PubMed · 501244
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G E Jones. 1979. Death and after death.. https://doi.org/10.1093/jmp%2F4.3.234
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We assessed the influence of bystander-initiated cardiopulmonary resuscitation upon outcome in 316 consecutive patients treated for out-of-hospital ventricular fibrillation. Of 109 patients who received bystander-initiated cardiopulmonary resuscitation, 47 (43%) were ultimately discharged home. Of 207 patients for whom resuscitation was delayed until arrival of fire department personnel, 43 (21%) survived (P less than 0.001). Improved survival was largely due to a reduction in subsequent hospital mortality rather than to a higher rate of initially effective resuscitation. In a separate analysis of 118 patients treated at a single institution after resuscitation, the reduced hospital mortality reflected a decrease in deaths due to shock and to anoxic encephalopathy. In addition, neurologic dysfunction was significantly less common if bystanders had initiated cardiopulmonary resuscitation. Bystander participation in cardiopulmonary resuscitation represents an important adjunct to a rapid-response emergency care system.
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As a result of studies in ego and developmental psychology, psychoanalytically oriented psychotherapy, empathy, countertransference, and object relations, the sphere of interest in psychoanalysis has been extended beyond the patient's intrapsychic life to embrace all aspects of the therapeutic relationship. A significant contribution to this trend has been a study of the collaborative aspects of the analytic relationship as exemplified in the concepts of therapeutic alliance and working alliance. A historical survey of writings on this subject serves as a background for a critical examination of the theoretical and clinical implications of these concepts. These studies have provided a useful conceptual basis for the understanding of many "given" aspects of the analytic relationship, delineating those personality attributes which make collaboration in the analytic work possible. This in turn has been helpful in making appropriate applications of psychoanalytic principles in the therapy of a broader range of clinical conditions. It is suggested that, along with the gains achieved by making explicit the rational and irrational elements of the collaborative aspects of analysis, there is also the danger of a shift of focus away from the nuclear analytic concepts of unconscious intrapsychic conflict, free association, and interpretation of transference and resistance. This danger lies especially in the tendency to see the therapeutic alliance as an end in itself--to provide a new and corrective object relationship--rather than a means to the end of analyzing resistance and transference.