The Psychological Trauma Clinic at LAC + USC Medical Center

The Psychological Trauma Clinic at LAC+USC Medical Center is a specialized program through the Department of Psychiatry at LAC+USC Medical Center. This program was created in 1998 in response to the mental health needs of the many victims of physical and sexual assault, gunshot wounds, motor vehicle accidents, and other traumatic events who present for medical treatment to the LAC+USC Medical Center.  The intent was also to provide state-of-the-art trauma-focused interventions, when appropriate, to those LAC+USC psychiatric outpatients with histories of trauma exposure.  A final goal was to provide education and consultation resources for psychiatric residents and clinical staff in the principles and practice of modern trauma therapy

The program is open to adult residents of Los Angeles County who have experienced a significant psychological trauma and who lack sufficient financial resources or insurance for private mental health services.   The clinic also provides medication and diagnostic consultation for clients followed by the Los Angeles Program for Torture Victims.  Treatment is primarily dynamically-informed cognitive-behavioral therapy, using methods that have been shown in treatment outcome studies to be helpful in resolving posttraumatic stress.  Therapeutic activities include titrated exposure to traumatic memories and restructuring of associated cognitive distortions.  Equally important is the therapeutic relationship, however, which is used to process trauma-related relational schemata and emotional responses.

Where appropriate, psychotropic medication is also provided.  Selective serotonin reuptake inhibitors (SSRIs) have been shown in several studies to be effective in reducing the symptoms of posttraumatic stress.  In addition, many trauma survivors suffer from co-morbid depression and anxiety that may also respond to treatment with SSRIs or other antidepressants.  The use of anxiolytics (benzodiazepines such as Ativan or Klonopin) is somewhat controversial in the treatment of trauma victims.  In acute trauma situations, such medications may be indicated for immediate symptom relief.  In instances of more long-term posttraumatic distress, however, an attempt is made to avoid the chronic use of anxiolytics, as this class of medication can interfere with appropriate processing of traumatic material, in much the same way as recreational substance use can inhibit processing and encourage avoidance.  

Each client is given a full psychological assessment, using standardized instruments sensitive to psychological trauma, to assist in evaluation and development of a treatment plan.  Medical evaluation is also provided, including physical exam and laboratory evaluation.  Other tests and referral to medical or other specialty clinics is provided when clinically indicated.

The Psychological Trauma Clinic will be expanding over the next year, and may be able to accept clients with victims of crime funding as well as those who have financial resources or private insurance.  In addition, the clinic may be able to offer diagnostic and medication consultation to therapists in the community who treat traumatized individuals. 

The Psychological Trauma Clinic is supervised by John Briere, Ph.D. (Director) and Catherine Ehrlich, M.D. (Medical Director) and is staffed primarily by 3rd Year psychiatric residents and one or more 4th Year residents in their elective rotation.  Psychological assessment is provided by MA-level psychology practicum students in the Psychological Assessment Clinic, supervised by Elaine Eaton, Ph.D.

Appropriate referrals to the Psychological Trauma Clinic are those who have experienced physical or sexual assaults, shootings or stabbings, motor vehicle accidents, disasters, severe storms (e.g., hurricanes) or earthquakes, being present during the violent death or injury of others, kidnapping, torture, hostage situations, or serious burns (e.g., recently discharged burn patients).  Clients should have clinically significant symptoms of posttraumatic stress (e.g., flashbacks or other intrusive symptoms, hyperarousal, numbing) or other trauma-related symptoms or disorders (e.g., posttraumatic depression or trauma-specific phobias).   A full diagnosis of PTSD or Acute Stress Disorder is not necessary for admission to this program.  

The Psychological Trauma Clinic is unable to serve individuals who are currently involved in a battering relationship (i.e., a relationship in which the patient has been assaulted by his/her partner within the last three months) or who have current involvement in the judicial or law enforcement system for criminal (including nonviolent) behavior.  The clinic is also unable to serve those who are experiencing active psychosis, or who are currently addicted to drugs or alcohol.  In many cases, only English- or Spanish-speaking patients can be accepted, although this varies dependent upon the languages spoken by the clinicians rotating through the program.

Clients may be referred to the Psychological Trauma Clinic by calling 323-226-6312.  Currently the clinic accepts clients MediCal and Medicare, and LA County residents without financial resources or insurance.  Financial eligibility will be determined by the Psychiatry Outpatient Clinic at the time of initial evaluation.  The Psychological Trauma Clinic operates from 9 AM to 5 PM, Monday through Friday, and is not an emergency service.  Call-backs from the Trauma Clinic line may take one or more days.  Clients should be referred to a local emergency room or trauma center if emergency treatment or crisis intervention is needed.