The Aftermath of Chiles v. Salazar: What Clinicians, Families, and Survivors Need to Know About Conversion Therapy

Conversion therapy has been surrounded by controversy, confusion, and deep personal pain for decades. For some individuals, conversion therapy—also called sexual orientation change efforts (SOCE)—presents itself as a legitimate path toward reconciling identity with family expectations, faith, or cultural values. For others, it leaves injuries that surface quietly over time—in fractured relationships, diminished self-worth, and a sense of self that was never quite allowed to form on its own terms.  What is too often missing from public discourse, however, is a clear and honest examination of what conversion therapy actually is, what it claims to accomplish, and how those claims hold up under clinical and scientific scrutiny.

Across its wide variation in names and methods, every form of conversion therapy is built on the same foundational assumption: that any sexual orientation other than heterosexual and gender identity consistent with biological sex assigned at birth are inherently pathological and require correction. Contemporary mental health research does not merely question this assumption—it rejects it outright (Conine et al., 2022). Survivors and clinicians report with striking consistency that conversion therapy efforts fail to produce lasting change while causing real and measurable harm across relational, emotional, and psychological domains (Richmond, 2019). In a field that holds do no harm as a foundational principle, the continued existence of these practices demands more than academic scrutiny. It demands clarity, accountability, and a commitment to separating myth from clinical reality. It is an ethical responsibility—and the foundation on which genuinely compassionate, evidence-based care must be built.

What Conversion Therapy is—and is Not!

Before the myths and harm can be fully examined, it helps to understand more clearly what conversion therapy is—and what it is not. The idea did not originate in churches or support groups. It emerged from the early era of psychological science, when researchers lacked a comprehensive understanding of sexuality, which the field has since developed (D'Angelo, 2023). Within that earlier framework, any expression of sexuality outside of heterosexuality was considered pathological and classified as a disorder.  Individuals were subsequently subjected to a range of “treatments” designed and intended to change their fundamental identity—including electroconvulsive therapy and forced institutionalization."

As psychological research advanced, the field eventually came to understand that diverse gender identities and sexual orientations are not disorders requiring treatment. Nevertheless, the impulse to "change" an individual’s identity persisted to match cultural expectations (Richmond, 2019). It simply migrated into new settings and adopted a new language (Alempijevic et al., 2020). Today, conversion therapy often surfaces under terms like "repair," "healing," "identity alignment," or "reorientation"—language that can sound gentle or spiritually affirming but causes the same harm and remains rooted in the underlying belief that identity can be “wrong,” and should be corrected (Higbee et al., 2020).

Chiles v. Salazar

The legal landscape surrounding conversion therapy shifted dramatically in early 2026. On March 31, 2026, the U.S. Supreme Court issued an 8-1 ruling in Chiles v. Salazar (2026), siding with a Colorado therapist who challenged her state's ban on conversion therapy for minors. The Court reversed the Tenth Circuit's ruling upholding the state ban and sent the case back to the Court of Appeals, holding that Colorado's ban constitutes viewpoint-based discrimination and must withstand strict scrutiny—a standard the court strongly suggested the law would fail (Chiles v. Salazar, 2026). At the time of the ruling, 23 states and the District of Columbia had enacted laws prohibiting conversion therapy for minors (Movement Advancement Project, 2026), and this decision places those laws in serious legal jeopardy. Justice Jackson, the sole dissenter, warned that the decision effectively strips states of their traditional authority to regulate what licensed healthcare professionals may say and do in a clinical setting (Chiles v. Salazar, 2026).

The ruling has created immediate and far-reaching uncertainty for clinicians, families, and the LGBTQ+ community alike. Every major medical and mental health association in the country supports bans on the practice, in part because LGBTQ+ youth subjected to conversion therapy continue to be more than twice as likely to attempt suicide compared to their peers (The Trevor Project, 2026). The tension between First Amendment protections and the clinical and ethical consensus against conversion therapy is no longer hypothetical—it is now an active legal and professional crisis unfolding in real time.

Amid this legal and ethical upheaval, precision of language matters more than ever. Opponents of these bans have strategically blurred the line between conversion therapy and legitimate clinical practice, arguing that any restriction on therapeutic speech infringes on both provider and client freedom of speech. It is therefore important to make clear what conversion therapy is not. It is not genuine counseling that helps an individual explore their sexuality, identity, values, or questions of faith with curiosity and without a value driven outcome. It is not supportive pastoral care, affirming spiritual direction, or ethically grounded religious counseling. It is not open-ended, client-centered therapy that honors the individual's autonomy and lived experience. What distinguishes conversion therapy from all of these is its starting premise: that the client's identity is the problem, and that change is the goal—regardless of what the client actually needs, expresses, or wants. The harm lies not only in the techniques employed, but in this foundational stance itself, a stance that communicates to the client—often repeatedly and with the authority of a trusted professional or religious figure—that who they are is fundamentally wrong. When the First Amendment is invoked not to protect liberty but to co-sign harm, it has been weaponized—and the provider or pastor who wields it to justify conversion therapy does not thereby become a protected professional; they become an abuser. 

Myth 1:  Conversion Therapy is Effective

A persistent myth holds that conversion therapy works, particularly when individuals come forward with testimonials claiming changed sexual orientation or gender identity. But hand-selected testimonials to examine long-term outcomes, the data consistently fails to support the practice's claims (Kinitz et al., 2022). Major psychological and psychiatric organizations are unambiguous on this point: sexual orientation and gender identity are not pathologies to be corrected, and they cannot be changed through therapeutic intervention.

What is frequently misinterpreted as success is more accurately understood as suppression. Individuals may learn to manage the presentation of their identity—to conform to intense social, familial, or spiritual pressure, while their internal experience remains unchanged. Many survivors have described feeling compelled to appear transformed, rehearsing a version of themselves they did not recognize, because the cost of honesty was too high. Sustaining that performance over time is not healing; it creates a chronic stress response, and the research on conversion therapy bears this out.  Specifically, research has linked conversion therapy to elevated rates of shame, depression, and identity confusion (Higbee et al., 2020). The short-term testimonials that circulate in support of these practices often capture this performance at its most convincing moment—before the weight of suppression becomes undeniable. The long-term evidence is consistent and clear: conversion therapy does not change who a person is. It changes only how safe they feel being honest about who they are.

Myth 2: Conversion Therapy is Harmless

A second myth frames conversion therapy as little more than conversation—a voluntary exchange of words between a willing client and a caring provider, making it inherently benign. This framing is both misleading and dangerous. Research consistently documents elevated rates of anxiety, depression, shame, suicidal ideation, and post-traumatic stress among individuals who have undergone conversion programs (Purshouse & Trispiotis, 2022). The harm is not incidental; it is patterned, reproducible across studies, and most severe among those who were subjected to these practices during childhood or adolescence—a population particularly vulnerable to the lasting effects of identity-based rejection from trusted adults (Alempijevic et al., 2020; D'Angelo, 2023).

The mechanism of harm is rarely a single traumatic event. It is cumulative. One of the most damaging factors is the sustained, authoritative message—delivered across weeks, months, or years by clinicians, clergy, or family members—that one’s identity is disordered and must be corrected. That message does not need to be shouted to be destructive; repeated quietly over time, it erodes self-worth in ways that are difficult to name and even harder to recover from (Higbee et al., 2020; Purshouse & Trispiotis, 2022). Survivors frequently describe emerging from these programs not transformed, but fractured—more confused, more isolated, and more alienated from themselves and from meaningful connection with others (Kinitz et al., 2022). Delivering this message softly does not mitigate the trauma. In many cases, it obscures it—making it harder for survivors to identify what was done to them, and harder still to be believed when they do.

Myth 3:  Conversion Therapy is a Matter of Faith

A common assumption holds that conversion therapy is primarily a religious phenomenon—a pastoral concern best left to faith-based communities to govern. This framing is inaccurate in two important ways. First, it overstates the role of religion in the practice itself. While some conversion programs operate explicitly within faith-based frameworks, many do not. A significant number present under clinical-sounding names that use language drawn from the therapeutic community—terms like healing, identity alignment, or sexual health restoration—in ways designed to signal legitimacy rather than doctrine (Graham, 2018). What these programs share is not a theological tradition but an ideological premise: that an individual's sexual orientation or gender identity is a problem requiring correction.

Second, and equally important, this myth misrepresents the relationship between faith and this practice. Many religious traditions and their leaders are vocal in their opposition to conversion therapy, advocating instead for pastoral care that is compassionate, non-coercive, and capable of holding space for the full complexity of a person's inner life (Tozer & Hayes, 2004). Authentic spiritual accompaniment does not begin with a verdict about who the person should become; it begins with presence, and it follows the individual's own questions and longings. Conversion therapy inverts this entirely. It enters the therapeutic or spiritual relationship with a predetermined narrative—one the client did not choose and may not want—and abuses the authority of faith or clinical expertise to reinforce the importance placed on achieving this goal (Graham, 2018; Tozer & Hayes, 2004). When faith is wielded as a pressure point rather than offered as a source of meaning and comfort, it does not guide—it coerces. And coercion, regardless of its theological dressing, causes harm.

The Reality: What Actually Happens in Conversion Therapy

When conversion therapy is mentioned, people often picture extreme practices from the past. In reality, most modern programs are much more subtle. They might resemble standard counseling sessions, prayer groups, or mentoring relationships (Purshouse & Trispiotis, 2022). This softer appearance can make them harder to recognize and easier to justify.  Participants are often encouraged to closely monitor their emotions, thoughts, and behaviors. They may be asked to avoid certain relationships, track “temptations,” or regularly report their personal struggles to a counselor or another leader (Parkinson & Morris, 2021). While this is presented as support, it can slowly become a form of self-surveillance that reinforces fear and shame, rather than growth (Richmond, 2019). 

Shame-based messaging is also common, even when its delivery is subtle. Clients may be told their identity comes from weak faith, poor family relationships, trauma, or moral failure (Garnets et al., 1991). When “change” does not happen, responsibility is placed on the individual: they did not try hard enough, pray hard enough, or surrender to the treatment enough. This often creates a cycle of discouragement and self-blame.

Secrecy and isolation often reinforce this cycle. Participants may be discouraged from connecting with affirming communities or speaking openly about doubts and struggles. Over time, many survivors describe feeling divided between the version of themselves that they present to others and the parts of the self that they are taught to hide, often contributing to depression, anxiety, and difficulties within relationships (Higbee et al., 2022). Most individuals enter conversion therapy with sincere intentions, seeking peace, spiritual clarity, or a felt sense of belonging (Kinitz & Salway, 2022). 

Ethical, Evidence-Based Alternatives to Conversion Therapy

Leaving conversion therapy is often only the first step of many a survivor will make on their path toward healing. Many survivors continue to carry shame, grief, broken trust, and identity confusion long after (Garnets et al., 1991). Healing begins with safety and validation — being believed, and knowing the harm was not their fault. Therapeutic work typically focuses on reducing shame, rebuilding self-trust, and processing spiritual and relational trauma.

Genuine support begins with respect for a person's identity and autonomy. Rather than attempting to "fix" someone, affirming care helps individuals manage stress, deepen self-understanding, and build authentic lives (Conine et al., 2022). Approaches that are both affirming and trauma-informed care reduce shame, strengthen emotional resilience, and invite clients to relate to their inner experience with curiosity rather than judgment and internalized negative beliefs (D'Angelo, 2023).

For those who value faith, ethical therapy does not require abandoning spiritual beliefs. Skilled clinicians have the capacity to help clients explore how identity and faith can coexist — grounded in personal values and emotional safety, not coercion or fear (Conine et al., 2022). Education also matters: understanding that diversity in sexual orientation and gender identity is a normal part of human development can help to directly counter the myths that fuel self-blame.

Healing From Conversion Therapy

The data is clear: attempting to change someone's identity causes harm, not healing. Separating myth from reality opens the door to ethical care — care that respects autonomy, supports mental health, and holds space for both values and identity without pressure or shame.  Healing rarely happens in isolation. Peer support, family counseling, and affirming communities rebuild a sense of belonging and trust. Healing can only occur in environments where people are accepted as they are, not as others wish them to be (Garnets et al., 1991).

Affirming relationships are equally essential. Community and connection remind survivors they are not alone. Healing is not achieved by suppressing one’s true self—it comes through reclaiming one’s voice, authenticity, and dignity (Kinitz & Salway, 2022). For clinicians, families, and communities, this means choosing listening over control. For survivors, it means knowing that healing is real, their stories matter, and they deserve care that allows them to live fully and authentically. At its simplest, it means placing human dignity at the center of everything.

References

Alempijevic, D., Beriashvili, R., Beynon, J., Birmanns, B., Brasholt, M., Cohen, J., ... & Viera, D. N. (2020). Statement on conversion therapy. Journal of Forensic and Legal Medicine, 72, 101930.

Chiles v. Salazar, No. 23-373 (U.S. Mar. 31, 2026).

Conine, D. E., Campau, S. C., & Petronelli, A. K. (2022). LGBTQ+ conversion therapy and applied behavior analysis: A call to action. Journal of Applied Behavior Analysis, 55(1), 6–18. https://doi.org/10.1002/jaba.876

D’Angelo, R. (2023). Supporting autonomy in young people with gender dysphoria: psychotherapy is not conversion therapy. Journal of Medical Ethics, jme–2023. https://doi.org/10.1136/jme-2023-109282

Garnets, L., Hancock, K. A., et al. (1991). Issues in psychotherapy with lesbians and gay men. The American Psychologist, 46(9), 964.

Graham, T. C. (2018). Conversion therapy: A brief reflection on the history of the practice and contemporary regulatory efforts. Creighton L. Rev., 52, 419.

Higbee, M., Wright, E. R., & Roemerman, R. M. (2022). Conversion therapy in the Southern United States: Prevalence and experiences of the survivors. Journal of Homosexuality, 69(4), 612–631. https://doi.org/10.1080/00918369.2020.1840213

Kinitz, D. J., Goodyear, T., Dromer Elisabeth, Gesink Dionne, Ferlatte Olivier, Knight, R., & Salway Travis. (2022). “Conversion therapy” experiences in their social contexts: A qualitative study of sexual orientation and gender identity and expression change efforts in Canada. Canadian Journal of Psychiatry, 67(6), 441–451. https://doi.org/10.1177/07067437211030498

Kinitz, D. J., & Salway Travis. (2022). Cisheteronormativity, conversion therapy, and identity among sexual and gender minority people: A narrative inquiry and creative non-fiction. Qualitative Health Research, 32(13), 1965–1978. https://doi.org/10.1177/10497323221126536

Movement Advancement Project. (2026). Conversion therapy laws. https://www.lgbtmap.org/equality-maps/conversion_therapy

Parkinson, P., & Morris, P. (2021). Psychiatry, psychotherapy and the criminalization of ‘conversion therapy’ in Australia. Australasian Psychiatry, 29(4), 409–411. https://doi.org/10.1177/10398562211014220

Purshouse, C., & Trispiotis, I. (2022). Is ‘conversion therapy’ tortious? Legal Studies, 42(1), 23–41. https://doi.org/10.1017/lst.2021.28

Richmond, L. M. (2019). ‘Conversion therapy’ misleads, harms patients. Psychiatric News, 54(18). https://doi.org/10.1176/appi.pn.2019.9b9

Salway, T., & Ashley, F. (2022). Ridding Canadian medicine of conversion therapy. Canadian Medical Association. Journal, 194(1), E17–E18. https://doi.org/10.1503/cmaj.211709

The Trevor Project. (2026). Chiles v. Salazar: What you need to know about the U.S. Supreme Court case on conversion therapy. https://www.thetrevorproject.org/blog/chiles-v-salazar/

Tozer, E. E., & Hayes, J. A. (2004). Why do individuals seek conversion therapy? The role of religiosity, internalized homonegativity, and identity development. The Counseling Psychologist, 32(5), 716-740.