The Supreme Court handed down a decision today striking down Colorado’s ban on conversion therapy for minors. The ruling, decided 8–1, surprised many. It will likely reshape how states regulate therapy, speech, and professional boundaries moving forward.
For many of my colleagues in counseling and mental health, this decision feels like a step backward. For some, it feels dangerous. I understand that reaction. Conversion therapy has a long and troubling history. It has been misused, overused, and in many cases, weaponized against vulnerable young people. Major medical organizations have rejected coercive or prescriptive attempts to change sexual orientation or gender identity, and rightly so. But I also believe the Court got this one right. That statement alone will make some people stop reading. But stay with me for a moment.
This Case Was Not About Endorsing Harmful Practice
The public conversation is already drifting toward a false binary: either you support LGBTQ youth, or you support conversion therapy. That framing misses the heart of the issue. The Court did not endorse coercive or harmful practices. It ruled on something narrower and more fundamental: whether the government can restrict what a licensed therapist is allowed to say in the context of therapy.
Justice Gorsuch framed it as a free speech issue. Justice Jackson, in dissent, argued that therapy is conduct, not just speech, and therefore should be regulated like other medical practices. That tension is real. Therapy sits in a gray area between conversation and intervention. But at its core, therapy is built on dialogue. Remove the ability to explore, question, reflect, and even challenge, and you begin to hollow out the very process we rely on to help people.
The Danger of a One-Tool Toolbox
Here’s where I part ways with many in my field. There is a growing trend, especially with younger clients, to treat “affirmation” as the only ethical response when a client presents questions about sexual or gender identity. Affirmation matters. Deeply. For many clients, it is life-giving and necessary. But affirmation should not mean direction!
If a young person comes into therapy questioning who they are, the ethical response is not to steer them toward a predetermined identity. It is to help them explore. Not every client is the same. Not every story is the same. When we limit therapists to a single pathway, affirmation in one direction only, we risk replacing one form of rigidity with another.
What Exploration Actually Looks Like
In real clinical work, things are rarely clean or ideological. I’ve worked with students who were clearly gay, and affirmation was exactly what they needed. They needed safety, language, and the confidence to embrace who they already knew themselves to be.
I’ve also worked with clients who were confused, not because of identity, but because of experience. One case still sits with me. A teenage foster youth came into counseling deeply distressed. He had always been attracted to girls. That had never been in question. But after a lack of supervision in a group home, he was coerced into sexual activity with another male resident.
It was not something he chose. But it was his first sexual experience. And like many forms of physical stimulation, it produced a physiological response. That created confusion. He came into therapy asking a painful question: What does this mean about me?
In that moment, what he needed was not a political framework. He needed clarity. He needed someone to help him separate physiology from identity. He needed someone to say: your body responded, but that does not define who you are. When he understood that, he cried. Not because he was being pushed in a direction, but because the confusion lifted.
That was therapy.
The Ethical Line
Let me be clear about something important. Coercion is wrong. Shame-based interventions are wrong. Predetermined agendas, whether pushing someone toward or away from an identity, are wrong.
But exploration is not coercion. And the concern I have is that in trying to protect clients from harm, we may be moving toward a model where exploration itself becomes restricted. That is not good therapy.
The Role of Law vs. the Role of the Therapist
Laws and often ethical standards are often blunt instruments. They are not designed to handle the nuance of human identity, trauma, development, and meaning-making. Therapy, at its best, is deeply individualized. It requires judgment, restraint, curiosity, and humility.
When laws and ethical codes begin to dictate not just what therapists do, but what they are allowed to say or explore, we step into dangerous territory. Not because therapists should be free from accountability, but because good therapy cannot be reduced to a script.
A Hard Conversation We Need to Have
I know this position will be misunderstood by many of my friends. Some will hear support for this ruling as support for harmful practices. That’s not where I stand. What I am advocating for is something both simpler and harder: trust in the therapeutic process when it is done well.
Clients deserve more than ideology, whether it comes from the right or the left. They deserve space to wrestle, question, understand, and ultimately arrive at a place that is authentically their own. And therapists need the freedom and the responsibility to walk with them through that process without being forced into a single, predetermined path.
Dr. Wesley
So much wrong with this…
First, let’s look at the term “conversion therapy.” That’s akin to “book banning.” In the entire history of the United States, very few books have been banned. Restricted? Yes, and nearly always for good reasons that we won’t get into. But when activists/advocates are allowed to frame an issue, and the media jumps on board, we get confusing terms like “conversion therapy” and — more recently — “gender assigned at birth.” (There are two sexes, you are born one or the other and you can’t change it. But, yes, you can choose to live as a different sex. But biology will always win this debate.)
This line is perplexing: “ In real clinical work, things are rarely clean or ideological. I’ve worked with students who were clearly gay, and affirmation was exactly what they needed. They needed safety, language, and the confidence to embrace who they already knew themselves to be.”
I’m assuming the student sought therapy not to be affirmed but rather to work through would could be anything from shame and guilt for sin to using the body in sexual ways it wasn’t meant for (that’s an exit point, guys, not an entry). But for some reason you decide on your own what’s necessary is “confidence” and “affirmation” rather than a deep dive into what’s truly troubling them.
Listen to people, be open to the fact they might be under conviction, not looking for affirmation of a lifestyle that has truly brought them to the point of seeking counseling.
Your are guilty of your own words: “Let me be clear about something important. Coercion is wrong. Shame-based interventions are wrong. Predetermined agendas, whether pushing someone toward or away from an identity, are wrong.”
Then this: “They deserve space to wrestle, question, understand, and ultimately arrive at a place that is authentically their own.”
These words are rooted in hypocrisy. You didn’t allow the person to explore, you “affirmed.”
I agree, SCOTUS made a decision largely based on freedom of speech. A correct decision. But the real battle goes on in the therapy room where the therapists themselves often introduce more confusion based on their own conclusions about a “healthy” society.
Let the client be open to the fact that their choices might be bad choices. As in AA, that’s step one to recovery.
Hey My friend! I appreciate you taking the time to really engage with this. And I hear the concern underneath what you’re saying.
Let me try to clarify a couple of things from the therapy side, because I think there’s a misunderstanding of what “affirmation” should mean in practice. Affirmation in therapy is not the same as endorsement or pushing someone toward a lifestyle. It’s about creating enough safety for a person to actually tell the truth about what they’re experiencing without fear of shame or rejection. Without that, people shut down or just tell you what they think you want to hear.
When I said I affirmed certain clients, I wasn’t deciding their identity for them. I was responding to what they had already come to understand about themselves. That’s very different from steering them. And I agree with you more than you might think on this: therapy should absolutely allow people to question their choices, wrestle with their convictions, and examine whether something in their lives is healthy or not. That’s part of the work. If a client believes their behavior conflicts with their values, we explore that. We don’t shut it down.
Where I draw a hard line is this: therapy should not start with a predetermined conclusion about who the person is supposed to be. Not from the therapist, and not from an ideology on either side. You mentioned AA, and that’s actually a helpful comparison. Step one only works when the person arrives at it on their own. If someone is pushed into it before they’re ready, it doesn’t stick. Therapy works the same way.
So when I talk about exploration, I mean exactly that, helping clients sort through competing thoughts, values, experiences, and yes, even beliefs about sin, identity, and purpose. But the direction has to come from them, not from me deciding in advance what the “right” outcome is. If I ever cross that line, then I’d be guilty of exactly what I said… imposing an agenda. And that’s something I try to stay very aware of.
I don’t expect us to land in the same place on all of this, but I do think we probably agree on at least this much: people deserve honest space to wrestle with big questions without being manipulated or shamed along the way. Your friend for over 50 years!