Justice Gorsuch wrote for the 8-1 court that the law is presumptively unconstitutional as to talk therapy. Justice Jackson dissented, writing that the “fallout could be catastrophic.“
A violation of free speech!?!? Doesn’t seem to matter what the psychological research and science has shown about the dangers of trying to change someone’s sexual orientation or gender identity. Or that Exodus closed its own doors because conversion therapy just didn’t work!! Good for Judge Ketanji Brown Jackson for standing up to this dangerous precedent…
As a psychotherapist and the mom of an LGBTQ person I am so devastated by this decision. People have died after exposure to conversion therapy and those who survive are often left with damage that lingers through their life. Don’t be silent people! Lives depend on you showing up and speaking up.
This gives me a bad headache. First of all talk therapy is not speech therapy. Speech therapy is a method to help people with “speech” = speaking. Second, conversion therapy is (usually) talk therapy with the purpose of changing a patient’s sexual or gender orientation. There is no reliable record that conversion therapy works. Reliable medical and psychological scientists think that some serious harm can come from this therapy. That may be because the patients are there under family pressure and don’t want to change. Or they may wish to change but cannot alter deeply rooted personality/biological issues. Originally, conversion therapy despite its ecclesiastical sounding name, was introduced to “convert” homosexuality to heterosexuality. Gender did not become a huge issue until this century. That any court, let alone the Supreme Court, dares to stick nine of their noses into this issue, makes me run for the Tylenol. It won’t give me autism, but other unqualified government officials may disagree.
I'm curious how the determination that therapy is "speech" applies to physical interventions that are sometimes used in conversion "therapy" (such as electric shocks and physical abuse intended to disincentivize certain thoughts and behaviors). Can that still be legislated against?
I think so, as well as laws against providing information regarding abortion and other reproductive healthcare. They seem to have no idea what they're getting into despite Justice Jackson's cogent warnings.
Chris, are you familiar with the concept of a “paper genocide”? It’s the eradication of a population by administrative refusal to recognize existence, & it’s proceeding apace in the US (as you know from your attention to the KS license law etc).
It’s supposed to be posted to their YouTube channel later today. I hope you will take a look at it. I greatly value your efforts to keep anti-trans legislation in the public eye.
I couldn't stand to read much of the opinion because it was so frustrating and infuriating. "Talk therapy" IS NOT EXPRESSIVE SPEECH. Yes, a therapist may express an opinion, but verbal communication (most often oral but sometimes written, signed, etc.) in therapy is the professional tool of the therapist intended to ameliorate mental health problems. It is as much a tool (and no more expressive than) the dentist's drill.
Despite Justice Gorsuch's dismissal of prevailing standards of care they are the foundation of medical, nursing, psychological, psychiatric and other health-related practices. A therapist who says to a patient, "I think homosexuality is a sin" or "as far as I am concerned there are only two genders" is expressing opinions, as misinformed as they might be.
When a therapist undertakes to change a patient's sexual orientation or gender identity they are not expressing opinions but rather using the tools of psychotherapy to try to achieve goals that are known to be impossible, are of no demonstrated psychological benefit and known often to be harmful. That the opinion denies, repeatedly, that speech in psychotherapy cannot be conduct is absolutely wrong. Engaging in a therapeutic PROCESS is conduct, not expressive speech, and attempting to change gender identity or sexual orientation is not expressing an opinion, it is malpractice.
Justice Jackson was absolutely right. If all talking in a professional relationship is protected speech our professional worlds will fall apart. Telling a medical patient how to take a medication is just speech, so what recourse is there if the instructions are wrong and serious harm results?
If health professionals in a HIPAA-covered entity breach a patient's privacy in conversations and allow others to find out their protected health information, well, that was just talking, and we can't regulate what professionals say, can we?
If a lawyer violates attorney-client privilege to the client's detriment, oh well, that's talking, not conduct and lawyers have the write to talk without restrictions from the state.
Getting back to therapists, say a psychologist spends several sessions trying to convince a patient to have sex with them and the patient is so distressed they attempt suicide and then reports the therapist to the licensing board. So? IT WAS JUST SPEECH, NOT CONDUCT. Therapists have the right to say what they want in therapy, and saying that they can't engage in seduction or sexual harassment would be, well, unconstitutional as long as nothing physical was involved. It's just speech, after all.
THAT is the world that Justice Jackson was talking about. This is SCOTUS' healthcare version of the Bruen decision and, as in Rahimi, they will soon have to be frantically backpedaling to try to undue the disaster they caused without admitting just how royally they f***d up.
Funny that since Justice Barrett was confirmed, and the right wing majority secured, everything has become “egregious” … or worse. Abortion, affirmative action, voting rights, gay rights, etc. Rules are exalted; their real effects on real people, feh!
"Talk therapy" is therapy, not talk, at least not in the Amdt I sense. It is medicine that happens to take the form of words as opposed to pills or surgery. Mr. Gorsuch, AJ, is too intelligent and experienced not to know it. Is disingenuity good judicial behavior? What if committed in a decision beyond appeal?
The future looks very bleak for LGBTQ+ rights in this country. I refuse to live in a society that is so unaccepting of anyone who dares to be different than the crowd. Separation of church and state is officially out the window.
There’s a hard truth people don’t like to say out loud: medicine has never been purely scientific—it’s always been shaped by power, institutions, and prevailing orthodoxy. The Court majority recognized that when the state starts dictating which viewpoints are allowed in treatment, you’re no longer regulating care—you’re policing thought. And history is full of examples where “accepted science” later proved dead wrong. That’s why dissent matters. That’s why protection matters. Because once you silence minority viewpoints in medicine, you don’t get safety—you get conformity. And conformity, when it’s wrong, doesn’t just fail. It harms. Sometimes permanently.
But nothing like protecting speech is getting in the way of the reinstated and hugely expanded global gag order that foreign NGOs are to be entirely excluded rom receiving U.S. assistance if they “provide, counsel, or advocate” for legal abortion, even using their own non-U.S. funds. January this year was expanded to all non-military foreign aid, and blacklists any supportive of LGBT rights, and (DEI) initiatives.
At first I was kinda <phfft>, then I took a breath. Sigh.
From my unlettered perspective (and for the rare moment, having not yet read the decision), I can understand the argument I imagine may've been made.
While it is medically unethical, it is not within the court's domain, outside of the potential Constitutional issue, therefore it is up to the professional standards of individual professions (and, perhaps, lawmakers) to rectify this. Whether it's a good or bad thing for those affected is not within our domain.
(This seems to me to have been a somewhat capricious choice, over time. As in, send it back to Congress, wrt other issues, when the Court may've tilted otherwise.)
No, what the decision says is that words spoken during therapy (or, presumably, in any professional relationship) are protected expressive speech, not (ever) conduct, and therefore cannot be regulated by the state.
The logical and obvious corollary is that NO professional speech can be subject to regulation by the state, such as professional licensing boards, despite the existence of professional standards of care that licensees are expected to adhere to.
So, as I mentioned above, a HIPAA violation consisting of speech shouldn't be punishable. Breaking attorney-client privilege is protected speech and cannot be sanctioned. Telling a patient who is bordering on cirrhosis to go ahead and drink what they want? Protected speech, not conduct and not subject to discipline.
Chris Geidner, and others I cherish, are such good teachers.
For intance, I was confronted with my own priors, contemporaniously adjacent to Skokie. That was a hard one to swallow, and it left a serious mark, and an inclination (as someone who'd been looking longingly across the lake) to compare how the idea and foundation of the planet and country I happened to be plopped into possibly had framed our experiment... correctly.
Plus, Ken White is part of the universe and a broad community. He has had a lot to do with helping me to understand and step back from my instantaneous reactions, for, I dunno, over a decade.
Odd that only one free thinker respects medical science among the nine.
A violation of free speech!?!? Doesn’t seem to matter what the psychological research and science has shown about the dangers of trying to change someone’s sexual orientation or gender identity. Or that Exodus closed its own doors because conversion therapy just didn’t work!! Good for Judge Ketanji Brown Jackson for standing up to this dangerous precedent…
And it doesn’t seem to matter that this ruling is a violation to the very being of those who know better for themselves.
As a psychotherapist and the mom of an LGBTQ person I am so devastated by this decision. People have died after exposure to conversion therapy and those who survive are often left with damage that lingers through their life. Don’t be silent people! Lives depend on you showing up and speaking up.
I just want to say how much I respect Justice Ketanji Brown Jackson.
💯
This gives me a bad headache. First of all talk therapy is not speech therapy. Speech therapy is a method to help people with “speech” = speaking. Second, conversion therapy is (usually) talk therapy with the purpose of changing a patient’s sexual or gender orientation. There is no reliable record that conversion therapy works. Reliable medical and psychological scientists think that some serious harm can come from this therapy. That may be because the patients are there under family pressure and don’t want to change. Or they may wish to change but cannot alter deeply rooted personality/biological issues. Originally, conversion therapy despite its ecclesiastical sounding name, was introduced to “convert” homosexuality to heterosexuality. Gender did not become a huge issue until this century. That any court, let alone the Supreme Court, dares to stick nine of their noses into this issue, makes me run for the Tylenol. It won’t give me autism, but other unqualified government officials may disagree.
I'm curious how the determination that therapy is "speech" applies to physical interventions that are sometimes used in conversion "therapy" (such as electric shocks and physical abuse intended to disincentivize certain thoughts and behaviors). Can that still be legislated against?
Can this decision be used to oppose efforts to restrict gender-affirming care?
I think so, as well as laws against providing information regarding abortion and other reproductive healthcare. They seem to have no idea what they're getting into despite Justice Jackson's cogent warnings.
Good thought!
Chris, are you familiar with the concept of a “paper genocide”? It’s the eradication of a population by administrative refusal to recognize existence, & it’s proceeding apace in the US (as you know from your attention to the KS license law etc).
A few days ago Trans Rescue hosted a webinar on the subject with the founder of the Genocide Studies Journal & some others—
https://transrescue.org/press-release-trans-rescue-joins-genocide-scholars-to-discuss-danger-for-trans-americans
It’s supposed to be posted to their YouTube channel later today. I hope you will take a look at it. I greatly value your efforts to keep anti-trans legislation in the public eye.
I couldn't stand to read much of the opinion because it was so frustrating and infuriating. "Talk therapy" IS NOT EXPRESSIVE SPEECH. Yes, a therapist may express an opinion, but verbal communication (most often oral but sometimes written, signed, etc.) in therapy is the professional tool of the therapist intended to ameliorate mental health problems. It is as much a tool (and no more expressive than) the dentist's drill.
Despite Justice Gorsuch's dismissal of prevailing standards of care they are the foundation of medical, nursing, psychological, psychiatric and other health-related practices. A therapist who says to a patient, "I think homosexuality is a sin" or "as far as I am concerned there are only two genders" is expressing opinions, as misinformed as they might be.
When a therapist undertakes to change a patient's sexual orientation or gender identity they are not expressing opinions but rather using the tools of psychotherapy to try to achieve goals that are known to be impossible, are of no demonstrated psychological benefit and known often to be harmful. That the opinion denies, repeatedly, that speech in psychotherapy cannot be conduct is absolutely wrong. Engaging in a therapeutic PROCESS is conduct, not expressive speech, and attempting to change gender identity or sexual orientation is not expressing an opinion, it is malpractice.
Justice Jackson was absolutely right. If all talking in a professional relationship is protected speech our professional worlds will fall apart. Telling a medical patient how to take a medication is just speech, so what recourse is there if the instructions are wrong and serious harm results?
If health professionals in a HIPAA-covered entity breach a patient's privacy in conversations and allow others to find out their protected health information, well, that was just talking, and we can't regulate what professionals say, can we?
If a lawyer violates attorney-client privilege to the client's detriment, oh well, that's talking, not conduct and lawyers have the write to talk without restrictions from the state.
Getting back to therapists, say a psychologist spends several sessions trying to convince a patient to have sex with them and the patient is so distressed they attempt suicide and then reports the therapist to the licensing board. So? IT WAS JUST SPEECH, NOT CONDUCT. Therapists have the right to say what they want in therapy, and saying that they can't engage in seduction or sexual harassment would be, well, unconstitutional as long as nothing physical was involved. It's just speech, after all.
THAT is the world that Justice Jackson was talking about. This is SCOTUS' healthcare version of the Bruen decision and, as in Rahimi, they will soon have to be frantically backpedaling to try to undue the disaster they caused without admitting just how royally they f***d up.
Funny that since Justice Barrett was confirmed, and the right wing majority secured, everything has become “egregious” … or worse. Abortion, affirmative action, voting rights, gay rights, etc. Rules are exalted; their real effects on real people, feh!
"Talk therapy" is therapy, not talk, at least not in the Amdt I sense. It is medicine that happens to take the form of words as opposed to pills or surgery. Mr. Gorsuch, AJ, is too intelligent and experienced not to know it. Is disingenuity good judicial behavior? What if committed in a decision beyond appeal?
The future looks very bleak for LGBTQ+ rights in this country. I refuse to live in a society that is so unaccepting of anyone who dares to be different than the crowd. Separation of church and state is officially out the window.
There’s a hard truth people don’t like to say out loud: medicine has never been purely scientific—it’s always been shaped by power, institutions, and prevailing orthodoxy. The Court majority recognized that when the state starts dictating which viewpoints are allowed in treatment, you’re no longer regulating care—you’re policing thought. And history is full of examples where “accepted science” later proved dead wrong. That’s why dissent matters. That’s why protection matters. Because once you silence minority viewpoints in medicine, you don’t get safety—you get conformity. And conformity, when it’s wrong, doesn’t just fail. It harms. Sometimes permanently.
But nothing like protecting speech is getting in the way of the reinstated and hugely expanded global gag order that foreign NGOs are to be entirely excluded rom receiving U.S. assistance if they “provide, counsel, or advocate” for legal abortion, even using their own non-U.S. funds. January this year was expanded to all non-military foreign aid, and blacklists any supportive of LGBT rights, and (DEI) initiatives.
At first I was kinda <phfft>, then I took a breath. Sigh.
From my unlettered perspective (and for the rare moment, having not yet read the decision), I can understand the argument I imagine may've been made.
While it is medically unethical, it is not within the court's domain, outside of the potential Constitutional issue, therefore it is up to the professional standards of individual professions (and, perhaps, lawmakers) to rectify this. Whether it's a good or bad thing for those affected is not within our domain.
(This seems to me to have been a somewhat capricious choice, over time. As in, send it back to Congress, wrt other issues, when the Court may've tilted otherwise.)
No, what the decision says is that words spoken during therapy (or, presumably, in any professional relationship) are protected expressive speech, not (ever) conduct, and therefore cannot be regulated by the state.
The logical and obvious corollary is that NO professional speech can be subject to regulation by the state, such as professional licensing boards, despite the existence of professional standards of care that licensees are expected to adhere to.
So, as I mentioned above, a HIPAA violation consisting of speech shouldn't be punishable. Breaking attorney-client privilege is protected speech and cannot be sanctioned. Telling a patient who is bordering on cirrhosis to go ahead and drink what they want? Protected speech, not conduct and not subject to discipline.
Too bad their conversation wasn’t this smart.
Chris Geidner, and others I cherish, are such good teachers.
For intance, I was confronted with my own priors, contemporaniously adjacent to Skokie. That was a hard one to swallow, and it left a serious mark, and an inclination (as someone who'd been looking longingly across the lake) to compare how the idea and foundation of the planet and country I happened to be plopped into possibly had framed our experiment... correctly.
Plus, Ken White is part of the universe and a broad community. He has had a lot to do with helping me to understand and step back from my instantaneous reactions, for, I dunno, over a decade.