 “The Constitution does not pose a barrier to reasonable regulation of harmful medical treatments just because substandard care comes via speech instead of scalpel.” - Justice Jackson, dissenting
Importantly this case is about how conversion practices are regulated not whether it is safe or legal. This ruling addresses a narrow question about whether states can legislate to prevent harm from a specific medical practice. This does not mean conversion practices are legal or free of sanction. We will continue to expect professional licensure boards to hold their licensees to account. We will also continue to work on legislative solutions not impacted by this decision to support efforts by people harmed by conversion practices to sue for damages. Treating conversion practices as a matter of free speech, as the Court positioned itself with today’s decision, does not adequately address the threat of conversion practices. Psychotherapy should not be reduced to “mere speech” because in professional practice it is not ordinary conversation, opinion-sharing, or public debate. Psychotherapy is a clinical intervention: a structured, goal-directed, theory-informed set of professional actions used to assess problems, alter behavior, regulate emotion, modify cognition, improve functioning, and reduce suffering. Language is one of its primary tools, but that does not make the intervention “just speech” any more than surgery is “just cutting” or pharmacotherapy is “just chemicals.” The relevant unit is the professional intervention, not the medium through which it is delivered. A licensed psychologist does not simply express views to a client. The psychologist applies specialized knowledge, selects techniques based on diagnosis and formulation, sequences interventions intentionally, monitors response, manages risk, and is held to standards of competence, ethics, and evidence. Exposure, cognitive restructuring, behavioral activation, motivational interviewing, family systems interventions, safety planning, and relapse prevention are all examples of treatments implemented largely through verbal interaction. Yet no serious clinician would say these are merely expressions of viewpoint. They are recognized therapeutic procedures designed to produce clinical change. That distinction matters because the state has long had authority to regulate professional conduct in the delivery of health care, including what methods are competent, unsafe, fraudulent, or below the standard of care. A psychologist may speak during treatment, but the speech is embedded in a professional act. When a therapist administers an intervention to reduce panic, treat OCD, address suicidality, or work with a distressed adolescent, the therapist is not participating in a public ideological exchange. The therapist is delivering health services to a vulnerable patient under a fiduciary and ethical duty to do no harm The members of the Kentucky Psychological Association recognize the many and grave, deadly effects of conversion practices, and we will continue to work to protect the wellbeing of all Kentuckians.
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