First Amendment or First-Degree Harm? Why "Conversion Therapy" Has No Place in Social Work

Chiles v. Salazar

On March 31, 2026, the Supreme Court of the United States issued a decision in Chiles v. Salazar that has sent shockwaves through the mental health community. In an 8-1 ruling, the Court determined that state laws banning "conversion therapy"—specifically those targeting the "talk therapy" version of these practices—must be held to the highest level of constitutional scrutiny. By framing these sessions as "protected speech" rather than "professional conduct," the Court has effectively dismantled the primary legal shield that 22 states and the District of Columbia used to protect LGBTQ+ youth from a practice that every major medical organization has denounced as harmful.

As a Clinical Social Worker licensed in Texas, I am bound by the laws of this state and this country. But I am also bound by a Code of Ethics that transcends political shifts. Today, I am speaking directly to my colleagues and our community: Legalized does not mean ethical.

The Cruelty Behind the "Cure"

The term "conversion therapy" (sometimes called Sexual Orientation Change Efforts or SOCE) is a misnomer. It is not therapy; it is a psychological assault. While modern practitioners may claim they have moved away from the physical "aversion" tactics of the past—such as ice baths or electric shocks—the "talk therapy" currently being defended in court is no less cruel.

Conversion "talk therapy" is rooted in the fundamental rejection of a person’s core identity. It involves the systematic shaming of a client’s natural attractions and gender expression. It utilizes "behavioral monitoring" and "thought-stopping" techniques to force a person into a state of constant self-surveillance and self-loathing. To tell a child that their very existence is a "brokenness" to be fixed is a form of psychological torture that leads to devastating outcomes.

Social Work Ethics

Social Work vs. Conversion Efforts

For social workers, the practice of conversion therapy is a direct violation of our most sacred professional standards. The National Association of Social Workers (NASW) Code of Ethics is clear:

1. Dignity and Worth of the Person: We are called to treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity. Conversion therapy treats identity as a pathology, stripping the client of their dignity.

   
   

2. Social Justice: Social workers challenge social injustice. Conversion therapy is a tool of oppression used to marginalize LGBTQ+ individuals and uphold heteronormative and cisnormative hierarchies.

   
   

3. Competence: We are required to practice within our areas of competence and use evidence-based interventions. Conversion therapy is not evidence-based. In fact, peer-reviewed research (including a study of 27,000 transgender adults) shows that exposure to conversion efforts is linked to significantly higher rates of psychological distress and suicide attempts.

   
   

The NASW's 2021 amendments to the Code of Ethics also emphasize Cultural Humility. We must recognize our clients as the experts of their own culture and identity. Conversion therapy does the opposite—it imposes the therapist’s "viewpoint" onto the client’s reality.

What Actually Works: Affirming Care

If the goal of therapy is truly to help a person "flourish," the path is not through suppression, but through Affirmative Practice. This is the evidence-based gold standard supported by the World Professional Association for Transgender Health (WPATH) and the APA. Affirming therapy involves:

• Validation: Acknowledging that being LGBTQ+ is a normal and healthy variation of the human experience.

  
  

• Supportive Exploration: Helping clients navigate the social and internal challenges of living in a world that can be hostile to their identity.

  
  

• Family Education: Working with families to increase acceptance, which is the single most significant factor in reducing suicide risk among LGBTQ+ youth.

  
  

End Conversion Therapy

A Call to Action

The Supreme Court may have opened a door for this practice to return to the shadows of "protected speech," but the social work profession must slam it shut.

To any licensed professional—whether you are an LCSW, an LPC, or an LMFT—who continues to practice conversion therapy under the guise of "faith-based counseling" or "voluntary talk therapy": You are practicing against the ethical standards of your license and against the overwhelming weight of scientific evidence. 

If you cannot provide care that honors the dignity and worth of LGBTQ+ people, if you cannot move past the desire to "change" a client's fundamental self, then you have no business holding a state license. I call on you to surrender your license.

A license is a pact with the public to "do no harm." By practicing conversion therapy, you have broken that pact.

In the state of Texas, where the legal landscape for LGBTQ+ care is increasingly complex, our commitment to our clients must be unwavering. We will continue to provide affirming, life-saving care because our ethics are not up for debate—and our clients' lives depend on it.

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If you are an LGBTQ+ person seeking safe, affirming care, please reach out to licensed professionals who explicitly state their commitment to affirmative practice. You are not broken, and you do not need to be "fixed."