Tara Lombardo, MA, LMHC, serves as the executive director of the Institute for Human Identity, the nation's first and longest-running provider of LGBTQ+-affirming psychotherapy. IHI is a national leader in culturally-responsive clinical services provision and professional mental health training and continuing education. As a psychotherapist, Tara focuses on supporting adults in LGBTQ+ communities, utilizing psychodynamic and existential approaches.
1. How has the conversation around mental health care for the LGBTQ+ community evolved in recent years?
The conversation around mental health care within the LGBTQ+ community has grown as mental illness has become demystified and less stigmatized. This shift has led more people to seek mental health care in order to navigate challenges in their lives. We understand that the personal is indeed political. Queer and transgender people often experience mental health issues like depression, anxiety, social isolation, or risky substance use, for example, and these challenges are often contextualized as pathology by mental health and medical providers. In the context of LGBTQ+-affirming psychotherapy, however, we understand them as likely responses to a stigmatizing social environment. This approach avoids pathologizing queer and trans patients and, instead, recognizes the impact of chronic minority stress, discrimination, marginalization, and even violence, framed in the lived experience of the patient’s multiple intersecting social identities.
Two major developments have shaped this conversation in recent years: COVID-19 and the political climate. While COVID-19 was physically and mentally devastating for so many people globally, its impact on the LGBTQ+ community was felt on a deeply personal level. Although access to care improved with the expansion of teletherapy, many in our community struggled with disability, depression, the loss of family and community members, and a heightened sense of vulnerability around historic mistrust of public health systems. At the same time, the political climate over the last nine years has taken a toll—marked by rollbacks of federal protections, particularly for transgender adults and youth, and the broader normalization of anti-LGBTQ+ rhetoric. These factors have made it even more essential to provide care that is not only clinically sound, but grounded in an understanding of the social conditions that shape patients' mental health.
2. What inspired the founding of IHI, and how has its mission evolved over time to address the specific needs of the LGBTQ+ community?
IHI was founded in 1973 by Dr. Charles Silverstein, a psychologist and activist who understood that LGBTQ+ people not only needed access to mental health care—they needed care that affirmed their identities and honored their lived experiences. That same year, Dr. Silverstein played a key role in persuading the American Psychiatric Association to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. At a time when queerness itself was still pathologized, he recognized that the therapy room should never be a place where clients feared judgment, shame, or erasure. IHI became the first and remains the longest-running LGBTQ+-affirming psychotherapy center in the United States, and its founding principles remain at the heart of our work: that identity is not an illness, and healing happens in spaces that reflect and respect who we are.
Over the last five decades, IHI has grown in response to the changing mental health needs of LGBTQ+ individuals and communities. We’ve expanded beyond direct clinical care to become a leader in education and training. Through our Advanced Clinical Internship program, we prepare graduate-level students to become the next generation of affirming therapists. Our professional continuing education initiative, IHI Competency Courses, supports professionals across disciplines to increase their capacity for cultural responsiveness in working with LGBTQ+ populations. These efforts are grounded in the same core belief that shaped our founding: that affirming care must address the social and political realities impacting mental health.
As our communities continue to evolve—and face new and ongoing challenges—IHI remains committed to delivering care that is clinically grounded, culturally responsive, and rooted in patients lived experiences.
3. What unique lessons does IHI offer in its clinical training to the next generation of LGBTQ+-affirming mental health clinicians?
IHI’s clinical training offers a perspective on mental health that is both affirming and deeply contextual—rooted in an understanding of LGBTQ+ history, identity, and the social conditions that shape our clients’ lives. Our Advanced Clinical Internship combines exposure to diverse therapeutic modalities with a strong emphasis on cultural responsiveness, trauma-informed care, and relational practice. Interns engage in individual, couple/partner, and group therapy work, receive layered supervision, and participate in a dynamic weekly seminar series that evolves each year in response to what clients are bringing into the therapy room. For example, recent seminars have explored practices like dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT), alongside timely topics such as the prevalence of autism within LGBTQ+ communities. These themes reflect the broader, ongoing conversation around queer and trans mental health—and our commitment to keeping clinical training grounded in both lived experience and emerging discourse. Just as importantly, we emphasize the development of self-awareness, emotional honesty, and nonjudgmental curiosity in our trainees—qualities essential to building the kind of healing relationships LGBTQ+ clients deserve.
4. For students preparing for careers in healthcare, what are the most common blind spots when it comes to serving LGBTQ+ individuals and communities?
Thank you for asking this question; it’s an important one! One of the most common blind spots we see among emerging health and mental healthcare professionals is a lack of attention to intersectionality: the ways in which sexual orientation and gender identity interact with race, class, disability, immigration status, and other social identities to shape a person’s experience of care. Too often, LGBTQ+ patients—especially those with multiple marginalized identities—encounter systems that fail to recognize how discrimination, stigma, and chronic minority stress impact their physical and mental health. When providers overlook these social realities, it can create barriers to treatment or, worse, replicate the very harms patients are seeking help for. Culturally responsive care begins with understanding that LGBTQ+ health isn’t just about identity—it’s about context, history, and the conditions in which people are trying to survive and thrive.
5. What advice would you give to LGBTQ+ students pursuing careers in traditionally conservative or high-pressure fields like medicine?
For LGBTQ+ students pursuing careers in high-pressure or traditionally conservative fields like medicine, your presence is not only necessary, it’s transformative. You bring empathy, nuance, and insight through lived experience to a profession that, while changing, has historically failed our communities through misdiagnosis, pathologization, and biased care. My advice is to seek out and build networks of support early: LGBTQ+ mentors, peers, and affinity groups within your field can be invaluable in navigating microaggressions, systemic bias, and institutional pressures. Just as importantly, don’t hesitate to access LGBTQ+-affirming therapy or mental health support as part of your professional journey. The challenges of medicine can be intense, and working with a therapist who understands your experience can help you stay grounded, resilient, and connected to your values. You don’t have to navigate this alone—and you shouldn’t. IHI, and other LGBTQ+-affirming orgs and practices like us, are here to support you!
Inspira Advantage is proud to feature insights from leaders like Tara Lombardo, MA, LMHC, to help pre-med students understand the importance of culturally responsive care and inclusive support for diverse communities. Our medical school admissions consulting provides the expert support you need to succeed in the admissions process.
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