On Tuesday morning, the Supreme Court heard oral arguments in Chiles v. Salazar, a case challenging a 2019 Colorado law banning conversion therapy. Conversion therapy is often defined as the effort to change someone’s sexual orientation or gender identity.

Kaley Chiles, a conservative Christian counselor who brought the case, says that the law encroaches on therapists’ freedom of speech by restricting them from engaging in “counseling conversations with minors” that could encourage those changes. But according to Colorado, such conversations constitute professional conduct, which is subject to regulation by the state. In September 2024, the U.S. Court of Appeals for the Tenth Circuit ruled in Colorado’s favor, citing studies indicating that conversion therapy causes harm to minors.

On Tuesday, lawyers argued that central question—speech or conduct—before the Supreme Court, revealing just how hard it is to separate speech from conduct when it comes to therapy. After all, therapy was once known as the “talking cure.”

The arguments also featured lawyers and judges alike grappling with what conversion therapy actually is. That’s because conversion therapy, and its relationship to gender identity, are frequently misunderstood.

How did we get here?

In 2014, a 17-year-old male, born Joshua Alcorn but identifying as a girl named Leelah, took his own life by stepping onto a highway in front of a semitruck. Alcorn’s mother had never affirmed his—her—gender identity, insisting that “God doesn’t make mistakes.”

Alcorn had prescheduled a suicide note to be published on Tumblr. “The only way I will rest in peace is if one day transgender people aren’t treated the way I was,” Alcorn wrote. “My death needs to mean something. Fix society. Please.”

This led to a petition with over 120,000 signatures titled “Enact Leelah’s Law to Ban All LGBTQ+ Conversion Therapy.” That petition read:

Leelah explained how her parents had forced her to attend conversion therapy, pulled her out of school and isolated her in an attempt to change her gender identity. “Conversion therapies” have been documented to cause great harms and in this case, Leelah’s death. . . . We respectfully seek your help to ban the practice known as “conversion therapy” and name the bill in honor of Leelah Alcorn.

In response, Barack Obama adviser Valerie Jarrett wrote that the administration “supports efforts to ban the use of conversion therapy for minors. . . . We share your concern about its potentially devastating effects on the lives of transgender as well as gay, lesbian, bisexual, and queer youth.”

Later, Obama’s Health and Human Services department published a 2015 report, “Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth,” which claimed that “efforts to change an individual’s sexual orientation, gender identity, or gender expression is [sic] a practice that is not supported by credible evidence.” Engaging in such practices, it said, “may put young people at risk of serious harm.”

I should note that there have been cases in which therapists and other adults in positions of authority really did try to “pray the gay away” with harmful techniques like shock therapy. The mental health field considered homosexuality a disorder until 1973, and wielded coercive tools to root it out. This has been chronicled in numerous studies, as well as memoirs like Boy Erased.

In the 1970s and ’80s, some gender nonconforming young people were sent to “normalizing therapy,” which used behavioral conditioning techniques to coerce them into conforming to traditional gender roles. Though these treatments weren’t officially understood as “conversion therapy” at the time—because their explicit goal was to change behavior, not sexuality—there was certainly a tacit acknowledgment that ridding the child of gender nonconformity might lead to a straight adulthood.

But by the time the previously obscure concept of “gender identity” was truly drawn into the controversy over conversion therapy in the 2010s, our society had expanded the definition of harm to include not only abuse or bullying, but any emotional discomfort or moral injury.

In 2018, the American Academy of Pediatrics (AAP) published a policy statement arguing that conversion therapy to “chang[e] a youth’s gender expression or identity” is “not only unsuccessful but also deleterious.” Included in the policy statement’s definition of conversion therapy were attempts to “dissuade [children] from exhibiting gender-diverse expressions.” The statement asserted that anything other than affirming gender identity was dangerous to trans youth—that not socially transitioning a child, or pushing back on the idea that transitioning would lead to greater happiness, was akin to abuse. The term conversion therapy has been deployed to remove checks and balances on gender-affirming care. Since then, the field has exploded.

Today, more than 20 states have bans on conversion therapy, each of them prohibiting attempts to change both sexual orientation and gender identity. And activists have worked hard to make sure that traditional talk therapy is continually recast as conversion therapy, akin to electric shock. If words are violence, as a generation has been led to believe, then asking about why someone might want to transition is the same as a blow to the head.

By the time “gender identity” was truly drawn into the controversy over conversion therapy, our society had expanded the definition of harm to include not only abuse or bullying, but any emotional discomfort or moral injury.

But as it turned out, gender identity should never have been included in any of these discussions, because the research that the AAP relied on was only about sexuality. As Dr. James Cantor wrote in 2018, “there are no studies of conversion therapy for gender identity.” So, many of the laws banning conversion therapy relating to gender identity had relied on irrelevant research. And subsequent research into gender identity conversion efforts has been riddled with flaws. This is one of many examples of the societal and professional lack of understanding about what conversion therapy is—not to mention the effect it has on minors.

I’m struck by something Obama adviser Valerie Jarrett wrote when responding to the original petition. Conversion therapy, her 2015 statement read, is often “used on minors, who lack the legal authority to make their own medical and mental health decisions.” Yet, somehow, these same minors can consent to double mastectomies or cross-sex hormones, decisions that will affect them for the rest of their lives. Indeed, those in favor of bans on conversion therapy often rail against bans on gender-affirming care.

I hope that the Supreme Court will consider this history as it deliberates on the case, because it’s not so clear what the best outcome is. Both banning conversion therapy and giving therapists carte blanche to say anything strike me as problematic. What I hope for from the case, above all else, is that we finally understand that conversion therapy historically has had nothing to do with gender identity—and that talking and shock therapy don’t belong in the same bucket.

A version of this piece was originally published on Lisa Selin Davis’s Substack, Broadview.