The U.S. Supreme Court heard oral arguments on Oct. 7 in Chiles v. Salazar, a challenge to Colorado’s 2019 law prohibiting licensed health care professionals from providing so-called conversion therapy to minors. Kaley Chiles, a licensed therapist, is challenging the law and arguing that as part of her faith-based counseling, she should be allowed to address clients’ unwanted same-sex attraction and to discuss living in alignment with their religious beliefs about biological sex. The state has never taken any disciplinary action against her or claimed that she has broken the law; her argument is that the law itself compels self-censorship.

The U.S. Conference of Catholic Bishops, along with the Colorado Catholic Conference and the Catholic University of America, has filed an amicus curiae brief supporting the plaintiff. The brief seeks to protect therapists’ freedom to engage clients in conversations about how to live in harmony with the church’s teachings on gender and sexual morality—at least when clients themselves desire such guidance. Colorado, for its part, argues that the law does not forbid faith-based counseling or religious discussion. The difficulty, however, is that the statute’s definition of “conversion therapy” could be interpreted as effectively barring counselors from supporting clients who wish to align their conduct or self-understanding with their religious beliefs, since such support could be construed as an attempt to “change” orientation or identity. 

In short, the U.S.C.C.B. fears the law’s reach is overly broad and could discourage faith-informed counseling, while Colorado maintains that it is narrowly focused on preventing harmful or coercive practices. As a priest who is also a trained and practicing therapist, I am concerned that this framing poses an unhelpful and ultimately unnecessary conflict between freedom to speak about faith and the practice of therapy as part of health care. Properly understood, therapy is not in tension with clear and honest communication about faith, but good therapeutic practice requires much more than just unfettered communication.

Conversion therapy refers to practices that alter or suppress a person’s sexual orientation or identity. Medical reviews consistently conclude that these interventions lack credible evidence of effectiveness and are associated with significant risk of harm, including depression, anxiety and suicidality. The American Psychological Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry and the American Medical Association all oppose such practices. International bodies such as the Pan American Health Organization, the United Nations and the European Parliament have issued similar warnings.

Only about half of U.S. states ban or restrict conversion therapy for minors, but the variations in state law reflect political differences, not a lack of agreement among health care professionals. And in health care, standards of care should be defined by training, ethics and evidence—not by political agendas.

Set aside philosophical debates about essentialism and social construction in gender and sexuality, and the case poses a deeper question: What is the purpose of therapy? Is it simply speech in the abstract? Ordinary conversation—with a trusted friend, parent or grandparent—can itself be profoundly therapeutic, reminding us that life is larger than the consulting room. But clinical talk therapy is not the same. It is structured, intentional and bound by professional training and ethics. In trying to make this case a test of free speech, the danger is that therapy gets reduced to words in the air.

In reality, therapy is a profession with standards, methods and responsibilities. It is not a casual conversation but a disciplined practice requiring thousands of hours of supervised training, guided by well-developed theoretical frameworks and shaped by evidence-based approaches. That training teaches therapists not only what to say but how to use words deliberately to promote growth, healing and change.

Yet therapy is more than words alone. It includes tone, silence, gesture, affect and the subtle forms of authentic human relating that build the therapeutic alliance. It is also expressed through advocacy, standing with clients against stigma and barriers, and accompaniment, walking alongside them in struggles and hopes rather than dictating outcomes. Language and relationship together become the medium through which clients express, reframe and reshape their inner world, producing transformations that ripple through feelings and behaviors and extend outward into family life, community and daily choices.

In psychodynamic therapy, for example, the process is collaborative, intended not to impose answers on the client but to help bring inner conflicts into awareness and to help the client discover meaning in previously unarticulated experiences. In cognitive-behavioral therapy, structured dialogue challenges distorted beliefs and allows clients to rehearse more constructive patterns, often through pointed questions such as, “What evidence supports that thought?”

Within the field, debate continues between brief, manualized treatments—targeting specific issues like anxiety or depression in a medical-model frame—and longer-term relational approaches, which hold that a formative connection between client and therapist makes healing possible. Both, however, underscore the same truth: Therapy is not merely speech but a professional practice with a clear purpose, where words are powerful instruments of care. The therapist has freedom to be authentic in dialogue but always within the boundaries of professional care—guidelines that provide structure while allowing flexibility to respond to each client’s needs.

Ethical practice also requires balancing empirical evidence with respect for client wishes and values. Consider a teenager who cites religious belief as a reason to want to diminish same-sex attraction. An ethical therapist would explore the request carefully: What does the young person hope to achieve? How does faith shape identity and belonging? What prior attempts have been made to suppress attraction, and what has the cost been? Can the person’s current faith community accommodate their needs, offering opportunities to belong, contribute and thrive? If not, what other sources of support might be available—whether within the client’s broader faith tradition, another denomination or L.G.B.T.Q. networks? The therapist’s role is not to steer clients away from their faith but to help them discern where they can find genuine support. 

With parents involved as appropriate, the therapist can affirm the supportive potential of faith while also naming the dangers of shame and self-contempt. The “middle way” is not to promise change in orientation or identity, nor to lock a child or adolescent into any fixed outcome, but to reduce distress, clarify values, foster resilience and safeguard dignity—work consistent with both developmental fluidity and the evidence-based standards of care that guide the profession.

As both a priest and a therapist, I find this tension neither abstract nor theoretical. I have often accompanied clients who are wrestling with choices—or who have made choices—that diverge from my own Catholic faith. My faith gives me a framework for seeing each person as loved and sustained by God, with a dignity that flows from that divine love. Yet it is not faith alone that guides the therapeutic process. I understand the human person in a psychospiritual and integrated way, where mind, body and spirit are interrelated. 

My own understanding of the human person and human flourishing has been formed and deepened by my understanding of church teaching. But when assessing whether a behavior or mindset is self-destructive, the question does not reduce to an application of church teaching but rather involves demonstrable effects on my client’s well-being and empirical evidence of harm. Within the standards of care in which I have been trained, I help clients examine the purpose and consequences of their actions or intended actions. I also provide accurate, evidence-based information from psychological and medical research, so that reflection and choice are informed by both conscience and knowledge. These encounters remind me that the ethical heart of therapy lies not in defending speech but in discerning how care itself is practiced and defined.

Beyond the specific question of conversion therapy, the wider landscape of child and adolescent care raises its own difficult debates. One could study and debate the ethics of different forms of care related to identity development, and the appropriateness of interventions given a child’s age and maturity, as well as the role and responsibility of parents in the therapeutic process. Another focus could be encouraging exploration without prematurely foreclosing possibilities. These debates should be pursued in a careful and scientific manner—never perfect but better than the alternatives of ignoring evidence or relying on ideology alone. 

What should not be in dispute, however, is that therapy itself is a professional practice with standards of care. To reframe these questions as if they were merely about “free speech” is to miss the point entirely. At its best, therapy helps people wrestle with who they are and who they are becoming. To reduce that process to a free speech dispute is to hollow out the profession and to fail those most in need of its care.