Why more than 20 states have outlawed LGBTQ ‘conversion therapy’ — and why the Supreme Court is now considering overturning those bans

On Monday the Supreme Court agreed to hear a First Amendment challenge to a Colorado law that prohibits so-called conversion therapy for LGBTQ minors. If the court’s 6-3 conservative majority decides to overturn such bans, it could pave the way for licensed therapists in Colorado — and more than 20 other states — to resume trying to change their patients’ sexual orientation or gender identity. Here’s everything you need to know to understand the issue — and what could happen next.

What is conversion therapy?

Conversion therapy is the medically discredited practice of trying to change, modify or suppress a person's sexual orientation or gender identity.

Over the years, conversion therapy has taken many forms: brain surgery, castration, electric shocks, hypnosis. Today’s practitioners and patients tend to operate in a socially or religiously conservative context where the underlying assumption is that homosexuality and gender nonconformity are mental disorders that can and should be “cured” — an assumption that has long been rejected by mainstream medicine, psychology and psychiatry.

The Williams Institute at the University of California, Los Angeles School of Law estimates that nearly 700,000 LGBTQ adults in the United States have undergone conversion therapy.

Does conversion therapy work?

No. According to a recent U.K. government review of roughly four dozen relevant studies, “there is no robust evidence that conversion therapy can change sexual orientation or gender identity.”

Likewise, a 2009 American Psychological Association survey of peer-reviewed journal articles dating back to 1960 found that “enduring change to an individual’s sexual orientation is uncommon” and that “compelling evidence of decreased same-sex sexual behavior and of engagement in sexual behavior with the other sex was rare.”

A more recent Cornell University investigation concluded that “most accounts of such change are akin to instances of ‘faith healing.’”

What researchers have discovered, however, is that conversion therapy can hurt those it’s purporting to help. In a 2002 study published in the journal Professional Psychology, a full three-quarters of conversion therapy participants (77%) reported one or more of the following symptoms: depression, anxiety, lowered self-esteem, internalized homophobia, self-blame, intrusive imagery or sexual dysfunction.

Other studies have shown that roughly one in three LGBTQ people who have tried to change their sexual orientation through conversion therapy go on to report suicidal attempts — a number that rises to more than one in four among patients who have tried to change their gender identity.

What does the law say about conversion therapy?

Twenty-two states (California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Utah, Virginia, Vermont, Washington) and the District of Columbia have enacted laws banning mental health professionals from practicing conversion therapy on minors. An additional five states (Arizona, Kentucky, North Carolina, North Dakota, Wisconsin) have partially banned conversion therapy for minors, while three are under a preliminary federal circuit injunction that prevents enforcement of conversion therapy bans.

The rest of the states have no laws protecting minors from such therapy — and even in the states that do have bans, religious providers are still allowed to perform conversion therapy and adult patients are still allowed to sign up for it.

What is the Colorado case about?

In 2019, Colorado passed a law prohibiting licensed therapists from performing conversion therapy on minors; instead, the state encouraged treatments that offer “acceptance, support and understanding.”

Importantly, counselors “engaged in the practice of religious ministry” were exempted from Colorado’s ban on conversion therapy.

Yet Kaley Chiles — a licensed professional therapist with conservative Christian beliefs who is nonetheless not a religious minister — challenged the constitutionality of the Colorado law in federal court, saying it violated her rights to free speech and the free exercise of religion.

Last year, a divided appeals court in Denver ruled against Chiles, citing evidence that conversion therapy harms minors and argued that Colorado is entitled to regulate a licensed professional’s conduct to prevent such harm.

But Chiles’s lawyers sought review from the Supreme Court, writing that as “a practicing Christian, Chiles believes that people flourish when they live consistently with God’s design, including their biological sex.”

On Monday, the court agreed to hear Chiles’s case.

“The government has no business censoring private conversations between clients and counselors, nor should a counselor be used as a tool to impose the government’s biased views on her clients,” the president of Alliance Defending Freedom — the conservative Christian law firm and advocacy group that is representing Chiles — said in a statement.

What does this mean for the future of conversion therapy?

Nobody knows yet. In 2023, the Supreme Court declined to hear a nearly identical case challenging Washington’s ban on conversion therapy; it was even brought by the same firm, Alliance Defending Freedom.

What’s different this time? Possibly America’s growing political focus on transgender issues, which played a central role in the 2024 presidential election.

As conservative Justice Clarence Thomas wrote in 2023, when he dissented from the Court’s decision not to grant review, “this petition asks us to consider whether Washington can censor counselors who help minors accept their biological sex.” He did not focus on sexual orientation in his dissent.

“Because this question has divided the courts of appeals and strikes at the heart of the First Amendment, I would grant review,” Thomas concluded.

At the time, Justice Samuel Alito — another conservative — concurred, calling it a “question of national importance.”

“In recent years, 20 states and the District of Columbia have adopted laws prohibiting or restricting the practice of conversion therapy,” Alito explained. “It is beyond dispute that these laws restrict speech, and all restrictions on speech merit careful scrutiny.”

Ultimately, the Colorado case is likely to turn on the question of whether restricting what people can talk about with their therapist violates constitutional free speech protections.

Those who say yes claim, as in the petitioner’s lawyers in the 2023 Washington case, that “a private conversation is speech, not conduct.”

“And that does not change just because one participant is a licensed counselor and the other his client,” the petitioner’s lawyers continued. “Otherwise, government can alchemize almost any professional’s speech into conduct that can be silenced — something the First Amendment forbids.”

Conversely, those who say that conversion therapy restrictions don’t violate the First Amendment argue (as Vox’s Ian Milhauser recently did) that “a lawyer cannot tell their client ‘nothing will happen to you if you go rob a bank’ without risking professional sanction. Nor can a physician cite the First Amendment to avoid a murder trial if they tell a patient to ‘go drink a jug of arsenic.’”

“States do not lose the power to regulate the safety of medical treatments performed under the authority of a state license merely because those treatments are implemented through speech rather than through scalpel,” Judge Ronald M. Gould wrote in 2023.