://cdn.ca9.uscourts.gov/datastore/opinions/2014/08/29/13-15023.pdf

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King v. Governor of New Jersey

Third Circuit — New Jersey SOCE Ban

• The Third Circuit upheld New Jersey’s statute prohibiting licensed counselors from engaging in sexual-orientation change efforts (SOCE) with minors.
• The court rejected free-speech and free-exercise claims.
• The legislature permissibly relied on medical evidence and professional standards identifying conversion therapy as harmful.

Primary source:
https://www2.ca3.uscourts.gov/opinarch/133234p.pdf

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II. Circuit Split on the Speech–Conduct Distinction

Otto v. City of Boca Raton

Eleventh Circuit — Florida Local Ordinances

• The Eleventh Circuit treated conversion therapy bans as content- and viewpoint-based speech restrictions, triggering strict scrutiny.
• The court enjoined enforcement, finding challengers likely to succeed on First Amendment grounds.
• This decision directly conflicts with the Ninth and Third Circuits.

Primary source:
https://media.ca11.uscourts.gov/opinions/pub/files/201914117.pdf

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Doctrinal Hinge Identified by Courts

Courts consistently frame the issue as whether conversion therapy is:

1. Speech incidental to professional conduct → deferential review; bans upheld
2. Pure protected speech → strict scrutiny; bans vulnerable

The split between Pickup / King and Otto is the clearest expression of this disagreement.

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III. Washington State and the Ninth Circuit’s Most Recent Ruling

Tingley v. Ferguson

Ninth Circuit — Washington SB 5722

• The Ninth Circuit unanimously upheld Washington’s ban on conversion therapy for minors by licensed health professionals.
• The court held the legislature “acted rationally” to prevent harm, relying on:
  • Extensive medical evidence
  • Near-universal professional condemnation of conversion therapy
• The panel rejected arguments that NIFLA v. Becerra overruled Pickup, reaffirming that conversion therapy bans regulate conduct, not speech.

Key excerpts summarized by:
National Center for Lesbian Rights
https://www.nclrights.org/about-us/press-release/tingley-v-ferguson-ninth-circuit-upholds-washington-conversion-therapy-law/

En banc rehearing: Denied
https://digitalcommons.nyls.edu/cgi/viewcontent.cgi?article=2485&context=fac_articles_chapters

Supreme Court action: Certiorari denied (Dec. 2023)
Washington State Standard summary:
https://washingtonstatestandard.com/2023/12/11/supreme-court-rejects-challenge-to-washington-conversion-therapy-ban/

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IV. Supreme Court Review: Colorado

Chiles v. Salazar

U.S. Supreme Court — Colorado Ban

• The Court is reviewing whether a state may restrict a licensed therapist’s conversion practices when treatment consists entirely of speech.
• Oral argument held October 7, 2025.
• The case squarely presents the unresolved speech-versus-conduct question left by the circuit split.

Docket:
https://www.supremecourt.gov/search.aspx?filename=/docket/docketfiles/html/public/23-____.html

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V. Consent, Assent, and the Role of Social Coercion

Judicially Relevant Findings (Synthesized)

Across cases upholding bans, courts and legislatures repeatedly emphasize that minors cannot provide meaningful consent or informed assent to conversion therapy due to:

1. Parental authority and dependency
2. Religious, cultural, or community pressure
3. Fear of rejection, punishment, or loss of housing
4. Therapeutic power imbalance with licensed professionals
5. Framing of treatment as “medically necessary” or morally corrective

Courts treat these pressures as structural coercion, not isolated parental preference.

Legal Implication

Under standard principles of medical ethics and informed consent:

• Consent must be voluntary
• Consent must be informed
• Consent must be free of undue influence

Where a minor faces overwhelming social, familial, or religious pressure—especially when the therapy itself pathologizes their identity—true consent or assent is legally and ethically impossible.

This reasoning underlies legislative findings relied upon by courts in Pickup, King, and Tingley, even where opinions do not use the word “coercion” explicitly.

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VI. Why These Findings Matter in Litigation

• They establish that conversion therapy bans are health-and-safety regulations, not ideological censorship.
• They provide a clear framework for rebutting First Amendment challenges by grounding restrictions in professional licensing authority.
• They support the argument that parental permission does not cure coercion, particularly when parents themselves are operating under ideological or religious pressure.
• They align with longstanding doctrines recognizing heightened state responsibility to protect minors in medical contexts.

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Therapist Power, Child Autonomy, and the Child’s Own First Amendment Rights

1) Licensed therapists hold coercive power that is legally relevant

In conversion-therapy litigation, courts and legislatures treat the licensed therapeutic relationship as inherently asymmetric: the clinician controls the clinical frame (what is “healthy,” “disordered,” or “normal”), is backed by state licensure, and operates in a context where minors are typically dependent on adults for access, safety, and stability. That power matters because conversion therapy is not mere discussion in the abstract—it is a state-regulated clinical intervention delivered inside a professional relationship, with predictable risks of harm.

This is why courts upholding bans repeatedly describe the prohibitions as regulation of professional conduct within a licensing scheme, even when the conduct is carried out through words. Ninth Circuit Court of Appeals+1

2) A child’s autonomy interest is not erased by parental preference

U.S. constitutional doctrine recognizes both the importance of parents and the fact that minors are not simply extensions of their parents. In Parham v. J.R., the Court acknowledged broad parental authority while also recognizing that the state is not without constitutional control where a child’s physical or mental health is jeopardized—an important frame for statutes that prohibit clinically discredited, harmful practices on minors. Library of Congress Digital Collections

That same logic applies with special force when the “treatment” targets an identity domain (sexual orientation or gender identity) and is delivered under conditions of dependency and potential punishment/rejection. In that setting, “consent” is structurally compromised.

3) Sexual orientation and gender identity implicate the child’s own First Amendment interests

For briefing purposes, it’s useful to frame orientation and gender identity not as “politics,” but as core identity-linked expression: self-understanding, self-description, association, and presentation. Supreme Court doctrine repeatedly confirms that young people possess First Amendment rights (even if those rights can be regulated differently in some settings).

• Tinker v. Des Moines is the canonical statement that students do not “shed their constitutional rights” simply because they are minors. Library of Congress Digital Collections
• Brown v. Entertainment Merchants Ass’n is especially helpful because the Court struck down a law in part because it abridged the First Amendment rights of young people, emphasizing that minors have their own speech rights independent of parental preferences. Library of Congress Digital Collections
• Barnette supplies the deeper principle: the state cannot force individuals—children included—to mouth or adopt an orthodoxy. Conversion therapy functions similarly in reverse: it pressures minors to renounce or disavow identity-linked truths to satisfy authority figures. Library of Congress Digital Collections

This framing matters because the First Amendment analysis should not be limited to the therapist’s speech claim. The child is also a rights-holder: when the state licenses a professional practice aimed at suppressing a minor’s identity expression, the state is not “neutral”—it is authorizing a coercive intervention into the child’s protected sphere.

4) Why “assent” and “informed consent” fail under conversion-therapy conditions

Informed consent/assent requires voluntariness and freedom from undue influence. In the conversion-therapy setting, the most common factual environment involves (a) parental authority and dependency, plus (b) community/religious stigma, plus (c) the therapist’s licensed authority and clinical framing. Put differently, the minor is surrounded by stacked incentives and threats: approval vs. rejection, housing vs. instability, belonging vs. ostracism, “health” vs. “disorder.”

Courts upholding bans credit legislative judgments that minors need protection precisely because the professional setting can magnify coercion and harm. That is the doctrinal through-line for treating bans as permissible professional regulation. Ninth Circuit Court of Appeals

5) Where the Supreme Court case fits

Chiles v. Salazar squarely presents the contested question: whether bans on conversion therapy for minors regulate professional conduct or instead violate the Free Speech Clause by restricting counselor-client conversations based on viewpoint. Supreme Court

Two points help keep the “child autonomy” argument clean in that posture:

1. even if the Court is skeptical of “professional speech” as a standalone category (as discussed in NIFLA), it still recognizes that states may regulate professional practice and standards of care in many contexts; Supreme Court and
2. the state’s interest is not only “protecting minors in general,” but protecting a minor’s own constitutional and developmental autonomy in a context where consent is structurally compromised and the intervention targets identity-linked expression. Library of Congress Digital Collections

Words as the scalpel: why “talk therapy” is still healthcare—and why treating it as untouchable speech would unravel healthcare regulation

In Tingley v. Ferguson, the Ninth Circuit used a line that belongs in every brief on this topic: states do not lose their power to regulate medical treatments “merely because those treatments are implemented through speech rather than through scalpel.” Ninth Circuit Court of Appeals That metaphor is doing real doctrinal work. It recognizes something every clinician and every patient already knows: in healthcare, words are instruments. They diagnose, prescribe, manipulate risk, and reshape behavior. A surgeon cuts with steel; a clinician cuts with clinical authority, framing, suggestion, and directive. The mechanism differs. The capacity to injure does not.

That is why courts upholding conversion-therapy bans treat them as professional regulation inside a licensing scheme—regulation of what licensed providers may do to patients, not censorship of public debate. In Pickup v. Brown, the Ninth Circuit upheld California’s SB 1172 on the ground that the state can define “conversion therapy on minors” as unprofessional conduct even though it is delivered through speech. (Primary source: https://cdn.ca9.uscourts.gov/datastore/opinions/2014/08/29/13-15023.pdf) Likewise, the Third Circuit in King v. Governor of New Jersey upheld New Jersey’s SOCE prohibition for minors, emphasizing legislative reliance on medical evidence and professional standards. (Primary source: https://www2.ca3.uscourts.gov/opinarch/133234p.pdf)

The therapist’s power makes “just words” a legal fiction

The “words as scalpel” insight also captures the power differential that defines licensed care—especially with minors. A therapist is not an ordinary speaker. They are:

• a state-credentialed authority,
• operating in a dependence relationship (minors often cannot freely leave, refuse, or choose a different provider),
• able to define the child’s identity as pathology (“confusion,” “distortion,” “disorder”),
• and often embedded in a social system (parents, school, church/community) that can reward compliance and punish dissent.

So when the “treatment” aims to suppress sexual orientation or gender identity, it isn’t neutral conversation. It is a clinical intervention delivered with institutional authority—exactly the kind of setting where undue influence and coerced compliance can masquerade as assent. That is the factual substrate behind legislatures’ findings and courts’ deference in Pickup, King, and Tingley.

The Child Is a Rights-Holder: Identity-Linked Expression Is Protected Speech, Not Expendable

This isn’t only about the clinician’s speech claim. The minor is also a rights-holder. Supreme Court doctrine recognizes that minors possess First Amendment rights, even if regulation differs by context. Tinker is the classic statement that young people do not “shed” constitutional rights because they are young. And Brown v. Entertainment Merchants Ass’n is particularly useful because the Court treated the law at issue as abridging the First Amendment rights of minors themselves, not merely parents.

Sexual orientation and gender identity are not abstract “viewpoints” in a political debate; they are core identity-linked expression—self-understanding, self-description, association, and presentation. A state licensing regime that allows a professional practice aimed at forcing minors to disavow those realities (to be acceptable, safe, or “healthy”) implicates the child’s autonomy and expressive interests in a way that cannot be hand-waved away as “parental choice.”

Why the “speech-only healthcare is untouchable” theory risks deregulating medicine

Here’s the hard-policy consequence of rejecting the Ninth Circuit’s “scalpel” logic: if any treatment delivered primarily through words becomes presumptively protected speech subject to strict scrutiny (or treated as beyond ordinary professional regulation), then huge swaths of healthcare regulation become constitutionally fragile.

That doesn’t stop at conversion therapy. The same logic would destabilize:

• regulation of dangerous “medical advice” delivered verbally,
• professional discipline for fraudulent or harmful counseling,
• standards of care for informed consent conversations,
• and enforcement against licensed practitioners who promote unproven or dangerous interventions as treatment.

The ivermectin episode illustrates the stakes. Public health authorities repeatedly warned that ivermectin is not authorized or approved by the FDA to prevent or treat COVID-19, and that misuse—including veterinary formulations—posed serious risks. U.S. Food and Drug Administration The point here is not to relitigate COVID policy. The point is structural: if “treatment by words” cannot be regulated as professional conduct, then disciplining a licensed provider who uses clinical authority to push dangerous, non-evidence-based care becomes far harder—because the act is recharacterized as protected “speech” rather than regulated medical practice.

That is exactly why Tingley matters beyond conversion therapy: it supplies a rule that preserves what healthcare regulation is. Healthcare is not defined by whether the clinician uses a scalpel, a pill, or a conversation. It is defined by the professional relationship, the claim of therapeutic purpose, and the predictable risk of harm—all of which exist in “talk therapy.”

In Chiles v. Salazar, Justice Sotomayor pressed counsel with a dietician-style hypothetical—essentially asking whether the State could regulate a licensed professional who recommends something known to be unhealthy, or whether that would have to be treated as “viewpoint” or “content” discrimination. (Supreme Court) That question matters in the conversion-therapy context because it forces the Court to confront the basic architecture of healthcare regulation: in the treatment relationship, words are not mere ideas but the means by which licensed professionals deliver interventions—our words are our scalpel. The State does not lose the ability to enforce evidence-based standards simply because the intervention is delivered through counseling rather than a prescription pad. Even assuming arguendo that strict scrutiny applies, a ban on conversion therapy for minors is justified by a compelling interest in preventing foreseeable harm and preserving the integrity of licensed care, and it is narThat exchange illuminates not only the nature of professional speech but also a recurring tactic in conversion-therapy litigation: credential laundering by advocacy organizations such as Do No Harm and the American College of Pediatricians. These groups use professional-sounding branding and selectively credentialed spokespeople to repackage ideological opposition as “medical disagreement,” even where the position lacks evidentiary support or conflicts with professional consensus. Courts, however, have repeatedly refused to treat litigation-manufactured controversy as equivalent to evidence-based standards: the Ninth Circuit upheld conversion-therapy bans by crediting mainstream medical consensus and by treating the regulation as professional conduct within a licensing regime, even when the conduct is carried out through speech. (Ninth Circuit Court of Appeals) The same logic appears outside the First Amendment frame as well: when organizations market conversion practices as legitimate treatment, courts have scrutinized the underlying claims and enforced legal accountability rather than deferring to titles alone. (NJ Courts) In the treatment relationship, words are clinical instruments—our words are our scalpel—and the State’s interest is preventing foreseeable harm by regulating the misuse of licensed authority. Even assuming arguendo that strict scrutiny applies, bans on conversion therapy for minors advance a compelling interest in patient safety and the integrity of evidence-based care and are narrowly tailored to prohibit a specific professional practice, while leaving intact general speech, advocacy, and religious expression outside the provider–patient relationship. (Ninth Circuit Court of Appeals) Treating such regulation as unconstitutional viewpoint discrimination would reward credential laundering and collapse the line between expertise and ideology, inviting sweeping deregulation of healthcare whenever harm is delivered through words rather than instruments. (Ninth Circuit Court of Appeals)
Links (copy/paste):
Pickup v. Brown (9th Cir. opinion PDF): https://cdn.ca9.uscourts.gov/datastore/opinions/2014/01/28/12-17681.pdf Tingley v. Ferguson (9th Cir. PDF): https://cdn.ca9.uscourts.gov/datastore/opinions/2023/01/23/21-35815.pdf Tingley v. Ferguson (U.S. Supreme Court opinion PDF, 12/11/2023): https://www.supremecourt.gov/opinions/23pdf/22-942_kh6o.pdf Ferguson v. JONAH (N.J. Superior Court memo of decision PDF, 6/10/2019): https://www.njcourts.gov/system/files/court-opinions/2019/fergusonvjonah.pdf Dubrowski (2015) on Ferguson v. JONAH (Northwestern Univ. Law Review Online PDF): https://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=1232&context=nulr_onlinerowly tailored because it targets a defined professional practice directed at a vulnerable population while leaving intact clinicians’ ability to discuss, debate, or express views about sexuality and gender outside the provision of prohibited treatment. Treating that kind of safety regulation as unconstitutional “viewpoint discrimination” would collapse the treatment/opinion line and invite a sweeping logic under which any unsafe clinical recommendation—so long as it is delivered in words—becomes constitutionally insulated, effectively deregulating healthcare. (Supreme Court)

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Key links

• Tingley v. Ferguson (9th Cir.) opinion (PDF): https://cdn.ca9.uscourts.gov/datastore/opinions/2022/09/06/21-35815.pdf Ninth Circuit Court of Appeals
  (Later posted/updated version also available here: https://cdn.ca9.uscourts.gov/datastore/opinions/2023/01/23/21-35815.pdf Ninth Circuit Court of Appeals)
• Pickup v. Brown (9th Cir.) (PDF): https://cdn.ca9.uscourts.gov/datastore/opinions/2014/08/29/13-15023.pdf
• King v. Governor of New Jersey (3d Cir.) (PDF): hthttps://www2.ca3.uscourts.gov/opinarch/133234p.pdf

Risk–Benefit Analysis, Evidence-Based Medicine, and Why “Words as the Scalpel” Is a Healthcare Rule—not a Metaphor

1. Healthcare is defined by risk–benefit analysis grounded in evidence

At its core, healthcare regulation is not about how an intervention is delivered, but whether its benefits outweigh its risks, based on the best available scientific evidence. This is a foundational principle across medicine and mental health:

• Interventions must be supported by data, not ideology.
• Claims of benefit must be evaluated against documented risks of harm.
• Professional standards evolve through peer review, replication, and consensus, not individual belief.

Licensing regimes exist precisely to enforce these principles—to prevent practitioners from offering treatments that lack evidence of benefit and carry known risks, even when patients or parents request them.

Conversion therapy fails this test. Legislatures and courts repeatedly note that it lacks credible evidence of efficacy and is associated with increased risks of depression, anxiety, suicidality, and self-hatred. That risk–benefit imbalance is why states classify it as unprofessional conduct when applied to minors.

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2. “Words are the scalpel”: risk does not disappear because the tool is speech

In Tingley v. Ferguson, the Ninth Circuit made explicit what medical regulation has always assumed: speech can be a clinical instrument. The court rejected the notion that a state’s power evaporates when treatment is delivered conversationally, explaining that professional regulation does not turn on whether harm is inflicted by metal or by language.

This aligns directly with risk–benefit reasoning. In healthcare:

• A scalpel carries risk → regulated.
• A prescription carries risk → regulated.
• A therapeutic intervention that restructures identity, behavior, and self-concept carries risk → regulated.

If courts accepted the argument that “talk therapy” is categorically immune from regulation, the consequence would not be narrow. It would collapse the evidentiary basis of healthcare regulation itself.

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3. Evidence and peer review are what distinguish healthcare from belief

Courts upholding conversion-therapy bans emphasize legislative reliance on:

• Peer-reviewed research
• Statements from major medical and mental-health organizations
• Established standards of care

In Pickup v. Brown and King v. Governor of New Jersey, the courts deferred to legislative judgments precisely because lawmakers grounded their conclusions in medical consensus, not moral disagreement.

This is critical legally. States are not choosing between viewpoints; they are choosing between:

• interventions supported by evidence, and
• interventions rejected by the relevant scientific community as harmful or ineffective.

That distinction preserves the integrity of healthcare as a data-driven enterprise rather than a marketplace of personal theories.

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4. Risk without benefit cannot be justified by consent—especially for minors

Standard medical ethics require that:

• risks be justified by expected benefits,
• patients understand those risks and benefits,
• and consent be voluntary and informed.

Where an intervention shows no credible benefit and documented harm, the ethical calculus collapses. No amount of consent can transform a harmful, ineffective practice into legitimate care—particularly when the “patient” is a minor facing parental authority, community pressure, and clinical power imbalance.

Courts upholding bans treat this as a protective function of the state, not a moral judgment: minors cannot be exposed to professional practices that fail basic risk–benefit scrutiny simply because the intervention is verbal.

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5. Why abandoning evidence-based regulation would deregulate all healthcare

The argument rejected by the Ninth Circuit—that treatments delivered through speech are presumptively protected and largely unregulable—has implications far beyond conversion therapy.

Healthcare routinely regulates:

• diagnostic conversations,
• treatment recommendations,
• informed-consent disclosures,
• and counseling that shapes patient behavior.

If speech alone were enough to defeat regulation, then any licensed provider could promote unproven or dangerous interventions so long as they are framed verbally. The ivermectin episode during COVID-19 illustrates the danger: public health authorities relied on evidence and data science to warn against non-approved uses precisely because unsupported treatments can cause real harm.

The lesson is structural, not political: without evidence-based standards enforced through licensure, healthcare becomes indistinguishable from ideology or salesmanship.

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6. The child’s autonomy and First Amendment interests do not negate evidence standards

Recognizing that minors have constitutional interests in identity and expression strengthens—rather than weakens—the case for evidence-based regulation.

When a licensed professional uses clinical authority to pressure a child to suppress or repudiate identity:

• the child’s autonomy is compromised,
• the risk of harm is high,
• and the absence of evidence of benefit becomes constitutionally salient.

The state’s role here is not to impose orthodoxy, but to prevent the misuse of professional power in ways that predictably harm children, under the guise of treatment.

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Bottom line

• Healthcare is regulated because it carries risk.
• Risk must be justified by evidence of benefit.
• Peer-reviewed science—not belief—defines legitimate care.
• Speech does not become immune when it functions as treatment.

The Ninth Circuit’s “words as the scalpel” formulation is not rhetorical flourish; it is the doctrinal bridge that keeps healthcare regulation coherent. Without it, the law would invite the deregulation of medicine itself—precisely what professional licensing exists to prevent.

That exchange illuminates not only the nature of professional speech but also a recurring tactic in conversion-therapy litigation: credential laundering by advocacy organizations such as Do No Harm and the American College of Pediatricians. These groups use professional-sounding branding and selectively credentialed spokespeople to repackage ideological opposition as “medical disagreement,” even where the position lacks evidentiary support or conflicts with professional consensus. Courts, however, have repeatedly refused to treat litigation-manufactured controversy as equivalent to evidence-based standards: the Ninth Circuit upheld conversion-therapy bans by crediting mainstream medical consensus and by treating the regulation as professional conduct within a licensing regime, even when the conduct is carried out through speech. (Ninth Circuit Court of Appeals) The same logic appears outside the First Amendment frame as well: when organizations market conversion practices as legitimate treatment, courts have scrutinized the underlying claims and enforced legal accountability rather than deferring to titles alone. (NJ Courts) In the treatment relationship, words are clinical instruments—our words are our scalpel—and the State’s interest is preventing foreseeable harm by regulating the misuse of licensed authority. Even assuming arguendo that strict scrutiny applies, bans on conversion therapy for minors advance a compelling interest in patient safety and the integrity of evidence-based care and are narrowly tailored to prohibit a specific professional practice, while leaving intact general speech, advocacy, and religious expression outside the provider–patient relationship. (Ninth Circuit Court of Appeals) Treating such regulation as unconstitutional viewpoint discrimination would reward credential laundering and collapse the line between expertise and ideology, inviting sweeping deregulation of healthcare whenever harm is delivered through words rather than instruments. (Ninth Circuit Court of Appeals)

Links:

https://cdn.ca9.uscourts.gov/datastore/opinions/2014/01/28/12-17681.pdf
https://cdn.ca9.uscourts.gov/datastore/opinions/2023/01/23/21-35815.pdf
https://www.supremecourt.gov/opinions/23pdf/22-942_kh6o.pdf
https://www.njcourts.gov/system/files/court-opinions/2019/fergusonvjonah.pdf
https://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=1232&context=nulr_online

Downloadable Document:

https://docs.google.com/document/d/1nAiRiefyHXS9QxKPU_1CfXAnMsZcQrsF_noRR7Lvut0/edit?usp=sharing