When Kaley Chiles welcomes therapy clients to her tranquil bungalow of an office, she offers loose-leaf tea and asks what brings them to counseling, what’s causing distress and how she can help them meet their goals.
Under a 2019 Colorado law, if clients under 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.
Mrs. 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,” Mrs. 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 on Tuesday hear Mrs. Chiles’s challenge to the Colorado law, 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 gay and transgender 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 to 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 L.G.B.T.Q.-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, Mrs. 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. Mr. Shurka’s father took him to a therapist who said he could eliminate an attraction to boys. Mr. 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, Mr. 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 Mr. Shurka, who went on to become an activist seeking an end to conversion therapy.
In the entrance hall of Mrs. Chiles’s office at Deeper Stories Counseling is a photo of a sunset with a biblical verse about the power of counsel and understanding. Mrs. Chiles, 35, said she has worked with patients in prison, families and teens in crisis, and young people experiencing gender dysphoria, a feeling of discomfort or distress with one’s sex.
As an undergraduate at Dallas Baptist University, Mrs. Chiles pursued a degree in biblical studies and psychology. For the past decade, she has counseled clients struggling with trauma and addiction. Some patients are referred to her through churches and seek faith-based counseling. Many believe that their faith and relationship with God supersedes romantic attractions and that God determines their identity, she explained in court papers.
Mrs. 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.
The Colorado law, Mrs. Chiles said, has forced her to turn away patients.
“If an adolescent comes to me and they say, ‘I actually do want to make a goal of coming to terms and coming to peace and gaining comfort with my biological sex,’ we cannot make that goal,” Mrs. Chiles said in an interview.
Colorado officials have never enforced the measure, which includes fines up to $5,000 for each violation and possible suspension or revocation of a counselor’s license. The law permits treatments that provide “acceptance, support and understanding.” It includes a religious exemption for those “engaged in the practice of religious ministry.”
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.
Mr. 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.
Colorado’s attorneys also say Mrs. Chiles has not cited instances of therapy sessions or conduct that she previously engaged in that would violate the law. Asked in an interview if she had ever practiced conversion therapy with a minor before the ban, Mrs. Chiles said she has worked with young people struggling with gender dysphoria and unwanted sexual desires.
“I’ll just have to let everyone else decide what that is as a label,” she said.
Mr. 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.
In response, Mrs. Chiles’s lawyers say the law is overly broad, putting her at risk of violating the ban if she works with young people who for religious reasons, for instance, voluntarily seek to eliminate same-sex attractions.
What matters, her lawyers say, is that Mrs. Chiles’s speech has already been chilled because of the threat of prosecution.
In general, the First Amendment prevents the government from restricting speech because it dislikes the content or message. But the court has allowed for certain restrictions aimed at governing a person’s conduct, even if they incidentally burden speech.
A lawyer for Mrs. 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,” Mr. Campbell said.
In her filings, Mrs. Chiles also rejected the state’s reliance on a medical consensus, saying there is insufficient evidence that voluntary talk therapy that seeks to change a minor’s gender identity or sexual orientation causes harm.
Both sides point to the court’s decision last year in U.S. v. Skrmetti to allow states to prohibit certain gender-transition treatments for young people that the states consider harmful. The state bans on gender treatments were backed by Republican officials.
Mr. Weiser, the Colorado attorney general, said the Skrmetti decision should also then stand for the principle that Colorado and other states controlled by Democrats may ban medical treatments they believe are harmful for young people.
But Mr. Campbell noted that the court’s decision in the prior case applied to the administration of drugs — not speech — by physicians.
The Trump administration will participate in oral argument in support of Mrs. Chiles’s position.
The constitutionality of laws banning conversion therapy has split the lower courts.
An appeals court in Florida found a set of local laws in the state were unconstitutional. A divided panel of the U.S. Court of Appeals for the 10th Circuit sided with Colorado, finding that talk therapy provided by a mental health professional is a medical treatment under the authority of a state license.
Siding with Mrs. 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,” Judge Hartz wrote.
Two years ago, the Supreme Court refused to take up a similar case from Washington State and left in place a decision by the U.S. Court of Appeals for the Ninth Circuit that said the law does not regulate speech because counseling is a type of medical treatment.
But three conservative justices — Clarence Thomas, Samuel A. Alito Jr. and Brett M. Kavanaugh — indicated they would have reviewed the decision, with Justice Thomas writing that Washington’s ban had “silenced one side of this debate” by restricting the First Amendment rights of medical professionals.
Julie Tate contributed research.
Ann Marimow covers the Supreme Court for The Times from Washington.
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