All Counseling is Trauma Counseling
A trauma can be something like a car crash or an earthquake or an eviction, a major event one can point to as life-changing. These are what clinicians refer to as capital T traumas, and many think that that’s all that trauma is. But therapist and educator Rachele Moskowitz sees it differently. “One of the pieces I hope to help my students grasp,” she says, “is that all clients are trauma clients.”
Moskowitz is the instructor of the course in “Trauma Counseling” at Antioch Santa Barbara, and her definition of trauma is any event that overwhelms our body’s natural coping mechanisms and resources in that moment. By this definition, basically everybody on the planet has experienced some trauma. This is the lens she hopes students leave the class with. But just knowing what trauma is and how it’s experienced isn’t enough—she also wants students to walk away with a fundamental understanding of how to effectively treat this trauma.
A Path That Led Back to Antioch
Moskowitz graduated from Antioch Santa Barbara’s MA in Clinical Psychology in 2007, and afterward, she spent years working in San Diego. Eventually, she wanted to teach, but she found a catch-22: one needed experience in the field of teaching to enter the field of teaching.
She moved back to Santa Barbara, where she reconnected with the Antioch community. Eventually, the MA in Clinical Psychology program invited her to teach a class. After teaching one class, then two, she found she loved the role, and today she works as the program’s Director of Clinical Training.
Moskowitz balances these roles in the program with a private practice. In that work, she’s found a niche treating clients with extensive childhood trauma. This experience made her want to teach Antioch’s advanced-level course in Trauma Counseling. “I’m very passionate about it in my personal life and my professional life,” says Moskowitz. “When you’re teaching, you want to teach the things that excite you.”
This excitement has led her to keep developing this course so that it stays up-to-date on research-based methods and trends in trauma counseling. She explains, “I consciously make an effort not to be afraid to look at the syllabus and say, you know what, they don’t need this. I’m going to drop this. I’m going to make room for another topic, which feels much more interesting and relevant right now.” For example, this semester is the first time Moskowitz has integrated discussion around psychedelics in the treatment of trauma.
Addressing Trauma at Sites of Integration
Another model that has been growing in the field—and gaining prominence in “Trauma Counseling”—is Somatic Therapy. Somatic Therapy, which focuses on body-oriented modes of treatment, is becoming a popular methodology. This practice focuses on how the body stores traumatic events and intentionally blurs the boundaries between mind and body, which have historically been thought of as being separate. The book The Body Keeps the Score by Bessel Van Der Kolk brought this concept into popular consciousness after its publication in 2014. It is now one of two central texts for the course.
Moskowitz loves getting to teach Van Der Kolk’s influential book. “It just beautifully illustrates how we walk through life and become products of our experiences.” She adds, “when we experience something that we’re not able to cope with, that information doesn’t get encoded in the same way as other experiences.” This text helps students gain an entry point to developing a trauma-based lens, to understand what happens to the body and mind when coping mechanisms are overwhelmed, and to grasp the long-lasting repercussions from these events.
One thing that students in the course learn is how, in the past thirty years, advances in neuroscience have allowed us to monitor the long-term effects of trauma and how it manifests in the brain and body. While this reveals the profound effects trauma can have across our lives, it also gives a lot of hope for people working with those who have experienced trauma. One recent graduate of the program, Janet Gunson, explains how transformative it is to learn this. “Psycho-education is a game-changer for people who think they’re stuck in a body that experiences fear and anxiety constantly,” she says. “Using physiology as my foundation, we can collaborate on ways to apply mindfulness and other techniques that will free [clients] from their prison. I have seen incredible progress and it is so rewarding.”
“Trauma Counseling” is offered to students after they’ve been seeing clients for three or four quarters. This means they are coming to class with context, questions, and curiosities. Many students are so excited about the tools and perspectives of the class they wonder why it isn’t offered earlier, but without a certain amount of foundational knowledge, students wouldn’t have a grounding for the discussions. And discussions are central to the course. “We’ll have dynamic conversations about the whole client, the big picture, not one symptom or behavior they’re stuck in, but from a wider lens,” explains Moskowitz. “And so, conceptualization almost occurs organically.”
So, while the course focuses on the integration of the body and emotional landscape of the client, it also integrates the practice of students with concepts presented in the class. Says the former student Gunson, “The trauma course opened my eyes to the physical, somatic elements of mental suffering due to events beyond a person’s control. It’s useful to be able to explain to clients why their bodies and minds react to stimuli the way they do.” Gunson finds she is now able to frame a client’s personal reaction or coping mechanism into an objective response, going from “a shameful secret” to “a non-reactive problem to be solved.”
This is exactly the sort of transformation that Moskowitz hopes to see therapists and their clients make. And there’s more room for innovation. Moskowitz also hopes to see more clinicians getting creative in the future, incorporating movement and props to truly integrate the body and the brain.
A Field That Is Shifting
Another way that “Trauma Counseling” is evolving is by more straightforwardly addressing systemic forms of oppression and the traumas it can leave on the body and the mind. Partly, the increased prominence of this subject in the course comes out several years during which institutions and individuals across the U.S. are asking how they are actively working against racism, oppression, and inequity. “You see people experiencing chronic, day in day out, trauma as a result of the pandemic. You see continued police brutality. You see unchecked expressions of privilege.” Moskowitz sees a need to incorporate these realities into her class. “There is the cultural piece and the treatment piece, I need to combine them both and figure out how to weave that into all of my classes,” And she finds that students welcome these conversations and are enthusiastic to engage.
Although over the last decade-plus there has been an overarching move toward “cultural competency” in the field of therapy, the question now is, “Is cultural competency enough?” Moskowitz feels the answer is an emphatic no. She is now actively working towards what it means to go beyond cultural competency as a clinician, and how to address elements of racial inequality in a clinical setting. Recognizing intergenerational trauma has become one of the ways she opens this conversation, looking at the ways race, discrimination, and oppression manifest in the body. Moskowitz is also interested in how clinicians can incorporate social justice into their treatment ethically and without pushing an agenda; for example, if they’re working with a racist client. She and her students in “Trauma Counselling” discuss all of these questions with open minds.
As she works to bring conversations about race into the room, Moskowitz is also navigating the ways “the room” has changed. Like many aspects of our lives, counseling has shifted into the virtual world. It is a change Moskowitz believes is here to stay. This means clinicians are going to have to develop new skill sets to work with clients effectively in a virtual format. The early results are positive, though. Says Moskowitz, this mode of counseling has been effective for many clients, bringing people in who may have never sought out therapy before.
In a constantly changing field, Moskowitz’s passion for this practice helps give her the energy and inspiration to meet the moment. “If I just open my eyes and look out the window, I can see what people are interested in,” she says. “So then the question is, ‘Okay, do I just notice that, or do I do something about it?’”
By teaching and continuing to improve the Trauma Counseling course, Moskowitz does something about it. She creates space for students to develop integrated practices that truly support clients. Certainly, this is how her students feel about it. “The trauma course opened my eyes to the physical, somatic elements of mental suffering due to events beyond a person’s control,” says Gunson. She left the class “understanding what the brain does to protect the self and survive.”