Some antitherapeutic effects of the token economy: a case in point.

This paper deals with some of the complaints of patients and difficulties in treatment which arose on a psychiatric ward which was administered as a token economy. Most evaluations of token economies have been made by advocates of the technique and have selected specific behaviors as "targets" for reinforcement. I do not wish to engage in polemics regarding the relative worth of behavioral and psychodynamic theories of treatment, but this paper reflects my own misgivings about certain aspects of the token economy and is concerned more with the quality of the ward atmosphere it creates than with specific behavior changes. I will describe the difficulties encountered on a single ward because I suspect that such difficulties, while perhaps ubiquitous to psychiatric wards and mental hospitals, are amplified within the token economy to the detriment of patient care. My purposes in this paper, then, are twofold: to present and briefly analyze several recurrent problems on a token economy within a wider context of events than is typical for such discussions; and to provoke advocates of the token economy system to consider the possibility that their favorite treatment modality may actually limit the potential for therapy. In fulfilling these purposes, I shall also be making reference to some psychiatric literature, now fifteen to twenty years old, which has struggled with similar problems with partial success, and of which psychologists and younger psychiatrists are too often unaware.