Under a 2019 Colorado law, if clients younger than 18 tell her that their same-sex attractions are causing them stress, as a licensed therapist, she is forbidden from counseling them to change their sexual orientation. If they want to talk about their gender identity, she cannot advise them to change it.
Colorado lawmakers and major medical groups say that kind of counseling is ineffective and potentially harmful for minors, and it is therefore appropriate for state governments to outlaw it for licensed mental health professionals.
Chiles, an evangelical Christian with a master’s degree in clinical mental health from Denver Seminary, says the law violates her First Amendment rights, constraining what she is allowed to say in therapy sessions with young people who have sought out her care.
“It seemed like an invasion for the state to kind of be peering into our private counseling sessions,” Chiles said in an interview. “My speech is being censored because my clients are not able to see me and make certain goals that the state does not endorse.”
The Supreme Court will hear Chiles’s challenge to the Colorado law on Tuesday, in a case with implications for more than 20 states with similar laws. It will now fall to the justices to decide whether Colorado’s law, as it applies to talk therapy, is about properly regulating medical treatment or impermissibly censoring speech.
The case is being argued in the first week of the court’s new term and puts the justices back at the center of a contentious political issue. Five years ago, the Supreme Court extended civil rights protections to LGBTQ+ workers. But the court’s conservative majority, with three justices nominated by President Trump, has since appeared to shift, amid pushback among more Americans to expanded rights for transgender people.
In June, the court was divided 6-3 along ideological lines when it upheld a Tennessee law banning certain medical treatments for transgender teens and allowed religious parents to withdraw their children from story time with LGBTQ+-themed books at odds with their faith.
The justices will also this term review a pair of state laws barring transgender athletes from participating on girls’ and women’s sports teams, an issue the Trump administration has seized on as it seeks to limit transgender rights on military service, bathroom access, and athletics.
In the Colorado case, Chiles is represented by the Alliance Defending Freedom, a conservative Christian legal organization, which is also behind recent challenges at the court to abortion access, insurance coverage for contraception, and gay and transgender rights.
Colorado is one of more than two dozen states that prohibit or limit conversion therapy for minors. Major health care associations say such therapy puts minors at increased risk of depression, anxiety and suicide attempts. (New York City repealed its far-reaching ban on conversion therapy in 2019 to avoid a lawsuit, but a state law remains in effect.)
Colorado’s 2019 statute prohibits counseling minors to change their “gender expressions or to eliminate or reduce sexual or romantic attraction or feelings toward individuals of the same sex.”
It was passed in response to the experiences of people like Mathew Shurka, who testified before lawmakers about the trauma he endured during five years of conversion therapy starting at age 16. Shurka’s father took him to a therapist who said he could eliminate an attraction to boys. Shurka was told to limit contact with his mother and sisters for three years so as not to look at women as his peers, and was trained to “defeminize.”
As a result, Shurka said he experienced anxiety, depression, and suicidal thoughts.
“I knew I wasn’t changing and I blamed myself for my failures; it didn’t occur to me that the therapist was harming me,” said Shurka, who went on to become an activist seeking an end to conversion therapy.
Chiles said she is not seeking to “cure” clients of same-sex attractions or to “change” their sexual orientation but only to help patients with their stated goals, which sometimes include “seeking to reduce or eliminate unwanted sexual attractions,” according to her filings.
Colorado’s Democratic attorney general, Phil Weiser, said states have long regulated medical practices, including treatments carried out through speech, to protect patients from substandard care. The law, he says, is about professional conduct, not speech.
Weiser warned that a Supreme Court ruling against Colorado would undercut the ability of states to regulate other professions and make it harder to sue all kinds of professionals, including doctors and lawyers, for giving bad advice.
Weiser said the Supreme Court would be ill-advised to take up what he characterized as “made up” or “hypothesized controversies.”
“We’re hypothesizing about what type of therapy she might do, given that she hasn’t actually shown to have done any of this therapy,” he said.
A lawyer for Chiles, Jim Campbell, the chief legal counsel with the Alliance Defending Freedom, said an earlier Supreme Court ruling requires a decision in her favor.
In 2018, the justices ruled that California could not require religiously oriented “crisis pregnancy centers” to supply women with information about how to end their pregnancies. In that decision, the justices cautioned against giving professional speech less constitutional protection to suppress unpopular ideas.
“The First Amendment doesn’t allow the government to shut down one side of a discussion,” Campbell said.
The Trump administration will participate in oral argument in support of Chiles’s position.
Siding with Chiles “would require us to conclude — erroneously — that mental health care is not really health care and that talk therapy is not really medical treatment,” according to the opinion authored by Judge Veronica S. Rossman and joined by Judge Nancy L. Moritz.
In dissent, Judge Harris L. Hartz questioned the strength of the scientific research the state Legislature relied on to justify the law.
“Courts must be particularly wary that in a contentious and evolving field, the government and its supporters would like to bypass the marketplace of ideas and declare victory for their preferred ideas by fiat,” Hartz wrote.