Texas Therapy Rooms Face Legal Threats Amid Gender-Affirming Care Ban

On March 2, 2023, Texas Attorney General Ken Paxton issued a legal opinion asserting that the state's ban on gender-affirming care for minors, codified in Senate Bill 14, extends to mental health professionals. According to Paxton, any therapist who affirms a trans youth's gender identity is engaging in illegal treatment, which he categorizes as child abuse. This interpretation places licensed counselors, psychologists, marriage and family therapists, and social workers at risk of losing their licenses, Medicaid funding, and facing criminal penalties. The opinion also imposes mandatory reporting requirements, compelling therapists to report colleagues and potentially parents who support a child's gender identity.

Texas Therapy Rooms Set to Become Crime Scenes

The ramifications of Paxton's opinion are profound. Therapists like Cherise Miles, a licensed professional counselor in New Braunfels, Texas, have expressed their commitment to ethical standards despite the legal risks. "I will continue to follow my code of ethics and the WPATH standards of care. It will not change how I care for my clients," Miles stated. This sentiment reflects a broader concern among mental health professionals about the potential for state mandates to undermine therapeutic practices that are widely recognized as essential for the well-being of trans youth.

Texas Therapy Rooms Set to Become Crime Scenes

Joel Blackstock, a licensed clinical social work supervisor in Alabama, echoed these concerns, emphasizing that the legal prohibition against affirming a child's identity transforms therapists into agents of the state, which can exacerbate trauma for vulnerable patients. Blackstock noted, "When you legally mandate that a therapist cannot affirm a child's identity, you completely destroy that safety."

Texas Therapy Rooms Set to Become Crime Scenes

Critics of Paxton's opinion argue that it is an overreach and lacks legal grounding. Will Francis, executive director of the Texas chapter of the National Association of Social Workers, contended that counseling is protected speech under the First Amendment, suggesting that mental health workers are not obligated to cease treatment for trans youth. Lambda Legal's senior counsel, Karen Loewy, labeled the opinion "baseless and overreaching." However, the chilling effect of the opinion is immediate, with many therapists reconsidering their practices due to the potential for legal repercussions.

Texas Therapy Rooms Set to Become Crime Scenes

The legal landscape surrounding gender-affirming care is evolving. The Fourth Circuit Court of Appeals recently ruled that West Virginia can exclude gender-affirming surgery from Medicaid coverage, marking a significant shift in the judicial approach to such care. Meanwhile, the Supreme Court is deliberating on Chiles v. Salazar, which could redefine the legality of conversion therapy and its implications for affirming care. If the court rules that conversion therapy is protected speech, it could further complicate the legal environment for therapists in states like Texas.

Texas Therapy Rooms Set to Become Crime Scenes

• “Some laws are unjust and should not be followed.” — Cherise Miles, Licensed Professional Counselor

Texas Therapy Rooms Set to Become Crime Scenes

• “When a state declares that basic, affirming talk therapy is illegal, they aren't just policing language; they are actively weaponizing the therapy room,” — Joel Blackstock, Licensed Clinical Social Work Supervisor

Texas Therapy Rooms Set to Become Crime Scenes

As the situation develops, therapists across the United States are grappling with the implications of these legal changes and considering how to adapt their practices while maintaining their commitment to ethical care.

Texas Therapy Rooms Set to Become Crime Scenes