Matt Salmon still remembers, with a shudder, the group therapy circles of his Arizona youth: a teenage boy forced to stand in the center, while others hurled obscenities at him, all under the watchful eye of a therapist who insisted this was the path to “healthy male intimacy.” Nearly two decades later, Salmon—now a psychiatrist—describes the experience of so-called “conversion therapy” as deeply traumatizing and abusive. “I remember watching these boys as they’re essentially being retraumatized and just broken down,” Salmon told CNN. “I’ve done a lot of healing, but those wounds are still very much present.”
Salmon’s story is one of many at the heart of a legal and cultural battle now reaching the highest court in the land. On Tuesday, October 7, 2025, the Supreme Court heard oral arguments in Chiles v. Salazar, a case challenging Colorado’s six-year-old ban on conversion therapy for minors—a law that prohibits licensed counselors from attempting to change a young person’s sexual orientation or gender identity. The case, which zeroes in on talk therapy rather than physical procedures, has become a flashpoint in a broader debate about LGBTQ rights, professional speech, and the power of the state to regulate mental health care.
Conversion therapy, as defined by Colorado law, includes any effort to alter a minor’s sexual orientation or gender identity, whether through changing behavior, gender expression, or feelings. The practice has been denounced by every major medical association in the United States, with studies consistently linking it to increased risks of depression, suicide, drug abuse, and other mental health crises among minors. According to a 2024 survey by The Trevor Project, 13% of LGBTQ youth aged 13-24 have either been subjected to or threatened with conversion therapy, though the actual number exposed to the practice has declined as more states have enacted bans. A 2022 study in JAMA Pediatrics pegged the annual economic burden of conversion therapy and its downstream harms at a staggering $9.23 billion in the U.S. alone.
But the legal question before the Supreme Court is not whether conversion therapy is harmful—it’s whether Colorado’s ban violates the First Amendment by dictating what counselors can say to their clients. The challenge was brought by Kaley Chiles, a licensed counselor in Colorado who describes her approach as “faith-informed counseling.” Chiles, backed by the conservative legal group Alliance Defending Freedom and the Trump administration, argues that her counseling is “speech only” and that her clients voluntarily seek her guidance. She rejects the term “conversion therapy,” framing her work as helping clients “become comfortable and at peace” with their bodies and beliefs.
“The problem is that the state has decided that my clients are not allowed to make certain goals,” Chiles told CNN. “People are struggling and suffering now because counselors like myself are not able to serve them without taking some pretty serious risks.” Under Colorado’s law, Chiles could face fines of up to $5,000 and lose her license if she is found to violate the ban. She says she has already changed how she interacts with clients, avoiding certain conversations, and has lost referrals and speaking engagements due to her advocacy.
Colorado’s Attorney General Phil Weiser, a Democrat running for governor, defends the law as a necessary protection for vulnerable youth. “This law says you can’t pressure people to be someone they’re not,” Weiser explained to CNN. “And if someone is gay, you can’t pressure them to be straight.” Weiser maintains that the law only prohibits licensed professionals from practicing conversion therapy, not families or religious organizations from seeking it outside the clinical setting. “She [Chiles] is free to give speeches, write articles and post on social media about conversion therapy. She could tell her patients about it and direct them to religious ministries. She just can’t practice it with a client because the state has deemed it ineffective and unsafe.”
Chiles’ legal team, however, argues that the law is a form of viewpoint discrimination, suppressing certain conversations between counselors and their clients based on the state’s preferred ideology. “The law is going further and telling the families and these struggling kids that you can’t pursue these goals,” said Jim Campbell, an attorney for Alliance Defending Freedom. Chiles’ side points to a 2018 Supreme Court decision, written by Justice Clarence Thomas, which held that “professional speech” is still protected by the First Amendment and cannot be regulated simply because it is uttered by professionals. “Speech is not unprotected merely because it is uttered by professionals,” Thomas wrote at the time.
The Supreme Court’s conservative majority—now a 6-3 bloc—has signaled a willingness to take an expansive view of First Amendment protections. During Tuesday’s oral arguments, several justices expressed skepticism about Colorado’s justification for regulating therapists’ speech. Justice Amy Coney Barrett wondered if the harms of conversion therapy could be addressed through malpractice lawsuits instead of outright bans, and questioned whether states should be allowed to “pick a side” in medical debates. Justice Samuel Alito suggested that medical consensus can be “taken over by ideology,” while Justice Elena Kagan, typically seen as a liberal voice, acknowledged the possibility that the law could be discriminatory if it allows one viewpoint (affirming a patient’s sexuality) but not the opposite (helping a patient change it). “That seems like viewpoint discrimination in the way we would normally understand viewpoint discrimination,” Kagan observed.
The Trump administration has intervened in the case, urging the court to side with Chiles and arguing that the lower courts did not scrutinize the law’s impact on free speech closely enough. In its brief, the Justice Department questioned Colorado’s reliance on the “professional consensus” that conversion therapy is harmful, warning of “the dangers of relying on the consensus views of professional organizations to dictate what professionals may lawfully say.”
Regardless of the outcome, the stakes are high. If the Supreme Court rules in Chiles’ favor, state-level bans on conversion therapy could be struck down nationwide, potentially opening the door for the practice’s return in places where it had been outlawed. This could have not only social and psychological repercussions—given the well-documented harms to LGBTQ youth—but also significant economic ones, as the JAMA Pediatrics study makes clear.
For Matt Salmon, the debate is not just abstract legal theory. “When you are operating with a license from the government to provide health services, you don’t have just carte blanche free speech to do and say what you want,” he told CNN. “You don’t have free speech to psychologically abuse children.” Salmon’s own therapist eventually lost his license. In the years since, Salmon has managed to repair his relationship with his parents, but the scars of conversion therapy remain.
The Supreme Court’s decision, expected by June 2026, could reshape the landscape for LGBTQ youth, counselors, and families across the country. As both sides await the ruling, the voices of those most affected—survivors like Salmon and the youth currently navigating these fraught debates—remain front and center in a national conversation about healing, harm, and the limits of free speech in the therapist’s office.
