Although use of a token economy has been shown to have significant
impact on adults and children with serious mental illness who participate
in inpatient and community treatment programs, the intervention has not
been widely adopted. The paper presents common criticisms of token
economies, which may explain the infrequent use of this treatment strategy.
They include perceptions that token economies are ineffective, that their
benefits do not readily generalize to other settings, that token economies
do not foster individualized treatment plans, that participating in a token
economy is humiliating, that token economies are abusive, that concerns
about milieu management are unimportant and irrelevant to treatment
delivery in the 1990s, and that effective token economies are impractical.
In an effort to rekindle interest in this potent treatment technique, the
author shows that many of these criticisms rest on misconceptions and
provides rebuttals based on empirical research. He describes three steps in
establishing a token economy.