Is This the Beginning of the Shitification of Therapy?

A big ruling from the Supreme Court on conversion therapy is being discussed as a free speech case in the media and legal circles. As a therapist, that’s not the part I can’t stop thinking about.

I keep coming back to this: what if this marks the beginning of the shitification of therapy?

How so? The Court held that therapy (that is, talk therapy or psychotherapy) can constitute protected speech. It took me a bit to grasp why that’s a big problem for our profession and our clients.

When speech is the treatment

The therapist in question was not prescribing medication, performing surgery, or physically intervening on a client’s body. She was talking. And in the Court’s framing, that matters. The implication is that because psychotherapy happens through words, it belongs in some different category. A potentially protected one. And that should alarm therapists, patients, and anyone who cares whether therapy remains a profession with enforceable standards.

Because without those standards, what you get is a free-for-all hiding behind a license. Quackery. Harm. Bad outcomes, immediate or long-term. And a profession that starts to look a lot more like what therapy chatbots are already doing — something that resembles care, with none of the accountability that comes with it.

The sky isn’t falling, but…

I don’t think good therapy suddenly disappears. But there’s something slower and more corrosive here: the erosion of professional standards when harmful treatment becomes harder to police and easier to defend as protected speech.

Here are two very real problems that I see:

1. The New Defense for Bad Therapy

The Court didn’t rule that conversion therapy is good care. The science has not changed. The ethical consensus has not changed. But when the Supreme Court strikes down a ban 8-1, the public reads that as validation, regardless of the fine print.

And beyond the signal, this gives bad therapy a new legal defense. You can already hear the argument taking shape: you are not enforcing standards, you are punishing my viewpoint.

That defense does not stop with conversion therapy. It can be used by any clinician practicing bad therapy who wants to call it a belief.

• The therapist who pushes conspiracy thinking onto a vulnerable client.
• The therapist who frames a predetermined moral conclusion as treatment.
• The therapist reviving discredited techniques and then claiming that a licensing board is really objecting to their philosophy, not their care.

And this isn’t hypothetical. Within days of the ruling, an anti-vaccine legal group cited the Chiles decision in pending lawsuits against state medical boards that had disciplined doctors for spreading COVID misinformation. The argument was immediate: physician speech is protected, even when the speech is the treatment itself.

These may not be particularly strong or compelling arguments, but they got a serious boost from the highest court in the land.

If I were sitting on a mental health licensing board right now, I’d have some serious heartburn. These boards oversee professions where the treatment is verbal and relational. The ruling doesn’t mean licensing boards suddenly lose all authority. But they may become more hesitant to draw clear lines in advance, because every standard about what a therapist should not do in session becomes more vulnerable to challenge.

A therapist practicing within their scope is not expressing a viewpoint. They are providing care.

2. The Framework

I think part of the deeper problem is that the Court did what courts do. It took a clinical relationship and mapped it onto the only framework it has: speech versus conduct, viewpoint-neutral versus viewpoint-discriminatory. Lawyers think in legal categories. That is their job.

But those categories do not describe what happens in a therapy room. A therapist practicing within their scope is not expressing a viewpoint. They are providing care. Those are different things. The Court lacks a bucket for “care” when it comes to talk therapy, so it shoves everything into “speech” and applies First Amendment logic to a situation that is not really about the First Amendment at all.

I’m not alone in that concern. American Psychological Association CEO Arthur Evans called the ruling unsettling, warning that it could affect “the broader authority of state licensing boards to enforce best practices in any profession that uses speech to deliver therapeutic interventions.”

What Good Therapy Actually Does

People often think therapy is advice. It isn’t. (Maybe this is exactly what the Supreme Court thinks therapy is.) A therapist is not someone who listens to your problem and then tells you what to do. That is closer to what a friend does, or a talk show host, or a chatbot.

Therapy is a structured clinical process supported by years of graduate training, supervised clinical hours, and ongoing ethical accountability. Research using brain imaging has shown that psychotherapy produces measurable changes in neural circuitry, strengthening the brain’s ability to regulate emotion, memory, and stress.

That is not a conversation. That is a clinical intervention.

And that distinction matters here, because if you think therapy is just advice, then of course, regulating it looks like regulating speech.

What good therapy actually does is sit with the things people struggle to sit with on their own. Confusion. Anger. Contradiction. The parts of identity that don’t resolve neatly. Including, sometimes, faith. That’s what the therapy room is for.

Not every therapy that engages religion is conversion therapy. Not every therapist who takes faith seriously is imposing ideology.

Therapy that explores

Good therapy already knows how to make room for complexity. When someone is struggling to reconcile a religious identity with their sexual orientation, for instance, the therapeutic task is not to mock the faith or bulldoze the conflict. It is to sit with it, talk about it, explore it, and help the person understand their own experience more honestly and more fully.

Therapy that imposes

That is not the same thing as entering the room with the answer already decided. Conversion therapy starts with a predetermined conclusion and reverse-engineers a therapeutic rationale around it. It treats certain experiences and identities as pathology and calls the resulting pressure “care.”

A court may have difficulty distinguishing between exploration and imposition when both are reduced to “just talking.” A practicing therapist should not.

The Slow Erosion?

Cory Doctorow coined the term “enshittification” to describe how tech platforms decay. It’s the same story as when a venture capital firm buys something of value and squeezes it for higher financial returns. What comes out the other end is always shittier than before.

Once psychotherapy is reduced to “just speech,” there’s less standing to insist that it’s a licensed mental health profession with rules, not just a conversation with opinions. And when oversight weakens, something else fills the gap. Lower-quality substitutes that still look enough like the real thing to confuse people. An analog is the unregulated and, at times, damaging and dangerous “therapy” already being provided by chatbots.

That is how professions get hollowed out. Not all at once. The floor drops a little, people adjust, and then it drops a little more.

• What was once clearly outside the boundaries of care becomes a possibility.
• What was once clearly sanctionable becomes contestable.
• What was once recognized as bad treatment is now expressed in the softer language of viewpoint, belief, or therapeutic philosophy.

As therapists, we don’t need the law to tell us how to sit with the full complexity of a client’s life. We need a profession that is still allowed to distinguish between exploration and imposition, between treatment and ideology, between therapy and something pretending to be therapy.

That is the distinction I worry we’re losing.