Talk Therapy as Protected Speech: The Sixth Circuit Subjects Conversion-Therapy Bans to Strict Scrutiny in Catholic Charities of Jackson v. Whitmer

I. Introduction

In Catholic Charities of Jackson, Lenawee, and Hillsdale Counties v. Gretchen Whitmer, the U.S. Court of Appeals for the Sixth Circuit held that Michigan’s statutory ban on “conversion therapy” for minors—when applied to talk therapy provided by licensed mental health professionals—is a content- and viewpoint-based restriction on speech that triggers strict First Amendment scrutiny. The court reversed the district court’s denial of a preliminary injunction and ordered that enforcement of the law be enjoined while the case proceeds.

The decision places the Sixth Circuit squarely on one side of a deepening circuit split over whether states may prohibit licensed therapists from engaging in sexual-orientation- or gender-identity-change efforts with minors. It aligns closely with the Eleventh Circuit’s approach in Otto v. City of Boca Raton and diverges from the Ninth and Tenth Circuits’ views in Tingley v. Ferguson and Chiles v. Salazar, which treat such regulations primarily as permissible controls on medical practice rather than speech. The dissent, authored by Judge Bloomekatz, underscores this divide and urges a dramatically different doctrinal framework.

At the core of the case is a clash between two powerful state and federal interests:

• The state’s interest in regulating medical treatment and protecting minors from what the legislature deems ineffective and harmful practices (here, conversion therapy); and
• The First Amendment interest in protecting consensual talk-based counseling—especially counseling shaped by religious and moral views—from governmental control based on the ideas it expresses.

II. Factual and Procedural Background

A. The Parties and Their Counseling Practices

The plaintiffs are:

• Catholic Charities of Jackson, Lenawee, and Hillsdale Counties, which employs 16 licensed counselors, and
• Emily McJones, a licensed clinical psychologist who runs her own private practice.

Both provide what they describe as “talk therapy” or psychotherapy: counseling delivered solely through spoken words. They do not prescribe medication, perform medical procedures, or employ aversive techniques such as electric shocks or nausea induction.

Their counseling is grounded in Catholic teaching. Clients—including minors, with parental consent—set their own goals for therapy. Some clients (and their parents) seek therapy specifically because they want a counselor who shares their religious beliefs and will assist them in:

• Becoming more comfortable with their biological sex,
• Reducing same-sex sexual behavior, or
• Aligning their sexual orientation identity with their religious convictions.

For clients with these goals, the plaintiffs understand themselves to have an ethical and religious duty “to help that client live the life she desires to live.”

B. Michigan’s HB 4616: The Conversion-Therapy Ban

In 2023, Michigan enacted two statutes collectively referred to as HB 4616. The law:

• Prohibits any “mental health professional” from engaging in “conversion therapy with a minor.” Mich. Comp. Laws §§ 330.1901a, 330.1100a(20).
• Defines “conversion therapy” as “any practice or treatment” by a mental health professional that “seeks to change an individual’s sexual orientation or gender identity,” including efforts to change behavior or gender expression or reduce same-sex attractions.
• Expressly excludes from the definition:
  • Counseling that provides assistance to an individual undergoing a gender transition; and
  • Counseling that provides acceptance, support, understanding, coping strategies, or identity exploration, so long as it does not “seek to change” sexual orientation or gender identity.
• Applies only to licensed mental health professionals—physicians, psychologists, nurses, licensed social workers, professional counselors, and marriage and family therapists.
• Imposes serious penalties: loss of license and fines up to $250,000.

The statute thus draws a sharp line between:

• Counseling aimed at helping minors adopt or affirm an LGBT identity or pursue a gender transition (permitted), and
• Counseling aimed at helping minors change or suppress LGBT identity, behavior, or attractions to align with biological sex or religious beliefs (prohibited).

C. District Court Proceedings

The plaintiffs filed suit in July 2024—about five months after HB 4616 took effect—asserting First Amendment and other constitutional challenges and seeking a preliminary injunction to bar enforcement of the statute during the litigation.

The district court:

• Held that the plaintiffs had standing to bring a pre-enforcement challenge.
• Characterized the therapy at issue as “treatment” or “conduct,” not protected “speech.”
• Applied rational-basis review, reasoning that Michigan was regulating professional conduct within its traditional authority over medical practice.
• Denied the motion for a preliminary injunction.

The plaintiffs took an interlocutory appeal under 28 U.S.C. § 1292(a)(1).

D. Appeal and Panel Composition

A Sixth Circuit panel consisting of Judges Kethledge, Larsen, and Bloomekatz heard argument in October 2025. Judge Kethledge wrote the majority opinion, joined by Judge Larsen, reversing the district court. Judge Bloomekatz dissented in a lengthy and detailed opinion.

III. Summary of the Sixth Circuit’s Decision

The Sixth Circuit’s ruling can be summarized as follows:

1. Standing: The plaintiffs have pre-enforcement standing. They intend to engage in counseling that is at least arguably protected by the First Amendment; that counseling is at least arguably proscribed by HB 4616; and they face a credible threat of enforcement that is already chilling their speech.
2. No Abeyance: The court refused to hold the case pending the Supreme Court’s decision in Chiles v. Salazar, despite acknowledging that Chiles raises the same core constitutional issue.
3. Talk Therapy Is Speech, Not Conduct: As applied to plaintiffs’ talk therapy, HB 4616 regulates speech, because its applicability turns entirely on the content and viewpoint of what therapists say to clients.
4. Content- and Viewpoint-Based Regulation:
   • The statute is content-based because it singles out counseling that “seeks to change” sexual orientation or gender identity.
   • It is viewpoint-based because it permits affirmative/supportive counseling for LGBT identities and gender transition while forbidding counseling that encourages alignment with biological sex or traditional religious views.
5. No “Professional Speech” Escape Hatch: The state may not evade First Amendment scrutiny simply by recharacterizing speech as “treatment” or invoking the general tradition of regulating licensed professionals. Under United States v. Stevens, it must identify a longstanding, specific tradition of regulating this category of speech—which it has not.
6. Strict Scrutiny Applies: Because HB 4616 is content- and viewpoint-based, it is subject to strict scrutiny (and possibly unconstitutional per se as viewpoint discrimination).
7. Failure of Strict Scrutiny: The state’s asserted interests—protecting minors and regulating professional conduct—are compelling at a high level of generality, but the state has not shown a “direct causal link” between plaintiffs’ talk therapy and the harms cited, nor shown that this broad speech ban is the least restrictive means.
8. Preliminary Injunction Required: The plaintiffs are likely to succeed on their First Amendment claim; ongoing loss of free-speech rights is irreparable harm; and the remaining injunction factors favor relief. The court reverses and remands for prompt entry of a preliminary injunction against enforcing HB 4616 against the plaintiffs’ talk therapy.

Judge Bloomekatz’s dissent would:

• Hold the case in abeyance pending the Supreme Court’s decision in Chiles.
• Treat psychotherapy as a medical intervention delivered through words and apply intermediate (not strict) scrutiny.
• Conclude that HB 4616 is a permissible regulation of medical practice that likely satisfies intermediate scrutiny, and therefore affirm the denial of a preliminary injunction.

IV. Detailed Analysis of the Majority Opinion

A. Standing and Chilling Effect

The majority applies the familiar pre-enforcement standing framework from Susan B. Anthony List v. Driehaus and Sixth Circuit precedent:

1. Intended expression: Plaintiffs allege they regularly see minors struggling with sexual orientation and gender identity, and that they wish to provide counseling aimed at:
   • Helping minors “change” their gender identity or expression to align with biological sex, and
   • Helping minors refrain from same-sex sexual activity or reframe their sexual-identity labels to match their faith.
   This is plainly expressive, idea-driven communication.
2. Expression arguably proscribed: HB 4616 explicitly bans counseling that “seeks to change” sexual orientation or gender identity—matching exactly the goals some of plaintiffs’ clients seek.
3. Credible threat of enforcement:
   • HB 4616 authorizes severe penalties (license loss and six-figure fines).
   • Complaints can be filed online by anyone, encouraging enforcement.
   • Michigan refuses to disavow enforcement and instead states it will proceed when it finds a “reasonable basis” for violations.
   • Plaintiffs allege their conversations have already become “guarded and cautious,” rather than “open” and “candid.”
   This chilling of speech is “the first and most important factor” in finding a credible enforcement threat in First Amendment cases.

The majority treats the chill as evidence that the threat is substantial: plaintiffs want to speak but self-censor because of the law. That is enough to create a ripe controversy.

B. The Court’s Refusal to Await the Supreme Court’s Decision in Chiles

The state asked the Sixth Circuit to hold this appeal pending the Supreme Court’s decision in Chiles v. Salazar, a case involving a materially similar conversion-therapy ban and the same First Amendment issue. The majority declined, emphasizing:

• The “virtually unflagging” obligation of federal courts to decide cases within their jurisdiction (Lexmark).
• Congress’s conferral of immediate appellate jurisdiction over preliminary-injunction orders in 28 U.S.C. § 1292(a)(1).
• The time-sensitive nature of preliminary injunctions: they determine the status quo while constitutional rights may be at stake.
• The value of additional circuit-level analysis for the Supreme Court’s eventual review.

The dissent sharply criticizes this move, citing the court’s and other circuits’ common practice of holding analogous cases for Supreme Court guidance and emphasizing that Chiles had already been argued at the Supreme Court before this appeal was heard.

C. Talk Therapy as Speech, Not Conduct

The district court had treated plaintiffs’ counseling as “treatment” or “conduct,” applying deferential review. The Sixth Circuit majority rejects that characterization for talk therapy that:

• Consists exclusively of spoken words,
• Reflects and transmits the moral and religious beliefs of therapists and clients, and
• Is targeted by the law precisely because of its communicative content.

Drawing on Cohen v. California and Holder v. Humanitarian Law Project, the court reasons:

• When the “only conduct” being punished is communication of a message, the activity is “speech,” not conduct (Cohen).
• Where “the conduct triggering coverage” under a statute “consists of communicating a message,” the statute regulates speech and must be treated as such (Holder).

HB 4616 is triggered by what the therapist says—the goal and direction of the counseling—rather than by any non-verbal act (e.g., prescribing medications, performing procedures, etc.). Thus, at least as applied to plaintiffs’ talk therapy, the majority holds that the statute regulates speech.

D. Content and Viewpoint Discrimination

The majority next applies the modern content-neutrality framework from Reed v. Town of Gilbert:

• A law is content-based if it “applies to particular speech because of the topic discussed or the idea or message expressed.”
• A law is viewpoint-based—a more serious form of content discrimination—if it favors or disfavors particular positions on a given subject.

Under that framework, HB 4616 is:

• Content-based, because it prohibits counseling that “seeks to change” sexual orientation or gender identity. The statute explicitly targets speech on a particular subject and with a particular purpose.
• Viewpoint-based, because it:
  • Prohibits counseling that aims to change a child’s sexual orientation or gender identity, including efforts to align with biological sex or religious beliefs; yet
  • Expressly allows counseling that “provides assistance to an individual undergoing a gender transition” and counseling that supports identity exploration without directing it toward cisgender/heterosexual outcomes.
  Thus, the law effectively embraces the viewpoint that sexual orientation is immutable (and efforts to change it are disfavored), while treating gender identity as fluid and supporting counseling that promotes transition away from birth sex. This mirrors the Eleventh Circuit’s characterization in Otto.

Because viewpoint discrimination is “an egregious form of content discrimination” (Rosenberger), the majority notes that such a law is almost never constitutional and may be invalid per se.

E. Rejecting a Broad “Professional Speech” Exception

The crux of the state’s defense—and the district court’s ruling—is that the legislature has broad power to regulate licensed professionals and their “treatments.” The majority emphasizes that this argument is exactly what United States v. Stevens rejects: the government cannot create a “First Amendment Free Zone” simply because an area has been traditionally regulated.

Applying Stevens’s framework:

1. Default rule: All speech is presumptively protected. The government bears the burden to show that some category of speech is historically unprotected.
2. Required showing: The government must identify a “long-settled tradition” of subjecting that specific category of speech to regulation—not merely a tradition of regulating the broader field (e.g., animal cruelty, professional licensing, or medical practice).
3. State’s failure:
   • Michigan has a long history of regulating medical practice and mental-health treatment, but that says nothing about whether there is a long tradition of banning consensual, non-coercive, non-aversive talk therapy based on its ideological content.
   • At oral argument, the state candidly admitted that, aside from recent conversion-therapy statutes, it could cite no example where liability for “treatment” turned on the content of a professional’s speech.

The majority thus declines to treat “professional speech” as a category outside First Amendment protection, consistent with the Supreme Court’s decision in National Institute of Family & Life Advocates v. Becerra (NIFLA), which repudiated broad professional-speech exceptions.

The majority distinguishes Casey and EMW Women’s Surgical Center v. Beshear, which upheld certain compelled disclosures by physicians:

• In those cases, disclosure obligations were triggered by performing a procedure (abortion); they were conditions on an underlying medical act (analogous, in the majority’s view, to factual warning labels on products).
• Here, by contrast, the speech itself is the regulated activity—there is no underlying non-speech procedure that triggers regulatory obligations.
• Thus, the law in NIFLA and the abortion-disclosure laws are conceptually different from a direct ban on particular therapeutic viewpoints expressed in conversation.

F. Strict Scrutiny and Its Application

Because HB 4616 is content- and viewpoint-based and not saved by any historical exception, the majority applies strict scrutiny. This requires the state to prove:

1. A compelling governmental interest, and
2. That the law is narrowly tailored to that interest and uses the least restrictive means of achieving it.

The state asserts interests in:

• Protecting public health and safety; and
• Safeguarding the physical and psychological well-being of minors.

The majority does not deny these are important—indeed, likely compelling in the abstract. But it faults the state’s presentation as too high-level and conclusory to satisfy the “precise analysis” demanded under strict scrutiny (Fulton).

Specifically:

• The state’s evidence largely focuses on:
  • Aversive techniques (electric shocks, nausea, etc.) that the plaintiffs do not use; and
  • Conversion practices by non-professionals (e.g., religious laypersons) outside the licensed context.
• The plaintiffs, in turn, offer studies and testimony indicating that their non-aversive, client-directed talk therapy may reduce distress and suicidality for minors whose religious identity conflicts with their sexual or gender identity.
• Given the conflicting record, the state has not established the “direct causal link” between plaintiffs’ specific speech and severe harms that the Supreme Court has required in other strict-scrutiny cases (Brown v. Entertainment Merchants Association).
• The state has also not shown that a categorical speech ban is the least restrictive means—e.g., as compared to:
  • Disclosure or informed-consent requirements,
  • Targeted regulation of coercive or aversive practices, or
  • Post hoc discipline for demonstrable harm or malpractice.

Given that no viewpoint-discriminatory law has ever survived strict scrutiny, the majority finds it “likely” that HB 4616 will not be the first. This strong likelihood of success on the merits drives the preliminary injunction analysis.

G. The Preliminary Injunction Factors

Applying the familiar four-factor test, the majority finds:

• Likelihood of success: High, for the reasons above.
• Irreparable harm: Ongoing deprivation of First Amendment freedoms, even briefly, is irreparable harm as a matter of law.
• Balance of equities: The plaintiffs face loss of core speech rights; the state’s interest can be vindicated at final judgment if it prevails.
• Public interest: Protecting constitutional rights serves the public interest.

The court therefore reverses and remands for “prompt entry” of a preliminary injunction barring enforcement of HB 4616 against plaintiffs’ talk-therapy practices.

V. The Dissent’s Competing Framework

Judge Bloomekatz’s opinion is important both as a doctrinal alternative and as a roadmap for what some other circuits—and likely some Supreme Court Justices—may find persuasive.

A. Abeyance and Institutional Posture

The dissent would have held the case in abeyance pending Chiles, emphasizing:

• Longstanding Sixth Circuit and inter-circuit practice of staying appeals when the Supreme Court has already granted certiorari and heard argument in a controlling case.
• Judicial efficiency, uniformity, and legitimacy: duplicating the Supreme Court’s imminent work risks inconsistency and unnecessary expenditure of resources.
• The plaintiffs themselves did not seek expedited review and delayed filing for months, undercutting claims of urgency.

B. Conversion Therapy as Medical Treatment

Factually and historically, the dissent presents conversion therapy as a medical practice that:

• Emerged when homosexuality and gender nonconformity were classified as mental disorders in the DSM.
• Was implemented through both aversive physical techniques and non-aversive psychotherapy.
• Has been repudiated by major medical and mental-health organizations as ineffective and harmful, with documented associations with increased suicidality and mental distress.

On this account, talk-based conversion therapy is not merely private opinion but an evidence-based (or, more precisely, evidence-rejected) clinical intervention. The dissent stresses:

• Psychological well-being is a facet of “health,” and psychotherapy is part of the “practice of medicine.”
• States have long regulated psychotherapy and its substance: licensing, training requirements, confidentiality, boundaries, avoidance of exploitation, and liability for negligent or harmful counseling.

C. Level of Scrutiny: Intermediate, Not Strict

The dissent accepts that speech is involved but disputes that strict scrutiny should govern. Instead, drawing on:

• NIFLA and Casey (speech “as part of the practice of medicine”),
• EMW Women’s Surgical Center (upholding abortion-related compelled speech), and
• Ohralik v. Ohio State Bar Association (upholding regulation of lawyer solicitation),

the dissent argues:

• There is a “common-sense distinction” between speech in the public square and speech that administers a professional service in a heavily regulated domain.
• When a law targets the non-expressive element (here, the delivery of a medical treatment) but incidentally burdens speech, intermediate scrutiny is appropriate.

The dissent contends that Casey and EMW cannot be confined to physical procedures and that the majority’s “physical vs. verbal” distinction is artificial and destabilizing: mental-health care is still health care, and talk therapy is still treatment.

D. Validity of HB 4616 Under Intermediate Scrutiny

Under intermediate scrutiny, the law must:

• Further an important or significant governmental interest; and
• Not burden substantially more speech than necessary.

The dissent finds:

• State interest: Protecting minors from demonstrably harmful and ineffective medical practices is a significant—indeed weighty—interest.
• Evidence: The record and broader medical consensus show conversion therapy is ineffective and associated with serious harms (e.g., increased risk of suicide attempts), even when delivered solely via talk.
• Tailoring:
  • HB 4616 applies only to licensed professionals and only when they are treating minor patients.
  • It does not bar discussion of conversion therapy, religious viewpoints, or moral disapproval of LGBT identities.
  • It does not apply to clergy or unlicensed lay counselors.
  • It still allows “cautious counseling” and identity exploration without a preordained goal; only efforts to change orientation or identity are banned.
• Alternatives:
  • Informed consent is problematic when minors cannot legally consent and often face familial or social coercion.
  • Malpractice suits are reactive and inadequate where the goal is to prevent suicides and serious harm before they occur.

Thus, the dissent would find the law likely constitutional under intermediate scrutiny and uphold the denial of a preliminary injunction.

E. Warning About the Majority’s Lack of Limiting Principle

Judge Bloomekatz expresses concern that treating psychotherapy as “words and nothing more” and subjecting all such regulation to strict scrutiny will:

• Invalidate or destabilize a wide range of standard regulations on therapists (confidentiality, conflicts of interest, boundaries, sexual conduct rules, etc.).
• Threaten state power to respond to other harmful talk-based practices (e.g., body-shaming anorexic patients, counseling foster children that their lives are valueless, or proselytizing in ways that exacerbate mental illness), unless the state can meet strict scrutiny in each instance.
• Either force courts to water down strict scrutiny—which would, in turn, weaken free-speech protections elsewhere—or to strike down numerous protective regulations of medical practice.

VI. Key Precedents and Their Role

1. United States v. Stevens (2010)

The majority uses Stevens to frame the requirement that, to exclude a category of expression from First Amendment protection, the government must demonstrate a long-standing, specific historical tradition of regulating that type of speech. General traditions (e.g., regulating animal cruelty or medical practice) are not enough; the tradition must apply to the expressive content itself (e.g., obscenity, fraud, incitement).

Applying this, the majority:

• Rejects the state’s reliance on its broad authority over licensed professionals.
• Notes the absence of any tradition of banning consensual, non-aversive talk therapy based on its ideological aim.

2. Cohen v. California (1971) and Holder v. Humanitarian Law Project (2010)

These cases support the majority’s speech–conduct distinction:

• Cohen invalidated a breach-of-the-peace conviction because the “conduct” prosecuted was “the fact of communication” (“Fuck the Draft”), not any non-expressive act.
• Holder held that a law banning “material support” to terrorist organizations, as applied to training and advice, regulated speech because the triggering conduct was “communicating a message.”

The majority uses them to argue that where the law hinges on what is said, it targets speech even if the state labels it “treatment.”

3. Reed v. Town of Gilbert, Mosley, Rosenberger, Otto

These cases provide the doctrinal backbone for content and viewpoint discrimination:

• Reed and Mosley define content-based laws as those targeting speech by subject matter, function, or purpose.
• Rosenberger emphasizes that viewpoint-based restrictions are “an egregious form” of content discrimination, strongly disfavored under the First Amendment.
• Otto is the closest factual analogue: the Eleventh Circuit treated municipal conversion-therapy bans as viewpoint-based restrictions on talk therapy and applied strict scrutiny, striking them down.

The Sixth Circuit closely tracks Otto’s characterization of such bans: codifying a particular view of sexual orientation and gender identity and disallowing opposing views in the therapy room.

4. NIFLA v. Becerra, Casey, and EMW

These cases define the boundary between permissible regulation of professional conduct and impermissible content-based speech regulation:

• Casey: Upheld abortion informed-consent disclosures, treating them as regulation of medical practice where speech was incidental to providing care.
• NIFLA: Rejected a broad “professional speech” exception but endorsed Casey as a legitimate example of regulating speech “as part of the practice of medicine.”
• EMW: Applied Casey and NIFLA to uphold Kentucky’s abortion-related compelled speech, framing it as incidental regulation of medical procedures rather than ideological censorship.

The majority distinguishes these precedents on the ground that they involved speech conditioned on performing a particular procedure, while the Michigan law targets speech as such. The dissent, in contrast, sees HB 4616 as an extension of that same medical-regulation logic to a therapeutic intervention delivered by words.

5. NIFLA, Ohralik, and Professional Regulation

The dissent leans heavily on Ohralik, where the Supreme Court upheld disciplinary rules against in-person solicitation by lawyers under intermediate scrutiny, recognizing that:

• Speech by professionals in the course of their work occurs in a heavily regulated environment.
• Regulation of professional conduct can legitimately affect their speech without triggering the highest level of scrutiny.

NIFLA reaffirmed that states can regulate speech that is part of medical practice without triggering strict scrutiny, though it barred the creation of a broad, undefined “professional speech” category. The disagreement in this case boils down to whether HB 4616 fits within that “speech as medical practice” lane or exceeds it by targeting pure ideological expression.

VII. Simplifying Key Concepts

1. Content-Based vs. Viewpoint-Based Laws

• Content-based: The law cares what you are talking about. Example: allowing picketing only about labor disputes but not other topics.
• Viewpoint-based: The law cares which side of a debate you are on. Example: allowing speech favoring government policy but banning criticism of it.

HB 4616 is both:

• Content-based: It regulates speech about sexual orientation and gender identity with a specific purpose (changing them).
• Viewpoint-based: It allows counseling that affirms LGBT identities and gender transitions but forbids counseling that seeks to align identity with biological sex or traditional religious views.

2. Strict Scrutiny vs. Intermediate Scrutiny

• Strict scrutiny (used by the majority):
  • The government must show a compelling interest.
  • The law must be narrowly tailored and be the least restrictive means of achieving that interest.
  • Very few laws survive this test, especially when they discriminate based on viewpoint.
• Intermediate scrutiny (used by the dissent):
  • The government must pursue an important or significant interest.
  • The law must not burden substantially more speech than necessary to serve that interest.
  • More forgiving; many regulations, especially of commercial or professional activity, pass this test.

3. Professional Speech and Medical Regulation

“Professional speech” refers to what licensed professionals (doctors, lawyers, therapists) say in their professional roles. While the Supreme Court has rejected the idea that this is a separate, lesser-protected category across the board, it has allowed:

• Regulation of speech that is part of professional conduct (e.g., informed consent, malpractice, ethical rules), and
• Lower scrutiny for regulations that target professional activity with only incidental impacts on expression.

The crux of this case is whether conversion therapy via talk is:

• Primarily speech (majority’s view), or
• Primarily medical treatment delivered through speech (dissent’s view).

4. Conversion Therapy vs. Supportive Counseling

• Conversion therapy: Efforts, typically by mental-health professionals, to change a person’s sexual orientation or gender identity. Historically included aversive methods but now often consists of cognitive-behavioral or psychodynamic talk therapy.
• Supportive counseling: Therapy that affirms or explores a person’s sexual orientation or gender identity without attempting to change it. Often aligned with current mainstream professional guidelines.

Michigan’s statute bans the former (with minors) and expressly permits the latter.

VIII. Likely Impact and Broader Significance

A. Immediate Effect Within the Sixth Circuit

Within the Sixth Circuit (Michigan, Ohio, Kentucky, Tennessee), this decision has several direct consequences:

• Michigan may not enforce HB 4616 against the plaintiffs’ talk therapy while the case proceeds.
• Any similar statutes or regulations aimed at prohibiting talk-based sexual-orientation or gender-identity-change counseling for minors are highly vulnerable to First Amendment challenges.
• Licensing boards must tread carefully when disciplining therapists based on the substantive viewpoints expressed in client-directed counseling.

B. Contribution to the Circuit Split

The opinion deepens a clear split:

• Eleventh Circuit (Otto): Treats conversion-therapy bans as viewpoint-discriminatory speech regulations; applies strict scrutiny.
• Ninth Circuit (Tingley): Upholds bans as regulation of professional conduct; applies lesser scrutiny.
• Tenth Circuit (Chiles): Similarly upholds such bans; dissent notes it is “materially indistinguishable” from Michigan’s law.
• Sixth Circuit (this case): Joins Otto in robustly protecting talk-based therapy as speech.

Given the Supreme Court’s pending decision in Chiles, this opinion will likely serve as one of the principal exemplars of the strict-scrutiny approach the Court must either adopt, reject, or modify.

C. Professional-Speech Doctrine Going Forward

Depending on how the Supreme Court resolves Chiles, Catholic Charities may mark:

• A significant expansion of First Amendment protection for speech by licensed professionals, particularly in psychotherapy and counseling; or
• A high-water mark that is later narrowed or overruled if the Court embraces an intermediate-scrutiny framework for speech-as-treatment, as the dissent recommends.

The majority’s reasoning—treating talk-based counseling as fully protected speech—could be invoked in:

• Challenges to restrictions on other controversial therapeutic practices (e.g., counseling related to abortion, assisted reproduction, end-of-life decisions, or gender-affirming care).
• Disputes over licensing-board discipline where the alleged misconduct is primarily verbal (e.g., counseling content, political or religious statements in therapy).

D. Asymmetry with Other Health-Regulation Cases

The decision also sits in tension with prior rulings that upheld state regulation of speech connected to medical procedures, particularly abortion. The majority attempts to reconcile this by distinguishing “speech incidental to a procedure” from “speech as the entire regulated act,” but the dissent’s critique suggests that boundary may be hard to police in practice. Litigants will likely test that line aggressively.

E. Religious Liberty and Parental Rights Dimensions

Although the opinion is framed purely as a speech case, its facts involve:

• Religiously motivated counselors and religiously motivated clients,
• Parents seeking counseling that aligns with their faith, and
• State-imposed limits on how families and therapists may address deeply contested moral questions.

The First Amendment analysis here may influence or intersect with religious-exercise and parental-rights arguments in other litigation about minors, sexuality, and gender identity—even though those doctrines are not central to the holding.

IX. Conclusion

Catholic Charities of Jackson v. Whitmer is a pivotal First Amendment decision at the intersection of speech, medicine, sexuality, and gender identity. The Sixth Circuit holds that:

• Talk therapy, even when licensed and regulated as “treatment,” remains core speech when its regulation hinges on content and viewpoint.
• Conversion-therapy bans that selectively forbid counseling aimed at changing sexual orientation or gender identity, while permitting counseling that affirms them, are content- and viewpoint-based speech restrictions.
• Absent a long historical tradition of regulating this category of speech, such laws must survive strict scrutiny—a burden Michigan has not met at this stage.

The dissent, by contrast, situates conversion therapy within the history of medical practice, urges intermediate scrutiny, and warns that the majority’s approach endangers the state’s ability to protect minors from harmful treatments and threatens the stability of professional regulation more broadly.

With the Supreme Court poised to decide Chiles v. Salazar, this decision both crystallizes and intensifies the doctrinal fault lines. However Chiles comes out, Catholic Charities will remain a critical reference point in any serious discussion of professional speech, conversion therapy, and the First Amendment’s reach into the therapy room.