Amicus Curiae Brief — Kaley Chiles, Petitioner v. Patty Salazar, in Her Official Capacity as Executive Director of the Colorado Department of Regulatory Agencies, et al.

NO. 24-539

In the

Supreme Court of the United States

________________

KALEY CHILES,

Petitioner,

v.

PATTY SALAZAR, in Her Official Capacity as

Executive Director of the Colorado Department

of Regulatory Agencies, et al.,

Respondents.

________________

On Writ of Certiorari to the United States

Court of Appeals for the Tenth Circuit

________________

BRIEF OF FAITH-BASED MENTAL HEALTH

PROFESSIONALS AS AMICI CURIAE

IN SUPPORT OF RESPONDENTS

________________

Sean P. Madden

301 Quay Commons

Sarasota, FL 34236

Paul Alessio Mezzina

Counsel of Record

Amy R. Upshaw

Nicholas A. Mecsas-Faxon

KING & SPALDING LLP

1700 Pennsylvania Ave. NW

Washington, DC 20006

(202) 737-0500

pmezzina@kslaw.com

Counsel for Amici Curiae

August 26, 2025

TABLE OF CONTENTS

TABLE OF AUTHORITIES ....................................... ii

STATEMENT OF INTEREST ................................... 1

SUMMARY OF THE ARGUMENT ........................... 4

ARGUMENT ............................................................... 6

I.

Colorado’s law does not require practitioners

to pursue certain outcomes or prohibit them

from expressing views about conversion

therapy ................................................................. 6

II. Value-congruent and effective treatment

methods exist and are permissible under

Colorado’s law .................................................... 11

III. Conversion therapy is frequently harmful

and ineffective in achieving its purported

goals ................................................................... 20

IV. The MCTL is one of many restrictions that

apply to ensure that therapeutic speech by

licensed providers comports with professional

ethics and the evidence-based standard of

care ..................................................................... 25

CONCLUSION ......................................................... 33

ii

TABLE OF AUTHORITIES

Cases

Boumediene v. Bush,

553 U.S. 723 (2008) ................................................ 10

Boyd v. Garvert,

9 P.3d 1161 (Colo. App. 2000) ............................... 31

Cipollone v. Liggett Grp., Inc.,

505 U.S. 504 (1992) ................................................ 27

Day v. Johnson,

255 P.3d 1064 (Colo. 2011) .............................. 27, 28

Free Speech Coal., Inc. v. Paxton,

145 S. Ct. 2291 (2025)............................................ 32

Fried v. Leong,

946 P.2d 487 (Colo. App. 1997) ............................. 26

Gonzales v. Carhart,

550 U.S. 124 (2007) ................................................ 31

Hustler Mag., Inc. v. Falwell,

485 U.S. 46 (1988) .................................................. 32

McKay v. State Bd. of Med. Examiners,

86 P.2d 232 (Colo. 1938) ........................................ 31

NAACP v. Button,

371 U.S. 415 (1963) ................................................ 30

Nat’l Inst. of Fam. & Life Advocates

v. Becerra (NIFLA),

585 U.S. 755 (2018) ................................................ 30

Snyder v. Phelps,

562 U.S. 443 (2011) ................................................ 32

iii

United States v. Skrmetti,

145 S. Ct. 1816 (2025)............................................ 31

Williams v. Boyle,

72 P.3d 392 (Colo. App. 2003) ............................... 31

Statutes

Colo. Rev. Stat. § 12-245-101 ............................... 9, 26

Colo. Rev. Stat. § 12-245-202(3.5) .............. 5, 7, 10, 15

Colo. Rev. Stat. § 12-245-203.5(3) ............................ 30

Colo. Rev. Stat. § 12-245-216(1) ............................... 30

Colo. Rev. Stat. § 12-245-217(1) ................................. 9

Colo. Rev. Stat. § 12-245-220 ............................. 29, 30

Colo. Rev. Stat. § 12-245-224(1) ............... 6, 26, 27, 28

Colo. Rev. Stat. § 12-245-225(1) ............................... 26

Colo. Rev. Stat. § 13-21-117(2) ................................. 30

Other Authorities

Am. Psych. Ass’n,

APA Resolution on

Sexual Orientation Change Efforts (2021) ............. 8

Blosnich, John R., et al.,

Sexual Orientation Change Efforts,

Adverse Childhood Experiences, and

Suicide Ideation and Attempt Among

Sexual Minority Adults, United States,

2016-2018, 110 Am. J. Pub. Health 1024

(2020) ...................................................................... 21

iv

DeAngelis, Tori,

Better Relationships With

Patients Lead to Better Outcomes,

50 Monitor on Psych. 38 (2019),

https://www.apa.org/monitor/2019/11/cecorner-relationships ............................................... 25

Jones, Timothy W., et al.,

Religious Trauma and Moral Injury

From LGBBTQA+ Conversion Practices,

305 Soc. Sci. & Med. 1 (2022) ................................ 24

Ryan, Caitlin, et al.,

Family Rejection as a Predictor of

Negative Health Outcomes in White

and Latino Lesbian, Gay, and Bisexual

Young Adults, 123 Pediatrics 346 (2009) ........ 17, 22

Worthington, Everett L., Jr.

& Michael Scherer, Forgiveness Is an

Emotion-Focused Coping Strategy That

Can Reduce Health Risks and Promote

Health Resilience: Theory, Review, and

Hypotheses, 19 Psych. & Health 385 (2004) ......... 28

Yarhouse, Mark A. & Julia A. Sadusky,

Gender Identity and Faith: Clinical

Postures, Tools and Case Studies for

Client-Centered Care (2022) ................................. 13

Yarhouse, Mark,

Understanding Sexual

Identity Therapy (Mar. 10, 2010),

https://tinyurl.com/2d49kau5 ................................ 12

STATEMENT OF INTEREST1

Amici curiae are faith-based mental health

professionals who work with minors on the topics of

gender and sexuality. Each of these therapists follows

traditional and theologically conservative Christian

teachings surrounding gender identity and sexual

orientation, and their deeply held convictions anchor

them in their clinical practice. They submit this brief

in support of Colorado’s ban on licensed mental health

professionals subjecting minors to “conversion

therapy.” Given their professional and religious

backgrounds, amici have an interest in explaining

how Colorado’s law neither impedes freedom of speech

nor hinders the ability to engage in effective, valuecongruent therapeutic practices that honor patients’

religious convictions while pursuing psychological

wellness. To the contrary, the law protects youth and

families from harmful practices that have been shown

to be ineffective in accomplishing their stated goals.

Dr. Julia Sadusky, Psy.D., is a licensed clinical

psychologist in Colorado and a Catholic Christian. She

received her bachelor’s degree from Ave Maria

University and her doctorate from Regent University,

where she participated in the Institute for the Study

of Sexual Identity, a research institute run by Mark

Yarhouse, a Christian psychologist specializing in

sexual and gender identity. Now practicing in

Colorado, Dr. Sadusky works primarily with religious

1 Pursuant to Supreme Court Rule 37.6, amici curiae state that

no counsel for any party authored this brief in whole or in part

and that no entity or person, aside from amici curiae and their

counsel, made any monetary contribution toward the preparation

or submission of this brief.

2

individuals and families, and she specializes in the

intersection of faith, sexual orientation, and gender

identity. She offers professional treatment to patients

in value-congruent ways, but without engaging in

conversion therapy. Indeed, many of Dr. Sadusky’s

patients and their parents come to her after negative

experiences with conversion therapy. Dr. Sadusky also

offers professional trainings and consultations with

religious leaders and faith-based mental health

professionals and has written extensively in this area.

Dr. Michele Willingham, Psy.D., is a licensed

clinical psychologist in California and an Evangelical

Christian. She specializes in anxiety, depression, grief

and loss, and LGBTQ and relationship issues. She

received her doctorate from the California School of

Professional Psychology, Los Angeles, and for the past

27 years she has served as a teaching faculty member,

administrator, and counselor at two different private

Christian universities in Southern California. She is

active in the California Psychological Association and

serves on the American Psychological Association

Commission for Accreditation, which is the primary

programmatic accreditor in the United States for

professional education and training in psychology.

Dr. Nathan Willis, PhD, LMHC, CFHMHE, is a

licensed mental health counselor in Florida and a

Christian who believes in a traditional biblical sexual

ethic. He has served as an adjunct faculty member at

the University of South Florida and Liberty

University. He holds a master’s degree in professional

counseling from Southeastern University and a Ph.D.

in counseling and counselor education from the

University of Florida, where he conducted research on

3

the moral decision-making processes of counselors.

His primary research focus remains on counselor

morality. In his practice, Dr. Willis works with clients

on, among other topics, sexuality and gender. His

work includes counseling children and teens as well as

parents.

4

SUMMARY OF THE ARGUMENT

The practice of mental health treatment is

governed by a wide range of state regulations and

accreditation requirements. One such regulation,

Colorado’s Minor Conversion Therapy Law (“MCTL”

or “Law”), bans “conversion therapy,” a treatment

aimed at causing a person to change their sexual

orientation or gender identity. There is almost no

evidence that this type of therapy is effective or

helpful, and there is substantial evidence that it

harms minor patients and their families.

As mental health providers and theologically

orthodox Christians, amici support Colorado’s law.

Given the culture-war narratives that surround the

development of sexuality and gender in youth, amici

understand the concern that some laws in this area

may conflict with First Amendment freedoms. But

amici know from experience that the MCTL is not one

of those laws. The MCTL leaves ample room for

licensed therapists to counsel minor patients in a

manner consistent with the therapist’s and the

patient’s religious beliefs while providing critical

protection for minors, including those with deeply held

religious views.

I. The restrictions on conversion therapy in

Colorado’s law are appropriately limited. The Law

prohibits, for minor clients, a specific mental health

treatment that lacks evidentiary support—namely,

treatment that sets as its goal or promises a change in

sexual orientation or gender identity. But the Law

stops there. It does not require mental health

counselors to encourage minors to identify in any

particular way, including as LGBTQ; to enter same-

5

sex relationships; or to transition. In other words,

mental health practitioners need not (and typically

should not) set as a goal of therapy any fixed outcome

in terms of gender or sexuality. To the contrary, the

Law expressly permits facilitation of “identity

exploration and development,” Colo. Rev. Stat. § 12245-202(3.5)(b)(I) (emphasis added), which allows for

a range of outcomes.

II. The Law thus leaves a broad range of mental

healthcare treatments available to licensed

practitioners, including methods that accommodate

religious beliefs and are backed by evidence. Amici

regularly work with theologically conservative

Christian clients, including minors, who are

experiencing same-sex attractions or gender

dysphoria. There are therapeutic approaches

available to such clients that allow them to explore

their identities, beliefs, and values—and potential

conflicts among them—without establishing as a goal

any particular outcome in terms of sexual orientation

or gender identity. Amici have witnessed firsthand

how such approaches can improve minor patients’

mental health, familial relationships, and personal

faith.

III. The Law prohibits mental health

professionals from offering conversion therapy

because it is harmful and not evidence-based. Amici,

who often meet with clients after negative experiences

with conversion therapy, have witnessed how such

approaches can harm the psychological wellbeing of

youth. This harm is compounded by the damage

conversion therapy can do to minors’ relationships

6

with their parents, their faith, and access to future

therapy.

IV. The Law is consistent with a wide range of

regulations, licensure requirements, and common-law

standards that govern the provision of professional

mental health services. These legal restraints require

amici and other licensed practitioners to adhere to a

professional standard of care in their practices, even

when that standard limits how they may “speak” when

treating clients. Adopting Chiles’s position here would

call into question whether any requirement governing

mental health professionals (or other professionals,

such as lawyers, whose professional services consist of

“speech”) could survive First Amendment scrutiny.

ARGUMENT

I.

Colorado’s law does not require practitioners

to pursue certain outcomes or prohibit them

from expressing views about conversion

therapy.

Contrary to the impression that may be left by

Chiles’s opening brief and many of the amicus briefs

supporting her, the provisions of the Law challenged

here are limited in scope. They prohibit mental health

professionals who are licensed, registered, or certified

in the state from providing conversion therapy to

minors. See Colo. Rev. Stat. § 12-245-224(1)(t)(V). And

they define “conversion therapy” as a practice or

treatment “that attempts or purports to change an

individual’s sexual orientation or gender identity,

including efforts to change behaviors or gender

expressions or to eliminate or reduce sexual or

romantic attraction or feelings toward individuals of

7

the same sex.” Colo. Rev. Stat. § 12-245-202(3.5)(a).

The restriction is thus narrow: It applies only to

therapies that set as a goal, or promise as a result of

therapeutic intervention, a particular outcome—

namely, a shift in attraction or a shift in gender

expression and behaviors. And it governs only licensed

mental health professionals.

The statute does not, however, go further than

these restrictions. The MCTL does not, for example,

require therapists or other mental health providers to

encourage minors to embrace gender transition,

initiate same-sex relationships, or identify as LGBTQ.

See Resp. Br. 18 (“Just as a therapist may not pursue

an a priori goal of making a minor patient

heterosexual or cisgender, the law likewise prohibits

them from seeking to make a minor gay or

transgender.”). Instead, the Law aims to protect

identity exploration and development free from

coercion by mental health professionals.

Confirming as much, the Law expressly permits a

therapist to support and “facilitat[e]” a minor’s

“identity exploration and development.” Colo. Rev.

Stat. § 12-245-202(3.5)(b)(I). In other words, if a client

chooses to no longer identify as gay or trans during the

course of therapy, the Law permits supporting this.

What the law prohibits is a licensed mental health

provider setting as the goal of the treatment changing

a minor’s sexual orientation or gender identity. This is

consistent with guidelines from a range of governing

bodies and professional organizations, all of which

indicate that effective therapy around sexual

orientation and gender must not set as a goal a fixed

8

outcome in any direction.2 See Resp. Br. 3 (noting the

law “prohibits licensees’ efforts to ‘change’ minor

patients’ sexual orientation or gender identity in any

direction” (emphasis added)).

It is also important to note two further ways in

which the Law leaves ample room for therapists with

conservative religious beliefs to exercise their freedom

of speech. First, nothing in the Law requires a

therapist to express viewpoints that they might find

objectionable—such as that same-sex sexual

behaviors are morally licit or that sex differences are

purely a social construct. Such a law would be

misplaced not only because of the freedom of speech

and religion concerns it would raise, but because it is

rarely appropriate for mental health providers to offer

such personal opinions—whatever they may be—

while providing care. Rather than dictate expression,

the Law even leaves covered providers free to express

their (misguided, in amici’s view) beliefs about the

See, e.g., Am. Psych. Ass’n, APA Resolution on Sexual

Orientation Change Efforts 5 (2021) (“[T]he APA opposes any

efforts by mental health professionals that aim at a specific,

predetermined sexual orientation or gender-expression

outcome ….”); J.A. 136 (2009 APA Task Force Report) (“[T]he

appropriate application of affirmative therapeutic interventions

for those who seek SOCE involves therapist acceptance, support,

and understanding of clients and the facilitation of clients’ active

coping, social support, and identity exploration and development,

without imposing a specific sexual orientation identity

outcome.”); J.A. 571 (SAMHSA 2015 Report) (“Appropriate

approaches support children and adolescents in identity

exploration and development without seeking predetermined

outcomes related to sexual orientation, sexual identity, gender

identity, or gender expression.”).

2

9

purported benefits of conversion therapy, so long as

they do not professionally practice it on minors.

Second, the Law does not prohibit all efforts to

change a minor’s sexual orientation or gender

identity—it only prevents licensed providers from

offering professional mental health treatment aimed

at or promising such a change. See Colo. Rev. Stat.

§ 12-245-101. The Law imposes no restrictions on such

efforts by citizens not subject to the licensure regime.

And it expressly specifies that its prohibition does not

extend to people “engaged in the practice of religious

ministry” who do not hold themselves out as licensed

mental health providers. Id. § 12-245-217(1). The Law

thus permits therapists to refer clients who seek a

ministry-based approach to other individuals not

covered by the statute. Rather than impose any bar on

speech, the Law is one of many restrictions that

govern mental health treatment offered by licensed

mental health professionals. See infra Section IV.

Chiles’s brief and those of her amici paint a

different picture of the Law, but that picture is

mistaken. She contends, for example, that she is

“forced to deny to her clients … any counseling that

fully explores sexuality and gender.” Pet. Br. 18

(cleaned up). She also contends that she “has been

unable to fully explore certain clients’ bodily

experiences around sexuality and gender and how

their thoughts, beliefs, interpretation, and behaviors

intersect.” Pet. Br. 18–19 (cleaned up). Chiles’s amici

present a similarly catastrophizing view of the Law,

arguing that the State “impos[es] penalties on

counselors who, by their profession and expertise,

recognize the value of open-ended, non-judgmental

10

conversation for youths who truly desire to

understand and explore all sides of the internal

conflict they are experiencing.” Amicus Curiae

Sexuality Research Scholar Amy E. Hamilton Br. 3;

see also, e.g., Amici Curiae American Association of

Christian Counselors, et al. Merits Br. 19 (contending

that the decision below means that “the state can bar

discussions based on the religious beliefs of a mental

health client”).

But the Law, in fact, specifically permits

facilitation of “identity exploration and development.”

Colo. Rev. Stat. § 12-245-202(3.5)(b)(I). Far from

penalizing

“open-ended,

non-judgmental

conversation,” Amicus Curiae Sexuality Research

Scholar Amy E. Hamilton Br. 3, the Law encourages

it by banning a practice defined by a fixed goal. It thus

does not prohibit the exploration of conflicts between

attractions and religious beliefs. And there are

effective, ethical, and legal therapeutic approaches to

doing just that. See infra Section II.

Confirming that the MCTL does not prohibit

therapy that is consistent with religious values and

that explores important questions of faith and

identity, the Law has never been enforced against

anyone since it was enacted in 2019. See Pet. App. 12a.

This litigation thus represents an effort to conjure an

unconstitutional restriction where none exists. The

Court should follow its ordinary practice of “avoid[ing]

constitutional problems” where “fairly possible to do

so” instead of mangling a state statute to create

constitutional problems to address. Boumediene v.

Bush, 553 U.S. 723, 787 (2008) (cleaned up).

11

II. Value-congruent and effective treatment

methods exist and are permissible under

Colorado’s law.

The MCTL leaves plenty of room for religious

practitioners to offer mental health treatment to

minors that is consistent with theologically orthodox

Christian values surrounding gender identity and

sexual orientation. And there are alternative

approaches that are fully consistent with the Law and

respect a range of religious values. At their core, these

licit practices allow minors to explore their sexual and

gender identities, and any conflicts between those

identities and their faith, without imposing on them a

specific outcome goal in any direction. As Christian

mental-health providers specializing in this area,

amici practice such approaches regularly.

A. Long before the MCTL was passed,

theologically conservative Christians recognized the

need for faith-congruent therapy options that avoid

the harm caused by conversion therapy. In the realm

of sexual orientation, two such Christians, Mark

Yarhouse and Warren Throckmorton, developed the

Sexual Identity Therapy (“SIT”) framework

specifically to address that need. This framework and

others like it allow for faith-congruent outcomes

without the harms caused by conversion therapy.3 One

3 See J.A. 190–91 (2009 APA Task Force Report) (collecting host

of “scholarly contributions” about “alternative frameworks” that

“address the religious and spiritual needs of LGBT individuals

from integrative and affirmative perspectives” and demonstrate

“that religious faith and psychology do not have to be seen as

being opposed to each other”); see also J.A. 288–91 (collecting

sources).

12

of the developers of this approach describes it as a

contrast to both “reorientation therapy”—that is,

conversion therapy—and “gay affirmative therapy”—

that is, “therapy [that] tends to assume that a person

is gay, that they are discovering this about

themselves,” and that therapy “simply creates a safe

place to discuss ‘coming out.’”4 There have also been

other, related “attempts to envision alternate

frameworks to address these issues.” J.A. 204 (2009

APA Task Force Report) (collecting sources).

SIT is “a client-centered and identity-focused

approach to navigating sexual identity questions or

concerns.”5 Unlike conversion therapy, it is not

oriented to a specific outcome in terms of sexual

orientation, attractions, or behavior: “Sexual

attractions or orientation may or may not change, but

the overall emphasis is on identity.”6 In focusing on

“weighted aspects of identity,” therapists practicing

SIT help clients work through conflicts between

aspects of their identity—like same-sex attraction and

their religious beliefs—and seek ultimately to help

clients find congruence among their identities,

behaviors, beliefs, and values.7

For issues concerning gender identity, amicus Dr.

Sadusky and Dr. Mark Yarhouse (one of the

developers of SIT) developed a related model known as

4 Mark Yarhouse, Understanding Sexual Identity Therapy

(Mar. 10, 2010), https://tinyurl.com/2d49kau5.

5 Id.

6 Id.

7 Id.

13

Gender and Religious Identity Therapy (“GRIT”).8

Like SIT, GRIT is “client-centered” and “allows clients

to explore gender and religious faith and any conflicts

between these two aspects of identity. The therapy

emphasizes the exploration of gender identity without

a fixed outcome, the attainment of coping skills, and

the establishment of social support.”9 GRIT also works

to help reduce parents’ anxiety surrounding gender so

that their fears do not negatively impact their

children.

Notably, these and other forms of therapy allow

Christian clients to set healthy, realistic, and faithcongruent goals that are not defined by specific

sexuality or gender outcomes. One common goal is

fostering acceptance. Another is clarifying forms of

support and identifying ways to improve social

support of the minor client, such as removing barriers

to communication with parents, repairing hurt that

sabotages connection, increasing involvement in

church and youth groups, and buffering against

bullying and peer rejection. These goals also prioritize

treatment of general mental health concerns, like

addressing trauma.

Unsurprisingly considering that this form of

therapy is not geared toward pushing specific

sexuality or gender outcomes, amici have witnessed a

range of outcomes. Some teens start therapy

identifying as heterosexual, despite attraction to the

8 See Mark A. Yarhouse & Julia A. Sadusky, Gender Identity

and Faith: Clinical Postures, Tools and Case Studies for ClientCentered Care (2022).

9 Id. at 45.

14

same sex, in the hope their attractions will change.

Others begin therapy having adopted labels such as

bisexual, confused, gay, or lesbian. And some avoid

labels altogether out of fear of prematurely setting a

trajectory for their lives that they feel unsure about.

As therapy proceeds (along with life and natural

development), some of these teens choose to identify

with a different label and pursue a range of romantic

and sexual relationships. Some maintain a label of

heterosexual, especially if their same-sex attractions

seem to subside in strength over adolescence, which is

a time of immense evolution and attraction fluidity for

some. Some teens pursue singleness and abstain from

sexual behaviors in adolescence or permanently

because of their deeply held convictions around

marriage, sexual ethics, and morality. Still others

enter into same-sex relationships, believing these are

blessed by God, while others enter such relationships

unsure about their values and beliefs around sexual

ethics.

Amici have also witnessed various outcomes in

the realm of gender. Some youth experience resolution

of gender distress as therapy progresses, and some

seek adaptive coping through changes in hairstyle and

dress to manage distress around embodiment, while

still aligning with their sex. Others make changes in

social identity and adopt labels outside of the binary

or adjust the names and/or pronouns that they use,

while others have concerns about doing so. Some

consider the use of puberty blockers and ultimately do

not seek them; some consider the use of hormones and

delay that step until they become adults; and some

seek out referrals to hormonal treatments as minors,

with parental support.

15

B. The current Colorado law does not impede this

natural developmental process or foreclose any of

these potential outcome possibilities for youth. It

simply prevents clinicians from representing that they

can manipulate attraction and identity through

therapeutic intervention or offering potentially

harmful therapeutic approaches that are not backed

by evidence. Identity-focused and outcome-open

approaches like those detailed above squarely align

with Colorado’s law, which permits treatment

providing “[a]cceptance, support, and understanding

for the facilitation of an individual’s coping, social

support, and identity exploration and development.”

Colo. Rev. Stat. § 12-245-202(3.5)(b)(I). And they do so

in a manner that is respectful of clients’ (and

clinicians’) religious beliefs by seeking to foster those

values as part of a holistic approach to identity

development.

These approaches also are consistent with the

American Psychological Association’s 2009 report on

this topic, on which Chiles mistakenly relies. That

report endorses treatment methods that are

“supportive of clients’ identity development without

an a priori treatment goal concerning how clients

identify or live out their sexual orientation.” J.A. 147–

48; see also J.A. 171 (“[A] multiculturally competent

affirmative approach aspires to understand the

diverse personal and cultural influences on clients and

enable clients to determine (a) the ultimate goals for

their identity process; (b) the behavioral expression of

their sexual orientation; (c) their public and private

social roles; (d) their gender roles, identities, and

expression; (e) the sex and gender of their partner; and

(f) the forms of their relationships.” (footnotes

16

omitted)). And it supports identity exploration,

defined as “an active process of exploring and

assessing one’s identity and establishing a

commitment to an integrated identity that addresses

the identity conflicts without an a priori treatment

goal for how clients identify or live out their sexual

orientation.” J.A. 316.10 Critically, the APA also

supports “an approach that respects religious values

and welcomes all of the client’s actual and potential

identities by exploring conflicts and identities without

preconceived outcomes,” and that “does not prioritize

one identity over another and may aide a client in

creating a sexual orientation identity consistent with

religious values.” J.A. 324.

C. Amici have witnessed firsthand the value that

these approaches offer Christian clients and their

parents. There are many benefits of pursuing a

religiously accommodative approach that does not

seek to force identity or orientation change. These

benefits include reduced depression, anxiety, and

10 See also J.A. 147–48 (2009 APA Task Force Report) (“Given

that there is diversity in how individuals define and express their

sexual orientation identity, an affirmative approach is supportive

of clients’ identity development without an a priori treatment

goal concerning how clients identify or live out their sexual

orientation or spiritual beliefs.”); J.A. 150 (2009 APA Task Force

Report) (“The clinical and research literature encourages the

provision of acceptance, support, and recognition of the

importance of faith to individuals and communities while

recognizing the science of sexual orientation. This includes an

understanding of the client’s faith and the psychology of religion,

especially issues such as religious coping, motivation, and

identity. Clients’ exploration of possible life paths can address the

reality of their sexual orientation and the possibilities for a

religiously and spiritually meaningful and rewarding life.”).

17

suicidality. In addition, one particular benefit of

religiously accommodative approaches—and one that

provides a stark contrast to conversion therapy—is

worth noting: the fostering of a strong parent-child

relationship.

The quality of a minor’s relationship with their

parents is a critical factor that impacts the mental

health and wellness of youth, particularly those

dealing with questions of sexual orientation and

gender identity.11 As detailed below, conversion

therapy can gravely harm that relationship. Infra

Section III. But so too can an approach that villainizes

the minor’s parents and their sincerely held religious

beliefs. Fortunately, approaches like SIT and GRIT

avoid these pitfalls and help to strengthen the crucial

parent-child relationship.

One way that religiously accommodative therapy

strategies can improve the relationship between

Christian parents and their children is through the

non-outcome-based goals noted above. Although every

client is different, amici regularly work with Christian

families who are hesitant to expose their child to

conversion therapy—having heard of its harms—but

still want a religiously accommodative approach to

therapy that doesn’t assume an outcome of transition

or entering same-sex partnerships. Some of these

parents have pursued conversion therapy despite such

hesitation because they were desperate and believed

11 See generally, e.g., Caitlin Ryan et al., Family Rejection as a

Predictor of Negative Health Outcomes in White and Latino

Lesbian, Gay, and Bisexual Young Adults, 123 Pediatrics 346

(2009).

18

it was the only approach that would respect their

religious beliefs. Amici have also met with teens

whose parents requested conversion therapy to

change their child’s sexual orientation. In discussing

with the parents, it was clear that they loved their

child and were motivated by fear that the child’s

sexual identity would ultimately lead them to reject

their faith. Explaining conversion therapy’s

ineffectiveness in changing orientation, and offering

alternatives that respect clients’ deeply held religious

beliefs, often allows those parents to see the value in

broader goals, such as reducing their child’s panic

attacks or other co-occurring mood symptoms;

assisting in resolving value conflicts their teen has

about sexual attractions; and improving family

communication around many topics, including faith

and sexuality.

Whether or not they initially seek conversion

therapy, parents (and their children) regularly

welcome alternative therapeutic approaches that

provide faith-congruent goals that do not seek a fixed

outcome. One such goal is acceptance of the reality of

a child or teen’s current experience. Christian parents

often quickly come to a place of awareness that they

do not want to signal that their acceptance or love of

their child hinges on heterosexuality or a lack of

gender dysphoria. They also do not want to suggest by

“acceptance” of their child’s current experience that

they agree with or approve of every pathway for their

child. In that way, they are like every other parent,

who can love and accept their child while also having

different perspectives on appropriate pathways. In

refraining from the conversion therapy approach,

amici facilitate conversations where parents speak

19

clearly to their minor child about their unconditional

love that does not hinge on change in any direction,

connecting this unconditional love to their faith.

Conversations also allow space to articulate

boundaries and concerns from a place of care and

honesty.

Relatedly, repair of any previous harm that

sabotages communication and connection between

parent and child is another common goal. Christian

parents often want to buffer against any hurt they

may have caused their child, whether intentionally or

not, by pushing conversion therapy or by interactions

that have signaled rejection of their child. Taking

accountability for intended and unintended hurt is

often important to religious parents, who want to

model virtues like humility and repentance as

Christians and as mature adults.

Reducing a youth’s shame about their experience

is another common goal. Amici talk clearly about what

support, compassion, and affirmation can look like,

even in cases where parents are not comfortable with

facilitating transition and/or are not comfortable with

supporting same-sex partnerships. In doing so, amici

work to reduce rejection of children and teens without

requiring parents to necessarily change their own

theological beliefs in the process.

***

In short, the MCTL targets a particular form of

mental health treatment. It does not prohibit therapy

that is congruent with religious beliefs. Nor does it

require that therapists abandon their faith in order to

work as licensed counselors. There are evidence-based

20

treatment options that fully comply with the Law and

with religious principles. The Law allows for these

approaches; it only prohibits establishing attraction or

identity change as a goal or promising it as a result.

III. Conversion therapy is frequently harmful

and ineffective in achieving its purported

goals.

In contrast to these sound therapeutic methods,

conversion therapy is demonstrably harmful to minor

patients. The legislative history highlights that

Colorado was concerned with these harms when

passing the statute here. One Senator, for example,

stated that “all of the prevailing science and modern

medicine tells us that not only does this practice [of

conversion therapy] not work, but it ... actually harms

young people.” See Pet. App. 40a (quotation marks

omitted). And indeed, the district court found that

“Colorado considered the body of medical evidence

regarding conversion therapy and sexual orientation

change efforts—and their harms—when passing the

Minor Therapy Conversion Law and made the

reasonable and rational decision to protect minors

from ineffective and harmful therapeutic modalities.”

Pet. App. 158a.

Conversion therapy increases negative outcomes.

At the extreme, one study shows that lesbian, gay, or

bisexual people who underwent conversion therapy

were almost twice as likely to think about or attempt

suicide as their LGB peers who did not participate in

such therapy.12 A wealth of research shows other

12 See John R. Blosnich et al., Sexual Orientation Change

Efforts, Adverse Childhood Experiences, and Suicide Ideation

21

harms, including depression, anxiety, shame, guilt,

self-hatred, worsening of family relationships, and

loss of faith. See J.A. 61–74 (documenting harms and

collecting sources).

Amici’s experience with individuals who have

undergone conversion therapy aligns with that body of

research. Such minors often suffer in their

psychological wellbeing, have a troubled relationship

with therapy, and experience significant discomfort in

their relationship with their parents. Moreover,

conversion therapy can trigger a crisis of faith, causing

many young people to walk away from their faith

altogether.

Psychological

Wellbeing.

Conversion

therapy—and its narrow focus on an outcome of

changing one’s sexuality or gender—can be

counterproductive to a minor’s overall psychological

wellbeing. Amici have seen numerous Christian

parents who bring a child to therapy only after the

child discloses same-sex feelings or gender questions,

even if the child has been demonstrating symptoms of

depression or anxiety for some time. Particularly

when these parents select conversion therapy, youth

observe that their parents are willing to seek

therapeutic support for them only to “correct” their

sexuality or gender. Teens have repeatedly shared

that this signals that sexuality or gender disclosures

are the “worst thing” and the only thing worth “fixing.”

Young people then internalize the belief that they are

broken, flawed, and in need of fixing, particularly by

and Attempt Among Sexual Minority Adults, United States, 20162018, 110 Am. J. Pub. Health 1024, 1027 (2020).

22

virtue of their sexual attractions or gender

exploration. Conversion therapy compounds these

harms because minors are vulnerable and often see

therapists—particularly therapists of similar faith

backgrounds—as sources of authority. These

therapists, who imply that heterosexual attraction or

lack of gender dysphoria is the goal, can quickly come

to represent what God is expecting of them to be able

to grow in holiness. This drives even worse negative

outcomes, including suicidality, when attractions or

gender distress persist.

Relatedly, conversion therapy can increase shame

in minors. It can instill in them a belief that they are

flawed or defective by virtue of their very existence.

The self-rejection that flows from this can lead minors

to act out sexually in unsafe ways as a form of

punishing themselves or distracting from emotional

pain, and can also drive depression, anxiety, and other

mental health issues.

Relationship with Parents. Worsening these

impacts, conversion therapy also often harms the

parent-child relationship. A critical factor that

impacts the mental health and wellness of minors,

particularly LGBT-identifying youth, is the quality of

their relationship with their parents.13 Too often,

therapists and others villainize Christian parents

without fully understanding their hopes and goals for

their families. But conversion therapy approaches also

alienate Christian youth from their parents,

something that amici have seen far too often in their

practice. For example, conversion therapy approaches

13 See Ryan et al., 123 Pediatrics at 346.

23

often signal that attraction or gender can change by

virtue of healing wounds with parents, which can have

the counterproductive impact of alienating youth from

their parents and causing resentment against them.

This impact is worsened because the conversiontherapy theory itself often places blame on parents for

their children’s attraction patterns. And promising

unrealistic outcomes not based in evidence to

Christian parents only exacerbates these problems.

There are plenty of established ways to improve

parent-child relationships in therapy, and banning a

practice that does the opposite is sound policy.

Faith. Conversion therapy can also impair

minors’ relationship with their faith and with God.

Amici have met with teens and adults who went

through conversion therapy at some point in their

adolescence, stirred by conviction, a longing to be

obedient to God and their faith community, and a

desire to participate in Christian marriage. Their

fervor at that time was profound. But many of these

youth eventually rejected their faith altogether.

Conversion therapy reinforced in them a misguided,

unsupported belief that a loving God would change

their attractions if they followed a protocol. This

created a conditional experience of love of God that

disillusioned them when their attractions did not

change. They came to believe that they were not

“doing it right” and “didn’t want it enough” and

blamed themselves for their continued attraction.

These youth also became angry at God when their

attractions or orientation did not change, coming to

believe that, if a loving God exists, he did not care to

help them despite their investment in conversion

therapy. Self-blame, rage, and futility in the face of

24

enduring experiences are unsustainable, so these

youth and adults who underwent conversion therapy

eventually rejected God and faith altogether, believing

that the only faith-congruent option was conversion.

These clinical observations are consistent with

research findings on the subject.14

Relationship with Therapy. Unsurprisingly

given these problematic outcomes, minors’ negative

experiences with conversion therapy can often drive

them away from mental health care altogether. Some

young people wait significantly longer to seek therapy

than they otherwise would have after a harmful

experience with conversion therapy, fearing similarly

unhelpful approaches. This translates into delaying

much-needed care until it becomes desperate,

worsening mental health symptoms such as

depression, anxiety, and suicidality that otherwise

could have been expediently addressed. So even where

conversion therapy as such has not prompted

worsened mental health, it can lead to worse outcomes

by delaying much-needed mental health care later in

life.

Relatedly, amici have experienced trouble

building trust with clients who previously had

negative experiences with conversion therapy. Trust

is essential to effective mental health care. In fact, one

of the top predictors of successful therapeutic

outcomes is the strength of the therapeutic

14 See Timothy W. Jones et al., Religious Trauma and Moral

Injury From LGBBTQA+ Conversion Practices, 305 Soc. Sci. &

Med. 1, 7 (2022); see also J.A. 67–68 (Glassgold Declaration);

J.A. 265, 277 (2009 APA Task Force Report).

25

relationship.15 Understandably, youth who have been

harmed by conversion therapy are often hesitant or

scared to meet with a Christian provider because of

fear that they will again be subjected to efforts to

change their attractions, orientation, or gender

expression. Colorado’s law addresses these harms by

reducing the likelihood of such practices and

increasing youth confidence in therapy through the

message that therapy will not seek to coerce an

outcome.

IV. The MCTL is one of many restrictions that

apply to ensure that therapeutic speech

by licensed providers comports with

professional ethics and the evidence-based

standard of care.

Colorado’s restriction on this harmful form of

therapy falls squarely within a long history of

restrictions on the practice of mental health

professions—and indeed, a history of state regulation

of professions more broadly. States have the

prerogative to regulate the professional conduct of

licensed medical professionals; and in the professional

therapeutic context, such conduct necessarily

manifests in speech. State regulation of such speech

as professional conduct is generally unexceptional.

A. Licensed therapists and other mental health

professionals are subject to a well-established

licensure regime that places important restrictions on

what providers may say to a client in therapy. Far

15 See, e.g., Tori DeAngelis, Better Relationships With Patients

Lead to Better Outcomes, 50 Monitor on Psych. 38 (2019), https://

www.apa.org/monitor/2019/11/ce-corner-relationships.

26

from representing “a sharp break from historical

counseling regulations,” Pet. Br. 2, the MCTL is

squarely in line with those restrictions on professional

conduct.

There are two primary sources of restrictions on

the practice of professional mental health care in

Colorado (as in other states): the state licensing

scheme, and malpractice law enforced through the tort

system. Both provide important limits on what a

licensed therapist may say to a client during

counseling.

First, Colorado has a regulatory scheme under the

Mental Health Practice Act that applies to anyone

licensed, registered, or certified to practice in certain

mental-health fields, like psychology, social work, and

certain types of counseling and therapy. See Colo. Rev.

Stat. § 12-245-101 et seq. If a covered practitioner

engages in prohibited practices, they may face

sanctions including probation, revocation or

suspension of their license, or an injunction

prohibiting them from practicing the profession. See

id. § 12-245-225(1). The restriction on conversion

therapy for minors operates within this scheme. Id.

§ 12-245-224(1)(t)(V). But the scheme is much

broader—indeed, it covers any scenario where a

licensed provider “[h]as acted or failed to act in a

manner that does not meet the generally accepted

standards of the professional discipline under which

the person practices.” Id. § 12-245-224(1)(g)(I).

Second, mental health providers may face liability

for their professional conduct under tort law in

malpractice actions. See Fried v. Leong, 946 P.2d 487,

488 (Colo. App. 1997). Professional malpractice

27

actions require showing that a defendant “failed to

conform to the standard of care ordinarily possessed

and exercised by members of the same [field] practiced

by the defendant.” Day v. Johnson, 255 P.3d 1064,

1069 (Colo. 2011). The Mental Health Practice Act

contemplates malpractice as a concurrent method of

regulating licensed therapists, stating that a

“malpractice judgment of a court of competent

jurisdiction is conclusive evidence that [an] act or

omission does not meet generally accepted standards

of the professional discipline.” Colo. Rev. Stat. § 12245-224(1)(g)(II); see Cipollone v. Liggett Grp., Inc.,

505 U.S. 504, 521 (1992) (recognizing that legal duties

can take the form of positive enactments or rules

imposed by common-law damages actions).

The professional duty of care incorporated into

the Mental Health Practice Act and the common-law

rule against malpractice imposes restrictions on

professional conduct, including in the realm of goalsetting, far beyond the ban on conversion therapy. A

therapist could not, for example, encourage a client to

die by suicide even if the therapist shared a secular or

religious belief that this was an appropriate course of

action. An atheist therapist could not push a client to

walk away from the client’s deeply held religious

beliefs because the therapist deems the client’s beliefs

to be at odds with the therapist’s personal values. Nor

could a therapist encourage a client to stay married to

an abusive partner at all costs, even if motivated by

her and her client’s beliefs in the sanctity of marriage.

Conversely, mental health providers need not

encourage divorce, just as they need not encourage

identifying as LGBT, engaging in same-sex sexual

activities, or transitioning gender. But they should

28

offer therapy that acknowledges a potential outcome

of divorce, just as sexuality- and gender-related

therapy should recognize the potential for a range of

outcomes.

As one more example, it would likely violate the

standard of care for a therapist working with a sexual

assault survivor to establish as the treatment goal

absolute forgiveness, defined as the elimination of any

feelings of residual anger at the perpetrator. While

this goal might, at first glance, align with Christian

values of forgiveness, an aspect of treatment planning

around forgiveness involves educating the client that

they should expect periodic feelings of anger and hurt,

even after they work through forgiveness in therapy.16

This tempers unrealistic goals, even when the goals

may, on some level, align with the therapist’s values.

The key to effective therapy is holding on to the value

of forgiveness, rather than eradication of “negative”

emotions completely.

The above examples would likely provide grounds

for sanction or a malpractice suit because such

treatment would “not meet the generally accepted

standards” of the mental health profession. Colo. Rev.

Stat. § 12-245-224(1)(g)(I); see also Day, 255 P.3d at

1069. They thus show that Chiles’s claim that the

statute “disrespects clients’ autonomy to set their own

See Everett L. Worthington Jr. & Michael Scherer,

Forgiveness Is an Emotion-Focused Coping Strategy That Can

Reduce Health Risks and Promote Health Resilience: Theory,

Review, and Hypotheses, 19 Psych. & Health 385, 387 (2004).

Similarly, a competent therapist, when a client asks for therapy

to eliminate same-sex attraction or gender distress, ought to

provide education about the unlikelihood of this outcome.

16

29

goals,” Pet. Br. 12, fails to account for the numerous

ways that goal-setting and absolute client autonomy—

and consequently, therapists’ “speech”—are properly

limited in the context of licensed, professional mental

health treatment.

Limits on therapists’ “speech” (or, more

accurately, their professional conduct) are not

confined to the goal-setting context. For example, the

Act also imposes confidentiality requirements on

therapists that prohibit them from speaking about

their client conversations with third parties.

Therapists are restricted from sharing identifying

information (through speech) about their clients, even

in cases where they may have value conflicts about not

sharing confidential information. For example, in the

case of an adult who is voluntarily in an emotionally

abusive relationship, barring imminent harm to self or

others, the therapist cannot report this without client

consent according to Colorado law. See Colo. Rev. Stat.

§ 12-245-220. So too for issues of public concern—a

therapist could not run to the papers with scandalous

information about a political candidate that was

revealed in therapy, even if the therapist had a firmly

held belief that the candidate should not hold office

based on what he had revealed. See id. And this

applies even if the therapist’s speech is religiously

motivated. A therapist cannot, for example, call up her

client’s pastor to express concern about her client’s

questioning of her faith or engagement in morally

problematic behaviors when these are disclosed in

therapy.

Conversely, the Act imposes speech requirements

in certain circumstances. Therapists are required by

30

law to break confidentiality in certain scenarios, like

when a client has communicated a serious threat of

imminent physical violence against a specific person.

See id. §§ 13-21-117(2), 12-245-220(5). If a minor child

seeks therapy services from a licensed therapist, the

Act requires the therapist to encourage the child to

notify the minor’s parents or guardians. Id. § 12-245203.5(3)(b). And the Act requires licensed

practitioners to provide certain information to clients,

including, for example, a statement indicating that

“[a] client is entitled to receive information about the

methods of therapy, the techniques used, [and] the

duration of therapy, if known” and that “[i]n a

professional relationship, sexual intimacy is never

appropriate and should be reported.” Id. § 12-245216(1)(d).

B. This Court has acknowledged that the State

plays an important role in regulating professional

conduct, even when that conduct takes the form of

speech. In National Institute of Family & Life

Advocates v. Becerra (NIFLA)—a case heavily relied

on by Chiles—the Court noted that “[l]ongstanding

torts for professional malpractice” do not raise First

Amendment concerns because they “‘fall within the

traditional purview of state regulation of professional

conduct.’” 585 U.S. 755, 769 (2018) (quoting NAACP v.

Button, 371 U.S. 415, 438 (1963)); see also id. at 769–

70 (recognizing that the Court has upheld speechmandating

informed-consent

requirements

as

regulations of professional conduct).

Chiles attempts to distinguish such regulations as

“incidental to regulable conduct.” Pet. Br. 32. But that

distinction collapses when the “speech” at issue is the

31

conduct being regulated. Many licensed professions

are practiced substantially or primarily through

speech, and that speech is routinely regulated as

professional conduct. An attorney can be sued for

malpractice or face bar discipline based on the advice

she provided or failed to provide. See, e.g., Boyd v.

Garvert, 9 P.3d 1161, 1162 (Colo. App. 2000). A doctor

can face liability or discipline based on the diagnosis

she gave. See, e.g., Williams v. Boyle, 72 P.3d 392, 401

(Colo. App. 2003) (citing McKay v. State Bd. of Med.

Examiners, 86 P.2d 232 (Colo. 1938)). And a licensed

mental health professional can face licensure

sanctions or malpractice liability for offering unproven

and potentially harmful therapeutic modalities. See

supra Section IV.A.

The Court recently held that States have leeway

in regulating professional services that are untested

and may pose serious harm. In United States v.

Skrmetti, in the context of gender-related treatments

for minors, the Court held that the Constitution

“afford[s] States ‘wide discretion to pass legislation in

areas where there is medical and scientific

uncertainty.’” 145 S. Ct. 1816, 1836 (2025) (quoting

Gonzales v. Carhart, 550 U.S. 124, 163 (2007)); see also

id. at 1852 (Barrett, J., concurring) (“The question of

how to regulate a medical condition such as gender

dysphoria involves a host of policy judgments that

legislatures, not courts, are best equipped to make.”).

There is no reason why that discretion should not

apply equally to professional healthcare services that

are provided through speech. And for the reasons

amici have explained, the Colorado legislature

exercised its discretion wisely here. Supra Section III.

32

C. If the Court were to adopt Chiles’s position that

strict scrutiny applies here, it would upend

malpractice law and the regulation of professions that

provide speech-based services. As this Court has

repeatedly held, the First Amendment applies in the

same manner to “state tort suits,” like malpractice, as

it does to traditional government regulation. See

Snyder v. Phelps, 562 U.S. 443, 451 (2011); see also

Hustler Mag., Inc. v. Falwell, 485 U.S. 46, 53 (1988).

So if statutory or regulatory restrictions on the

professional practice of licensed therapists trigger

strict scrutiny under the First Amendment, so too does

the entire regulatory and malpractice regime that

governs other speech-based professional services.

Not only therapists but also lawyers, doctors,

schoolteachers, financial advisors, real estate agents,

and many others practice their regulated professions

partly or entirely through their words. States regulate

that “speech”—really, that professional conduct—to

ensure those professions are practiced responsibly and

to protect the public. Given that strict scrutiny is

“fatal

in

fact

absent

truly

extraordinary

circumstances,” Free Speech Coal., Inc. v. Paxton, 145

S. Ct. 2291, 2310 (2025), a ruling for Chiles here would

mark a sea change in the regulation of professions in

this country. See also id. (“Strict scrutiny therefore

cannot apply to laws … which are traditional,

widespread, and not thought to raise a significant

First Amendment issue.”).

***

As Christians, amici sympathize with Chiles’s

concerns about laws that target religious populations

and impinge upon deeply held beliefs and values. But

33

the law here does not implicate those concerns. And

adopting Chiles’s position would not just undermine

the Colorado law at issue here; it would call into

question the entire regulatory regime for licensed

therapists and other professionals that is critical to

ensuring patient care and protecting the public.

CONCLUSION

The judgment below should be affirmed.

Respectfully submitted,

Sean P. Madden

301 Quay Commons

Sarasota, FL 34236

Paul Alessio Mezzina

Counsel of Record

Amy R. Upshaw

Nicholas A. Mecsas-Faxon

KING & SPALDING LLP

1700 Pennsylvania Ave. NW

Washington, DC 20006

(202) 737-0500

pmezzina@kslaw.com

Counsel for Amici Curiae

August 26, 2025