Only the therapist and child play in the room for the first five sessions. Other therapists and parents also watch their games through the glass or the camera. In later sessions, the parent is also involved in the games. Then, the session is Decoupled between parent and child with therapist observation and accompaniment. During the first sessions in which the parent is involved, the therapist plays an active role in facilitating the interaction between the child and the parent. These sessions are then monitored and talked to the parent with a camera, situations where the parent disrupts the interaction and is forced are transferred to the child by the therapist, and new skills are shown to the parent by creating awareness.

 Theraplay is focused on four key elements:

1. Structure

This element includes security, organization, and regulation. The parent sets boundaries, sets body boundaries, and keeps the child safe. For example; Measuring children's height, arm, leg, hand, and ear length. Measuring how far it will jump. To mummify the child by wrapping toilet paper around his body and then to make the child get rid of it.

 2. Commitment

It involves attachment, acceptance, and expanding positive emotions. The parent provides a strong bond, a shared experience of joy. For example; stick a colored paste on your nose, and ask the child to remove it.

 3. Feeding

It involves editing and seeing value. Parents respond with a moderate, gentle, calming approach. For example, when feeding a child fruit or pudding, embrace the child with care. Paint each other's faces, and add a word to praise each place you paint.

 4. Struggle

The competition includes self-confidence and supporting exploration. The parent supports the child to take risks, strive, explore, and master their skills. For example; both the child and you, hold a pillow in front of you, and blow the feather toy over this pillow. Let the child also try to hold it with his pillow.

Theraplay can be applied to children between the ages of 2-12. It is a play therapy used in children who have difficulty in social relationships, introversion, behavioral problems, depression, shyness, attachment problems, confrontational or anger attacks, that is, experience emotional difficulties. It is also effective in children with autism spectrum disorder, developmental delay, and physical difficulties.

You can get more detailed information from the Theraplay Game and Family Therapy Association, established in Turkey in 2019 for the dissemination and development of game and family therapies and theraplay therapy.

Researchers have explored neurostimulation interventions for the treatment of resistant OCD cases, including repetitive Transcranial Magnetic Stimulation (rTMS), ablative stereotactic neurosurgery, and deep brain stimulation.

rTMS is a technique introduced by Barker et al. (1985), involving the non-invasive application of electromagnetic pulses to specific areas of the brain. Utilizing a non-isolated coil, an electric current is passed through it, generating a magnetic field of approximately 2 Tesla. These currents create magnetic field pulses in a localized area beneath the coil, traversing the superficial skin and skull to reach the superficial brain region (Sehn, Eslick, & Brakoulias, 2018). Consequently, it induces depolarization of cortical neurons, leading to the generation of action potentials in neurons through trans-synaptic mechanisms (Jaafari et al., 2012).

rTMS has various methods, including single-pulse, paired-pulse, and repetitive transcranial magnetic stimulation (rTMS), which involves delivering transmissions to the brain in a repetitive training manner.

As for the side effects of rTMS, they include headaches, neck and back pains, and sensations of discomfort in the scalp. Physiologically, rTMS has some negative effects, such as triggering certain seizures, which vary based on the intensity, frequency, and the individual's medical history (Wassermann, 1998; Rossi et al., 2009).

While research on rTMS therapy has primarily focused on depression, it has also been studied for conditions such as anxiety disorders, PTSD, and OCD (Jaafari et al., 2012).

When examining the neurobiology of OCD, it has been found that specific brain regions, including the caudate nucleus, Anterior Cingulate Cortex (ACC), and thalamus, are associated with emotion and cognition regulation (Whiteside, 2004). Generally, OCD is linked to a disorder in the orbitofronto-striato-pallido-thalamic circuit, which includes the Dorsolateral Prefrontal Cortex (DLPFC), ACC, Supplementary Motor Area (SMA), Orbitofrontal Cortex (OFC), medial prefrontal cortex, and basal ganglia. Neurophysiological studies have shown hyperactivity in DLPFC, SMA, and OFC in OCD patients, indicating a deficiency in response control in information processing (Sehn, Eslick, & Brakoulias, 2018). The high activity in SMA may explain the lack of control over behavior in OCD. Therefore, TMS therapy targets specific areas associated with OCD in cases that do not respond to first-line treatments and exhibit resistance.

REFERENCES

Tan, O., Hızlı Sayar, G., Önen Ünsalver, B., Arat, M. A., Karamustafalıoğlu, O. (2015). Combining transcranial magnetic stimulation and cognitive-behavioral therapy in treatment-resistant obsessive-compulsive disorder. Anadolu Psikiyatri Dergisi, 16, 180-188. doi: 10.5455/apd.160156.

Jaafari, N., Rachid, F., Yves-Rotge, J., Polosan, M., El-Hage, W., Belin, D., Vibert, N., Pelissolo, A. (2012). Safety and efficacy of repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder: A review. The World Journal of Biological Psychiatry, 13:3, 164-177. DOI: 10.3109/15622975.2011.575177.

Wassermann EM. (1998). Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, Electroencephalogr Clin Neurophysiol 108(1) – 16.

Rehn, S., Eslick, D. G., Brakoulias, V. (2018). A Meta-Analysis of the Effectiveness of Different Targets Used in Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Obsessive-Compulsive Disorder (OCD). Psychiatr Q, 89:645–665. https://doi.org/10.1007/s11126-018-9566-7.

However, taking the in-depth examination of the causes of their problems out of the process significantly reduces the time required for consultation. In other words, when solutions are focused, consultation sessions end in less time. Behavior is more in the foreground than insight.

If we look at it from the consultant's perspective, consultants who adopt a solution-oriented approach take care to use their clients' words, so it becomes even easier for clients to understand the process. In this way, an ideal environment is created for both sides during the consultation process.

From the client's point of view, this process will help the client determine his own goals. The wishes of the client, not the consultant, are important, and clients are seen as experts who know themselves best. This situation brings with it the belief, trust, and respect for the client.

Solution-oriented therapy is based on principles such as;

“If it's not broken, don't fix it.”,

“Do more if it works.”,

“If it's not working, do something different.”,

“Small steps can lead to big changes.“,

"No problem always exists; there are always times when there is no problem, exceptions that can be taken advantage of.”,

“The future is both creatable and reconcilable." (De Shazer and Dolan, 2012).

Based on this, solving problems healthily as soon as possible instead of detailing them in depth is the essence of solution-oriented therapy, and many of the techniques used in therapy are attractive to clients because they focus people on the goal and the positive.

Viktor Frankl was Adler’s student in Vienna. When World War II began, he already started his studies on logotherapy. He was a Jewish psychiatrist, and he was sent to concentration camps. Frankl spent 3 years in Auschwitz-Birkenau, Tuerkheim and Dachau. During the time he was in concentration camps, Frankl witnessed the worst side of human beings, he experienced disease, malnutrition, and pain in firsthand, however, he says: “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in any given set of circumstances, to choose one's own way.” These words are the milestone of his understanding in logotherapy. Logotherapy touches upon the meaning of life at the existential level and that life has meaning even when it seems the worst and insurmountable. People have free will to choose and change of their behaviors even during suffering.

Frankl has developed some techniques for logotherapy. Viktor Frankl explains how people can find meaning in life. According to Frankl, we can find meaning in three different ways: (1) by creating a work or doing an action; (2) by loving someone; (3) by our attitude towards inevitable suffering. Only then, Frankl says, can we reach our highest potential and recognize our true essence. Viktor Frankl applies his logotherapy perspective to success also. Frankl says “Don't aim at success. The more you aim at it and make it a target, the more you are going to miss it. For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side effect of one's personal dedication to a cause greater than oneself or as the by-product of one's surrender to a person other than oneself. Happiness must happen, and the same holds for success: you have to let it happen by not caring about it. I want you to listen to what your conscience commands you to do and go on to carry it out to the best of your knowledge. Then you will live to see that in the long-run—in the long-run, I say! —success will follow you precisely because you had forgotten to think about it.” (Man’s Search for Meaning).

The things that we encounter might look unbearable and miserable time to time, however, there are lots of information that we can learn from Viktor Frankl’s logotherapy. Viktor Frankl, who once got off the train heading towards a concentration camp and was separated left and right by Nazi officers in the choice between life and death, developed a world-known and practiced therapy. He did not lose hope even in the most difficult times, and his aim of sharing his logotherapy studies after the war connected him even more to life. I believe that there are many areas where we can apply logotherapy to our lives. We must dedicate ourselves to a cause, love people, and remember that there is meaning in pain. Despite everything, we must say yes to life and maintain our hope.

References

Barnes, R. C. (2000). Viktor Frankl's logotherapy: Spirituality and meaning in the new millennium. TCA journal, 28(1), 24-31.

Frankl, V. E. (1967). Logotherapy and existentialism. Psychotherapy: Theory, Research & Practice, 4(3), 138.

WHAT IS EMDR THERAPY?

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a psychotherapy method developed to alleviate distressing symptoms and support emotional healing after traumatic experiences that profoundly affect individuals' mental and emotional health.

EMDR therapy stands for Eye Movement Desensitization and Reprocessing. EMDR therapy was developed by Francine Shapiro, an American psychologist. EMDR was discovered as a result of Shapiro's accidental realization that eye movements would be effective in coping with traumatic memories. Francine Shapiro, as a result of her studies, revealed EMDR as a therapy method that aims to process traumatic experiences and reduce the negative emotional reactions they create.

EMDR therapy refers to a therapy method used for the purpose of obtaining emotional relief through understanding and processing the ethics of traumatic events and memories that are subjectively perceived and whose effects cannot be meaningfully avoided.

EMDR WHOM AND HOW IS IT APPLIED?

EMDR therapy is applied to individuals who want to cope with the symptoms resulting from traumatic experiences, it is an effective therapy option especially for those with Post Traumatic Stress Disorder (PTSD) (such as sexual assault, traffic accidents, natural disasters and childhood traumas).

EMDR therapy differs from other therapy methods in some aspects. Unlike other therapies, this therapy uses distracting stimuli such as visual or auditory stimuli. These vary according to the preferences of the therapists, but the visual stimuli generally used are finger gestures or light rings, while auditory stimuli are in the form of clapping or audible stimuli. The therapist asks the client to follow these stimuli with their eyes. This method involves a bidirectional process in which the individual's attention is directed to both the traumatic memory and the distracting stimuli.

EMDR therapy works like this: the therapist asks the client to describe a traumatic memory he has chosen, while he tells the client the event while at the same time watching the therapist's fingers moving left and right with his eyes. During therapy, the therapist guides the client to reinforce and support positive thoughts. At the end of the therapy, it is observed that the level of discomfort of the traumatic event described during the therapy sessions is reduced by this method and is replaced by more functional emotions. 

EMDR BENEFITS

EMDR therapy has many benefits. The benefits of EMDR therapy are as follows:

EMDR therapy provides the opportunity to reprocess traumatic events in individuals and transforms them into healthier, more functional thoughts and memories.

EMDR therapy helps to reduce emotional reactions such as anxiety, fear, panic and anger, which are the symptoms of PTSD caused by traumatic experiences.

EMDR therapy helps individuals to increase their self-confidence and strengthen their self-esteem.

During EMDR therapy, the individual can become more aware of his feelings, thoughts and body, so he can connect with himself better, which helps to increase self-awareness.

In addition, EMDR therapy can be used in combination with other therapy methods and is effective in increasing the effectiveness of therapy. For example; cognitive behavioral therapy.