J Dawgert Carlin (@jcarlin1insight)

The Consulting Room Was Never Neutral. On today's Supreme Court ruling, and the long history of therapy as a technology of compliance Today, the Supreme Court ruled 8-1 that Colorado's ban on conversion therapy for LGBTQ youth violated the free speech rights of the therapist practicing it. Justice Gorsuch, writing for the majority, framed the issue as one of viewpoint censorship. Justice Ketanji Brown Jackson, alone in dissent, warned the ruling could gut states' authority to regulate medical care. The ruling is dangerous. But it is not surprising. And if we are going to be honest about why, we have to go further back than the current court, further back than the DSM, further back even than the word "therapy" itself. We have to go back to the rooms where this whole project began. I am a licensed marriage and family therapist. I have sat across from people in the deepest pain of their lives. I believe that something real and meaningful can happen in a clinical relationship. I say this not to cushion what follows, but because I think it matters that the critique come from inside the house. The house was built on a compromised foundation. When Franz Anton Mesmer arrived in Paris in the 1770s with his theory of animal magnetism, he was not simply offering a proto-scientific curiosity. He was offering a technology for managing suffering in a way that left the social order intact. His patients, overwhelmingly women, were experiencing something real—distress, bodily symptoms, despair. His answer was not to ask why their lives had produced these symptoms. It was to restore their equilibrium so that they might return to those same lives. The women who later filled the consulting rooms of Charcot, Breuer, and Freud were doing something audacious in their bodies. They were refusing. Refusing appetite, refusing speech, refusing movement, refusing reproduction. The early analysts named this hysteria and set about decoding it. Some of what they found was genuinely illuminating. But the therapeutic goal was never liberation. It was compliance and manageability. The hysterical woman was to be understood, yes, but understood well enough to be returned to her household, her husband, her function. Freud himself was candid about the limits of the project. Psychoanalysis aimed to convert neurotic misery into ordinary unhappiness. This is not a liberatory promise. It is an adjustment promise. The goal was to make suffering bearable enough that the sufferer could keep participating. Participating in what, exactly? The twentieth century answer was unambiguous. It is participation in production. The expansion of psychotherapy in the postwar United States was not accidental. Returning soldiers needed to be functional enough to work. Women who had filled industrial roles during the war needed to be redirected back into domesticity or low wage jobs. The psychological establishment, newly institutionalized and increasingly professionalized, provided the interpretive framework. Unhappiness was an intrapsychic event. The root cause was in your childhood, your unconscious, your attachment patterns. The fix was individual. The system itself did not appear in any diagnostic frame. This was not a conspiracy. It was a structural inevitability. A profession that defines the unit of treatment as the individual person or family, that locates pathology inside that person, and that measures outcomes by that person's ability to function in existing social roles, will always reproduce the existing social roles as the standard of health. The DSM's removal of homosexuality from its diagnostic categories in 1973 is sometimes told as a story of progress, of science correcting itself. It was also a story of political organizing by queer activists who disrupted APA conferences and forced the professional class to confront its pathologization of identity. The science did not simply evolve. People made it evolve by refusing the frame. Conversion therapy is that original frame, undisguised. It makes explicit what most of clinical psychology keeps implicit. Which is that the goal of treatment is conformity to a normative ideal. In the conversion model, the ideal is heterosexual, cisgender, and implicitly white, usually Christian, and middle class. The suffering of the client is real. The cause of that suffering, in the conversion model, is the client's own deviant interior. Change the interior. Return the person to compliance. This is Mesmer's project, dressed in Christian counseling language. What today's ruling did was grant that project First Amendment protection. It said, in effect, that the viewpoint that queer identity is pathological and correctable is a viewpoint the Constitution will shield. That is a profound statement about whose interiority the law considers legitimate and whose it considers available for revision. Here is what I want to say directly, as a clinician who has also been trained in liberation psychology and critical frameworks—the problem is not only conversion therapy. The problem is the entire architecture of individualized healing as the primary response to structural harm. When we locate the cause of suffering in the individual, we also locate the remedy there. The person who has been ground down by poverty, racism, transphobia, migration violence, or wage theft comes to a clinician and is offered tools for managing their emotional response to those conditions. Mindfulness. Cognitive reframing. Attachment work. Grounding techniques. These are not without value. But they consume the person's finite energy, time, and often money, and they direct that energy inward, at the self, at the parents, at the intrapsychic drama, rather than outward, at the systems that organized the harm. Ignacio Martín-Baró, the Jesuit psychologist assassinated by a US-trained military death squad in 1989, called this the individualization of social problems. Writing from inside a society torn apart by state violence, he argued that psychology's deepest political function was not its overt content but its framing: by making the person the unit of analysis and the person's interior the site of pathology, the discipline systematically deflected attention from the social conditions producing that pathology. He called for a psychology that began not with the individual psyche but with the suffering of the people, and that understood healing as inseparable from the transformation of the conditions causing harm. He was killed before he could finish building it. There is no meaningful path to collective transformation if the primary language we have for suffering is clinical and individual. You cannot build a movement out of people who are being asked to process their trauma in fifty-minute increments and then return, better regulated, to the same conditions. The consulting room, whatever good happens in it, also functions as a pressure release valve. It makes the intolerable livable enough that the intolerable continues. This does not mean therapy is worthless. It means therapy, as currently organized and currently funded, is insufficient and often ideologically complicit. The sufferer is real. The suffering is real. The clinical relationship can hold something important. But it cannot be the whole answer, and when it is positioned as the whole answer, it forecloses the political questions before they can be asked. Martín-Baró understood this. He understood it so clearly that people with institutional power decided he needed to be silenced permanently. Today's ruling will expose LGBTQ youth, in particular, to practitioners who will tell them their queerness is the problem. That is a specific, acute harm and it demands a specific response. But the broader question the ruling invites us to ask is one the profession has been avoiding for over a century: what is therapy for, who does it serve, and what does it make possible or impossible? A practice that began by making hysterical women manageable did not arrive at conversion therapy by accident. It arrived there by following its own internal logic. The question is whether we are willing to follow that logic all the way to where it leads, or whether we are ready to build something different. Martín-Baró gave his life trying to build something different. The least we can do is be honest about why that work was, and remains, so threatening. The author is a licensed marriage and family therapist, a community college instructor, and a doctoral candidate in leadership equity. They practice, write, and teach from a liberation-oriented framework.