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The Eromin Center was founded in Philadelphia in 1973, aiming to provide lesbian, gay, bisexual, and transgender (LGBT) affirmative mental health treatment 6 months before the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM–II; American Psychiatric Association, 1968). This study of archival records and oral histories with Eromin Center staff and volunteers reveals an iterative and improvisational approach to community-based affirmative care. Rather than waiting for national leadership or institutional change, they aimed to respond directly to otherwise unrecognized needs of LGBT people through psychotherapy and social services—what we are calling clinical activism. Without training or guidance from research, they tended to base their work on their own experiences, an approach with inherent limitations in particular because most of the staff were White, cisgender, and identified as gay and lesbian. They attempted to address these limitations until Eromin's closing in 1984. Largely overshadowed by the broader policy changes in mental health care, Eromin's work provides a crucial case study in community-based clinical activism and affirmative practice with continuing salience today. This historical case study of an early LGBT counseling center reveals the central role that clinicians played in developing affirmative forms of mental health treatment for LGBT people. The findings challenge conventional histories of LGBT mental health care, which emphasize the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1968). This research shows instead how clinicians in the field actively worked to change clinical practice and social beliefs. [ABSTRACT FROM AUTHOR]